Comprehensive ACA Health Insurance Plans for Seniors and Pre-Retirement Individuals

Frequently Asked Questions

• When can I enroll in health coverage?

  November 1: Open Enrollment starts.

  December 15: Deadline to enroll coverage that starts January 1.

  January 15: Open Enrollment ends. The last day to enroll for coverage that starts February 1.

  After January 15, you can only get a health plan if you qualify for a Special Enrollment Period.

  You can apply for Medicaid or the Children’s Health Insurance Program (CHIP) any time of the year. Learn more about Medicaid and CHIP.

• Where can I find Marketplace plans and prices?

  Preview plans and prices.

• How do I report changes to my income, household, or address?

  You can report changes to the Marketplace 3 ways: online, by phone, or in person — not by mail.

• How do I pay my monthly premium?

  When you have Marketplace insurance, you'll pay your premiums directly to the insurance company — not the Marketplace. Your coverage won't start until you pay your first premium. Contact your plan to find out how they accept payment.

• What happens if I want to quit a Marketplace health plan during the year?

  It is important that you contact both the Marketplace and the health plan and let them know you no longer need coverage. In HealthCare.gov states, you can log into your Marketplace account, select the “terminate coverage” option, and enter the required information.

• I lost my job and my health coverage. Can I buy a Marketplace plan now or do I have to wait for the next Open Enrollment?

  Yes, you can apply now. HealthCare.gov and all state Marketplaces allow a special enrollment opportunity when people lose other coverage, including job-based coverage.

  In general, you have 60 days following the loss of other job-based coverage to apply for a special enrollment opportunity through the Marketplace. If you have advance notice of your coverage loss, you can apply for the special enrollment opportunity up to 60 days in advance.

  After you complete your application, you may be asked to send documents to confirm you qualify for the special enrollment period in your Marketplace Eligibility Notice. If you are asked to submit documentation, you will be allowed to select a plan, but will not be able to use your coverage until you confirm your eligibility and make your first premium payment.

  After signing up for a Marketplace plan during this special enrollment opportunity, your coverage will take effect on the first day of the following month, even if you made your selection after the 15th of the month. For example, if you lose coverage starting on March 7 and select your Marketplace plan on February 18, your new coverage will begin on March 1.

• Do I have to prove eligibility for a special enrollment period?

  Yes, in some cases. When you apply for Marketplace coverage and qualify for a Special Enrollment Period, the Exchange may request additional documents to confirm that you qualify for coverage in your Marketplace Eligibility notice.

  If you apply for Marketplace coverage following loss of other coverage, HealthCare.gov will let you select a health plan but will delay the effective date of coverage while it verifies your loss of other coverage. If the Marketplace cannot automatically verify your other coverage loss using electronic data sources, you will have 30 days to provide documentation.

  HealthCare.gov will tell you what documents are acceptable to verify your eligibility for the SEP and how to submit them. Once the Marketplace verifies your eligibility, you will be able to complete enrollment in the plan you selected. Keep in mind that only one person in a household applying for coverage or financial assistance through the Exchange must qualify for a SEP in order for the entire household to qualify for the SEP.

  It is very Important to act quickly to complete this verification process. If you do not submit the required documentation within 30 days, your plan selection may be cancelled. You can reapply for the SEP and restart the verification process if your qualifying event was less than 60 days ago.

  If you submit documentation on time but the Marketplace determines it to be insufficient, you can apply for an extension of the 30-day review period to submit additional documentation. However, you cannot apply for an extension of your Special Enrollment Period. If your eligibility is not verified by the end of your 60-day SEP, your plan selection will be cancelled, and you will not be able to enroll until the next Open Enrollment period.

• I have COBRA and it’s too expensive. Can I drop it during Marketplace Open Enrollment and enroll in a Marketplace plan instead?

  During Marketplace Open Enrollment, you can sign up for a Marketplace plan even if you already have COBRA. You will have to drop your COBRA coverage effective on the date your new Marketplace plan coverage begins. After Marketplace Open Enrollment ends, however, if you voluntarily drop your COBRA coverage or stop paying premiums, you will not be eligible for a special enrollment opportunity to enroll in a Marketplace plan and will have to wait until the next Marketplace Open Enrollment period. Only exhaustion of your COBRA coverage triggers a special enrollment opportunity.

• How do I find my tax Form 1095-A?

  Log into your Marketplace account and select the application for the year you’re filing taxes. Then, select “Tax Forms” to get your 1095-A.

  Your 1095-A for last year’s Marketplace coverage may be in your Marketplace account anytime from mid-January to February 1. It should arrive by mail no later than mid-February.

• My Child aged off my work provided health coverage. When can they sign up for a Marketplace plan?

  Your child can sign up for a marketplace plan using a Special enrollment period. They have 60 days since coverage was dropped to sign up for a plan, but the plan will not go into effect until the first day of the following month. Please note each state has different ages and stipulations of when they are no longer covered under a parent or guardian’s plan. Reach out to a licensed agent for more details.