Q. If I sign up for the exchanges, will that coverage take effect immediately? How soon will my coverage take effect after completing the enrollment process?
a. In most cases, your health insurance coverage will not take effect right away. There are general effective date rules that apply each year during open enrollment and during special enrollment periods triggered by qualifying events, which are discussed below.
Open enrollment begins November 1 and continues through at least January 15 in almost all states (only idaho opted for a December deadline during the open enrollment period for 2022 coverage).
In most states, registrations completed before December 15 will have an effective date of January 1, and registrations completed between December 16 and January 15 will have an effective date of January 1. February.
but there are several state-run exchanges that allow signups to be completed until December 31st and still have an effective date of January 1st. and there are a handful of state exchanges that have open enrollment deadlines until January 31; for some of them, people who sign up at the end of January will have coverage starting March 1.
also, if any insurer exits the market or cancels certain plans (replacing ppos with hmos, for example) at the end of the year, people enrolled in those plans will be eligible for special enrollment periods. the special enrollment period, in that case, will run for 60 days before and 60 days after the loss of coverage.
People in this situation who choose a replacement plan before the end of December will be covered starting January 1 (even if they joined after December 15). If they choose a replacement plan in the first 60 days of the new year, their new plan will likely take effect the month after enrollment is complete. prior to 2022, in most states, enrollment in that situation had to be completed by the 15th of the month to be covered beginning the first of the following month. but that is no longer the case in states that use healthcare.gov as of 2022.
special enrollment periods
Outside of open enrollment (that is, if you enroll because of a qualifying event), the effective date rules are different beginning in 2022. in prior years, in most states, and for the In most qualifying events, an application filed by the 15th of the month would have coverage effective the first of the following month. and an application filed in the second half of the month would have been covered effective the first of the second following month (for example, an application filed on July 20 would have been covered on September 1).
but that changed starting in 2022 in states that use healthcare.gov. The 18 state-run exchanges have the option to switch to the approach healthcare.gov uses, or continue with their own effective date rules. Historically, most state-run exchanges have had a deadline of the 15th of the month, but exchanges in Massachusetts and Rhode Island have always allowed people to sign up until the 23rd of the month and still have a first day the next. month expiration date
In most states, enrollments completed due to a qualifying event may be covered on the first of the following month beginning in 2022, regardless of the date the application is completed. therefore, in the July 20 example above, coverage would be effective August 1 (or even September 1, if the member requests it).
qualifying events with different effective date rules, even on state exchanges
As stated above, most special enrollment period applications have effective dates of the first month following in most states beginning in 2022, but state-run exchanges may set their own rules for this. however, there are some qualifying events that have their own effective date rules, regardless of status:
- If you get married, you are eligible for coverage beginning the first day of the following month, no matter how late in the month you sign up.
- If you have a baby, adopt a child, or receive a medical child support court order, coverage can go back to the date of birth, adoption, or court order.
- Loss of other coverage is a qualifying event that also allows for different effective date rules, if you enroll before your previous plan ends. you can enroll up until the day your old plan ends and your new plan will be effective the first day of the following month, so you won’t have any break in coverage, assuming your old plan ends on the last day of the month.
A few points regarding losing other coverage: It’s important to note here that the date of your qualifying event is the last day your old plan is in effect, not the first day you will no longer have coverage (since the new plan will be effective the first day of the month following the date of the qualifying event).
If your previous plan ends in the middle of the month, you will have a gap in coverage until the beginning of the following month, as individual market plans can only start on the first day of the month, unless the coverage is for a newborn or newly adopted child. You might consider a short-term health insurance plan for the latter part of the month your coverage ends. or if charging is an option, you can choose to charge retroactively if a medical need arose before the new plan went into effect.
If you wait and enroll within 60 days of your previous plan ending, your effective date could be the first of the second following month if you’re in a state that still has a June 15 deadline. month and you register after the 15th.
Off-exchanges, effective dates generally follow the same rules as on-exchanges. however, some insurers in some states choose to extend the enrollment deadline to December 31 for coverage beginning January 1, if the individual applies outside of the exchange during open enrollment.
If you’re enrolling in a plan that doesn’t comply (such as a short-term health plan), coverage may be effective as soon as the day after you enroll, but the insurer may use the subscription to determine your eligibility for coverage.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinion pieces and educational articles on the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by the media covering health reform and by other health insurance experts.