Missed Open Enrollment Season? Here’s What To Do

Thanks to the Massachusetts Health Connector, getting health insurance in Massachusetts has never been easier. This state-run exchange is open to individuals, families, and small businesses with 50 employees or less. A marketplace of this sort also helps keep prices down by offering government subsidies to make premiums more affordable. It’s important to remember that there is a limited window for you to apply each year. The exact dates change from year to year, but they generally run from early November to mid-January. It is not always convenient for people to apply during this time. This can be quite inconvenient when affordable coverage is a priority. Luckily, state and federal laws allow for some exceptions to the open enrollment period. Here’s everything you need to know to get your family the coverage they deserve. 

Special Enrollment Periods

When the Affordable Care Act was passed in 2010, it established Special Enrollment Periods for marketplace enrollees. The law also establishes a set of qualifying life events that determine eligibility for special enrollment. While there are many qualifying circumstances, they fall into three major categories. The first is a change in your household. This includes events like marriage, divorce, death, and childbirth. The second category is for applicants who have recently lost health insurance coverage. You may qualify if you’ve recently lost a job, changed jobs, or if your employer has changed your healthcare plan. Finally, special enrollment periods may be granted to individuals who have recently become eligible due to a change in incarceration or immigration status. While these are the primary circumstances, this is not an exhaustive list and there are miscellaneous exceptions that may qualify you as well. 

You’ll be prompted to disclose any potential qualifying life events when you apply online or over the phone. Applicants applying by mail will receive correspondence on how to continue once their application is received. Generally, applicants are allowed 90 days to supply proof of any qualifying life events.

Open Enrollment Waiver 

If you don’t have a qualifying life event or your claim is rejected, you still have options. The Massachusetts Office of Patient Protection allows applicants to apply for a waiver that may still allow them to participate in the Massachusetts Health Connector. Before you are eligible for a waiver, you must first be denied enrollment by an insurer. Depending on how you applied, you will receive the notice online or by mail. Once you’ve received notice, you can contact the OPP and request a waiver. Once you’ve received the waiver simply fill it out and return it with a copy of your denial notification attached. The Office of Patient Protection can accept your claim online, by mail, or by fax. They will then process your claim and respond with a decision within 30 days. In the event that your waiver request is denied, then you will need to wait until the next enrollment period to apply.

It’s always best to take advantage of the open enrollment period, but these avenues allow for more flexibility when it is needed. 

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Crystal Green

I'm Crystal. I'm married to Del, and mother to Jimmy. Some might say that my life is perfect because I get to do all the cliché wife things like cooking, cleaning, and decorating - but there's more! I also have many hobbies including needlework (crochet), sewing, and reading. My son's education is important, so we homeschool him together.

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