ACA Special Enrollment Period: Plan Duration and Changes

The Affordable Care Act (ACA) provides a Special Enrollment Period (SEP) for individuals who experience certain life events, such as job loss or marriage, that qualify them for coverage outside of the annual open enrollment period. However, the duration and potential changes to ACA plans enrolled through SEP can be confusing.

Plan Duration

According to the ACA, plans enrolled through SEP typically last for 12 months from the effective date of coverage, regardless of the calendar year. This means that if you enroll in a plan with an effective date of November 1, 2023, your coverage will generally continue until November 1, 2024.

However, there is an exception to this rule. If you enroll in an ACA plan during the SEP that ends on December 31st of the current year, your coverage may only last until the end of the calendar year. This is because ACA plans are typically run on a calendar year basis, and plans enrolled after December 31st are considered 2024 plans.

Potential Plan Changes

ACA plans enrolled through SEP are generally subject to the same premium, coverage, and benefit changes as plans enrolled during the annual open enrollment period. These changes may include:

– Premium hikes
– Out-of-pocket maximum increases
– Deductible increases
– Changes in plan coverage

It’s important to note that these changes may vary depending on your location and the insurance carrier you choose.

Income Changes

If your income changes during the coverage period, you may need to update your insurance application. In some cases, changes in income may affect your eligibility for premium tax credits or subsidies. You should contact your insurance carrier or a licensed agent to determine how income changes may impact your coverage.

Decision-Making

When considering ACA plans through SEP, it’s crucial to carefully review the coverage details and compare them to other options, such as COBRA. Consider factors such as plan duration, potential changes, and overall cost. If you have a fluctuating income, it may be wise to wait until the open enrollment period to enroll in a plan to avoid potential coverage interruptions due to income changes.

Seek Professional Help

Enrolling in an ACA plan during SEP can be complex. It’s highly recommended to consult with a licensed agent who can help you understand your options, compare plans, and guide you through the enrollment process seamlessly.