The enrollment

You are not required to purchase your health insurance from the Marketplace or employer and can go directly through a carrier. However, when going through a carrier directly, you will not receive those discounted prices (called premium tax credits and cost-sharing reductions – based on your income) that many individuals are eligible for.

If you don’t get health insurance at all (through any outlet of Marketplace, carrier, or employer), four states enforce a penalty: New Jersey, California, Rhode Island, Massachusetts, and Washington D.C. 

If you’re in a state without a penalty, be aware that choosing to not have health insurance at all will put you in a position of having barely any accessibility to healthcare services. One accident or illness can put you in the face of a medical debt and inability to access prescriptions for treatments without spending hundreds of dollars on urgent care and testing. 

Note:
Money is difficult, especially when you need groceries, rent, car payments, etc. But before kicking out the idea of health insurance completely, go through the Marketplace application to see if you’re eligible for discounts because it’s possible you can be offered a plan with a very low premium. It would also let you know if you’re eligible for Medicaid instead, which can offer $0 premiums and copays.

While employer-based plans may still be expensive, remember that the cost of the premium would be deducted from your gross pay before taxes rather than your final paycheck, and thus may also lower the amount of overall taxes cut from paycheck.

After knowing what you’re offered, make your decision from there on what’s best for you.

The time period every year for the Marketplace is from November 1 to January 15 of the next year. This may differ slightly by days for employment-based coverage, though the general period is the same (exact dates should be communicated to you by HR).

Medicare has a different annual time period from October 15 to December 7.

Special tip for Marketplace coverage: If you’d like your coverage to begin on January 1st for the new year, enroll before December 15th. Keep in mind, you will need to submit required documents and wait for them to be verified, so do not wait till the 15th to submit your application.

If you complete your enrollment after December 15, your coverage will begin February 1 of the next year. This means any appointments or services you have in January will not be covered. This does not apply for employment-based coverage.

If you miss the enrollment period, you may not need to wait till next year. 

Most marketplaces and employers offer a Special Enrollment Period. This period is for any time of the year that’s not the enrollment period, and allows individuals to apply for multiple circumstances. According to healthcare.gov, these reasons can include: “life events, including losing health coverage, moving, getting married, having a baby, or adopting a child, or if your household income is below a certain amount.”

The criteria to be eligible for Special Enrollment will differ for employment-based coverage and may be more rigid, such as income changes not being a valid reason to qualify.

If you miss the enrollment period and can define a significant circumstance in your life that may have influenced your ability or need to get coverage, you may qualify through special enrollment and can get health insurance outside of the open enrollment period. 

Special tip: If you’re unsure if your circumstance would qualify, call your Marketplace or email your HR and say you’d like to be considered for special enrollment due to [state life reason]. Let the representative tell you if you would be eligible. And if you are, they will carry you through with the next steps. Don’t doubt that your circumstance would be ineligible until you actually ask.

Only downfall: the call wait time for Marketplace reps or persistence for a follow-up with HR, but don’t let that discourage you!

Employment:
You will need to apply via your company’s instructions, usually through your company portal.

Marketplace:
If you see your state in the list below, your state has its own Marketplace and website.

If your state isn’t in the list below, your marketplace will be through Healthcare.gov and the needed information is within the method menus underneath.

You can apply online, through phone, through a broker, enrollment partner websites, or with a paper application. The pros and cons of each method are included below the list of states.

Washington

Methods of Applying:

Phone

Pro: can talk to someone to help guide you through.

Con: wait time is very long before getting an agent on the call.

Tip: most times, the phone option is better left if you have specific questions about your application.

You can call Healthcare.gov at 1-800-318-2596 (open 24 hours a day, 7 days a week except holidays. However, if your state is listed above, click it and contact your state’s specific Marketplace.