ACA Health Insurance: Understanding Waiting Periods and Your Rights

Waiting periods in health insurance refer to the period you may need to wait before your health insurance coverage begins after enrolling in a plan. The Affordable Care Act (ACA) sets specific limits on waiting periods for employer-sponsored health insurance plans.

ACA Regulations on Waiting Periods

According to the ACA, employer-sponsored group health plans cannot impose waiting periods that exceed 90 days. This means that once you have completed 90 days of employment, you should be eligible to enroll in your employer’s health insurance plan.

Exceptions to the 90-Day Rule

There are a few exceptions to the 90-day rule, including:

Small Employers: Employers with fewer than 50 employees may impose waiting periods of up to 180 days.
Multi-employer Plans: These plans may impose waiting periods of up to 180 days for employees who are not employed by the plan sponsor.
Non-Group Plans: Individual health insurance plans and short-term health plans are not subject to the 90-day waiting period rule.

What to Do if Your Employer’s Waiting Period Is Longer Than 90 Days

If your employer’s waiting period exceeds 90 days and you believe it is unlawful, there are steps you can take:

Contact your employer: Politely question your employer about the validity of the waiting period. Refer to the ACA regulations and ask for an explanation.
Contact the Department of Labor: You can file a complaint with the Employee Benefits Security Administration (EBSA) of the Department of Labor to report a potential violation of the ACA.
Consider alternative health insurance options: If you need health insurance coverage before your employer’s plan becomes available, you may want to explore other options such as COBRA, Medicare, or Medicaid.

Conclusion

The ACA protects your rights to timely access to health insurance coverage. If you believe that your employer’s waiting period violates the law, do not hesitate to take action to ensure that your health insurance needs are met. Remember, you have valuable options and support systems available to you. It is crucial to seek assistance from licensed health insurance agents or the Department of Labor if you encounter any barriers in accessing health insurance.