It should apply to all qualified life events.
“A time outside of the open enrollment period during which you and your family have a right to sign up for health coverage. In the Marketplace, you qualify for a special enrollment period 60 days following certain life events that involve a change in family status (for example, marriage or birth of a child) or loss of other health coverage. Job-based plans must provide a special enrollment period of 30 days.”
Seems like it. @Patsam – it couldn’t hurt for your friend to call healthcare.gov and ask if the daughter could enroll during the special extension period.
LM, what are we doing up at this hour?
Here’s a list of SEP events https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/
There’s still a category for complex SEPs.
we’d need to know Patsam’s friend’s state.
It’s not even 1:30 here, quite reasonable for us night owls. What are YOU doing up at this hour?
This is so complicated. Yet another problem which would be solved by the option which must not be named. 
@ lasMa, that un-named option might have been considered if she knew right away, now it’s over 6 weeks later and the situation was accepted etc. That option is likely not on the table. Catholic background too…
I thought the mom could drop her off policy, but apparently you have to lose coverage involuntarily, like if mom lost job.
The insurance is moms. The girl is also employed full time, but on moms insurance. The job is probably going to be her career, so she’d be shooting herself in the foot to quit, no guarantee she’d be rehired. I wish they could just take her off the books (fire/quit) but it’s a big corp,so it probably couldn’t be done.
I’m mad that people who didn’t know there would be a penalty get enrollment extended, when you had to live under a rock not to know, but she can’t get it for this unpublicized event.
I advised them to call the marketplace. There is an extension for people who,couldn’t get through by 2/15, but she didn’t find out until after so she didn’t have a password etc. tried to log in last night and access was denied.
I don’t know about the Cobra, it might to be Cobra exactly, something about a third party insurance but she could apply through her company’s benefit site, like Cobra. She is going to check Into to that.
So, the question remains…can or cannot a person purchase their own, unsubsidized policy outside of open enrollment? We are in NJ where apparently regulators have made it hard or impossible to buy short term coverage.
Ok, just looked at the link, http://obamacarefacts.com/2015/02/20/obamacare-extra-enrollment-2015-march-15-april-30/
I only saw the part about not knowing you had to pay a fee before, So can she say she was confused and that’s all she has to say? From the link:
“You were confused or didn’t know about open enrollment dates for 2015 coverage, and need another opportunity to enroll in coverage for the remainder of 2015.”
That would be ok. She is supposed to have bloodwork at 12 weeks (next week I think) but I’m sure it could wait another week.
Would the coverage be effective the day she applies? Without a subsidy what’s the easiest way to get covered? Just call insurer directly.
Finally, if she can get open enrollment, is the subsidy based on gross income or after you deduct for dependents? I just realized she may qualify based on a family of 2, I looked at the charts for one person, but does baby make 2? It still wouldn’t probably be much. She will also want coverage that is easy to work with. I know so e people have had nightmares getting things covered and with billing etc.
I will,suggest she call them now to,try formate current extension, saying she couldn’t get through and hasn’t realized the deadline was so soon. Maybe she can get in sooner.
More…this page says you had to have created an account for,the special deadline 2/22 (she hadn’t) but later it refers to if you couldn’t sign up “for any reason”
http://obamacarefacts.com/2015/02/20/obamacare-extra-enrollment-2015-march-15-april-30/
I don’t want to divert help from Patsam but I have a question. I have a daughter working abroad and she will probably come home this summer. She will no longer be working for her employer. She is too old for our insurance (27). Will she be able to sign up for ACA? Is moving back to the country a life changing event? It is for her (and so would having a baby- I find that very odd.)
Getting pregnant is not a qualifying life event. Being born is a qualifying life event, but being pregnant isn’t.
Moving back into the country is a qualifying event.
Just to be clear, @patsam obamacarefacts.com is NOT an official website. It is a “help” website run by private citizens and may or may not be accurate.
Thanks, Cardinal Fang.
Patsam, earlier, I think the unnamed option was an unavailable form of coverage.
It looks like pregnancy alone may not qualify for a special period. But there were changes being discussed.
But I ran into this, for anyone who wondered-
"If a child under 26 can be covered under a parent’s policy, can they get lower costs on Marketplace insurance based on income if they apply themselves?
It depends on whether the child is included as a dependent in the parent’s tax household.
If the under-26 child is a dependent in the parent’s tax household — and if they have access to a parent’s job-based coverage that’s affordable and pays for a certain percentage of benefits — they aren’t eligible for lower costs on a Marketplace plan. This is because they have access to job-based coverage.
If the child isn’t a dependent in the parent’s tax household, they may be eligible for premium tax credits and other savings on a Marketplace plan based on their income. This is true even if they have access to a parent’s job-based coverage. But if they are enrolled in a parent’s job-based coverage, they’re not eligible for lower costs on a Marketplace plan."
I think this last line means, if they are currently on the parents plan, no.
…
I just posted this on @Patsam 's other thread. Am I misunderstanding the article? I thought that turning 26 IS a QLE that would entitle the young person to sign up for an ACA plan outside of the regular enrollment period.
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Dropping off the parents plan is not qualified event.
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@Patsam, I think that’s incorrect. This link says otherwise - Blog Archives | HHS.gov
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What happens when you turn 26? You’re responsible for signing up for your own coverage. Some young adults have access to job-based plans, while others, like my son, do not. That’s when you turn to the Health Insurance Marketplace.
If you turn 26 outside an Open Enrollment period, don’t worry. You can still get covered! Life events — like turning 26 — mean you may qualify for a Special Enrollment Period. Some other qualifying life events include getting married, having a baby, or moving to a new state.
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OP, I would suggest your friend call a health insurance agent in NJ, preferably someone who seems to do a lot of business there. Each state has different ways of implementing all this so you need to talk to someone in your state for something this specific.
An agent should actually know more than the people you call at Healthcare.gov. That sounds snarky, but just as a fact, the agents have been in the business for years, they understand all the health insurance basics, they have worked with the companies. That means learning the ACA provisions is just an add on to something they know a lot about, any new Healthcare.gov employee has to learn it all and I am just not that impressed with the people I have spoken to.
Any time I have needed real help with a client, if I don’t know the answer, I have a much better chance of getting a quick accurate answer from a fellow agent than from the 800 #
The idea of a qualifying event is that the person couldn’t have bought insurance before, but now they can, or they had other insurance but it ended.
So, a newborn wouldn’t have insurance before she’s born. Being born is a qualifying event.
A person who had employer insurance, but either lost their job or retired, had other insurance but now they need to get new insurance. Leaving a job is a qualifying event.
A person who moves to a new coverage area, or returns to the US from overseas, wouldn’t have had insurance in the new coverage area before, because they didn’t live there. Moving to a new coverage area is a qualifying event.
A person who turns 26 was covered up until their birthday, and then the coverage disappeared. Turning 26 is a qualifying event.
A person who had bad insurance that didn’t cover pregnancy, and then got pregnant, could have bought good insurance beforehand. So getting pregnant isn’t a qualifying event-- you were supposed to already be covered for getting pregnant before you got pregnant, just like you were supposed to be covered for cancer before you got cancer.
Now, if it were me I’d try to get an exemption on the basis that the lack of coverage for dependent children who get pregnant is a secret. The woman (or her mother) should have known, but this misfeature isn’t exactly publicized. (And it also shouldn’t be allowed, IMO.)
I missed that the pregnant girl is 22. I don’t think Patsam’s other thread mentioned that. I thought she was turning 26 and was about to be dropped from her parent’s insurance plan. Sorry.
@Patsam Sorry, I didn’t mean that unnamed option. I would never suggest that to anyone, and I’m sorry I wasn’t as clear as I should have been.
In one of the last threads someone mentioned people who would help you find the best policy for you at no cost to you.
Were these brokers?
My brother lives in Fla with his wife and they are paying $12000 a year in premiums. He is 62 and wife is 61. Both in good health.
Anyone know where he can go for some help? I figure income approx $100,000 now that he is getting SS.
I forget who has said what, but thanks for the input. She is 22 and would be voluntarily dropping coverage so it doesn’t count.
@cardinalfang, I agree with what you said, but I don’t know how much latitude they have for theses exemptions. I think they might exempt her from getting coversge and the penalty, but would they allow enrollment? I bet it would depend who you got on the phone. I might have agreed it was reasonable not to have the coverage for the “children” back when the children were usually kicked off the policy by age 19 or 22, but age 26 is not realistic to exclude it.
Her dad did call one of the insurers on finder.healthcare.gov. The man there said she can get in on the current extension using the “she couldn’t get through” reason. He would sign her up. I hope she can call today and do it, but I know she had to work. They said she can do it tomorrow. It will be better than nothing but still cost her $$, plus the dr bills that have already accumulated.
Also, she had called her insurance prior to going to the dr and prior to tests. I know this because I asked her if insurance covered all the ultrasounds as I had never heard of having so many. They told her she was covered for everything and could even add the baby! I don’t know if calls are recorded, she has only the first name of the person and when she called. Is that any grounds to appeal? And, what about the dr doing 2 ultrasounds! One at 6 weeks (why?) and again at 10. Her mom was there for the 10 week, but were these medically necessary? I doubt it. I would fight paying for the second one as office should have notified them it wasn’t covered. Hopefully she and her mom will fight that one. I warned them not to let it go because, apparently, doctors now report to credit bureaus (S has a mark on his for an e-room copay that was partly a clerical error on their part, but that we let go too long before it got fixed)
I’ll post back if she is successful, meanwhile, keep the advice coming! I am such a googler and always try to help people. I feel like I have read so much and I hope her dad or mom knows as much as I do about health plans (company’s, deductibles, etc). They probably do, as her dad is disabled and I’m sure has had plenty of bills over the years. I would just hate to see them miss the chance to get her enrolled. Even the premiums of $300 month and 4k out of pocket will be less than the bills, especially if there is a problem.
Thanks. Enjoy your snow if you are getting it. We got 3" or more since 1:00 and they predicted only 3-5… Still snowing, and both my boys are at work. Nervous mom here…
I would think she and her Mom could at least try to negotiate to pay the doctor’s office whatever amount they would have accepted had the insurance company paid. It’s not the doctor’s fault, though, that the insurance company gave the wrong info. I do agree that two ultrasounds seems over done, but I don’t know what they were looking for.
If she is in NJ, is she close enough to another state that she could move, like to NY, and use that as a qualifying event. Then move back to NJ a few months later and use that qualifying event? I am from the west, I have no clue about the distances and commutes, but it does seem like there are places back there where people live in one state, but work in the other.