ACA Basics
Laying a Solid Foundation | Lesson 6

ACA Enrollment Opportunities

Now that we’ve covered the marketplace, let’s take a look at who is eligible for ACA plans and when they can enroll.

Let’s start with eligibility.

To be eligible to enroll in an ACA plan, the individual must be a resident of the state where they are applying for coverage, be a United States citizen or a lawfully present non-citizen, and not be incarcerated.

While people who qualify for other coverage, like employer coverage or TRICARE, are still eligible for marketplace plans, they aren’t eligible for financial assistance.

And a big compliance note, if your client is enrolled in Medicare, it is against the law to sell them a marketplace policy. You should instead be looking at their Medicare options, which we’ve covered in our other modules.

Let’s move on from eligibility to enrollment opportunities.

In order for an eligible individual to enroll in a plan, they must be in a valid enrollment period. This can either be the Open Enrollment Period or a Special Enrollment Period.

The Open Enrollment Period is an annual enrollment opportunity. Historically, this period of time has run from November 1 to December 15 each year in most states.

Recently, new rules were finalized to extend this time frame and the Open Enrollment Period will still start on November 1 but will now end on January 15 for most states.

But an important note here, to ensure your client’s coverage begins on January 1, you’ll need to complete the enrollment by December 15.

While most states stick to this timeline, it’s best to familiarize yourself with your state’s specific rules about the ACA Open Enrollment.

In addition to the annual Open Enrollment Period, individuals may qualify for a Special Enrollment Period. These enrollment opportunities are tied to certain life events and need to be acted on within 60 days of the event.

Some examples of special enrollment periods (SEPs), are getting married, having a baby, or losing your current coverage.

When enrolling with a special enrollment period, the coverage begins the first day of the month after your client enrolls in the plan.

Keep these special enrollment opportunities in mind, as they can be beneficial to help your clients enroll in a plan when they need it most.

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