Whether you are getting a health insurance plan for the first time or you want to replace the one you have, it’s important to know when you can sign up for or make changes to your health coverage. Here’s what you need to know about these periods, called open enrollment, and what happens if you miss them.
When Is Open Enrollment?
If you are in the market to buy a private health plan, you will be able to do so through the Health Insurance Marketplace during an official open-enrollment period.
Open Enrollment for 2018 is now closed. You can enroll or change plans only if you qualify for a Special Enrollment Period.
You can apply for Medicaid or the Children’s Health Insurance Program through the Marketplace at any time.
What's New for 2018?
Many health plans have made changes to their marketplace offerings for 2018. Please find below the most current information that is available. We will update all insurance information for 2018 as soon as that information is available along with NorthShore’s participation.
- Blue Precision HMO - NorthShore will participate for 2018 (verify PCP participation)
- Blue Choice - NorthShore DOES NOT participate
- Cigna Connect - NorthShore DOES NOT participate
- Ambetter - NorthShore DOES NOT participate
Effective June 19, 2017 insurers can require repayment of 2017 missed premiums before issuing coverage for 2018.
If a consumer has had a premium tax credit for 2017 they were required to file a 2016 income tax return in spring with IRS form 8962. If form 8962 was not filed, the consumer will NOT be eligible for premium tax credit in 2018 until they file an amended tax return and include form 8962.
Alert for Automatic Renewals: There will NOT be an option to change your plan in January of 2018 if you are unsatisfied with the auto renewed plan, please actively shop for a marketplace plan.
What Is a Special Enrollment Period?
There are a few circumstances in which you may be able to enroll or change your health insurance plan outside of the official open-enrollment period. If you have certain so-called qualifying events occur, you may be eligible for what’s called a special enrollment period. Pre-enrollment verification is required for special enrollment periods. Documentation must be submitted that proves eligibility for the special enrollment period before consumers are allowed to enroll in marketplace coverage.
These events include:
- Moving to a new state
- A change of income
- Marriage, divorce or a new baby
In most cases, the special enrollment period runs 60 days from the qualifying event.
What Happens if I Miss the Deadline?
If you miss the open enrollment deadline and you are without a health plan, you likely will have to pay a fee. This fee is called the individual shared responsibility payment, and you pay it when you file your taxes the following year. It does not give you health insurance coverage.
The cost of the fee depends on the size of your family and your income. For lack of coverage during 2018, you pay the higher amount of either:
- 2.5 percent of your household income or
- $695 per adult and $347.50 per child under 18 (up to $2,085 per family)
There are some situations in which you might not have to pay the fee for being uninsured. For example, if you:
For one-on-one help applying for health coverage through the Marketplace, visit http://localhelp.healthcare.gov.
Last updated: November 2017