QUESTION

My income has gone down and I think I may now qualify for cost-sharing reduction subsidies in the health insurance Marketplace. Do I have to wait for an open enrollment period before I can enroll?

Individuals with no coverage | Open and Special Enrollment Periods |
ANSWER

It depends. In most states, if your income is below 150 percent of the federal poverty level, you can enroll in a Marketplace plan year-round. Additionally, if you are currently enrolled in a Marketplace plan and become newly eligible for cost-sharing reduction subsidies (CSRs), or if you’ve had a change in eligibility for CSRs, you should qualify for a special enrollment so long as you apply within 60 days of your change in status. If you are newly eligible for CSRs, you may enroll in either a silver plan or within the same metal level as your current plan. (45 C.F.R. § 155.420.)

Note: In most states, if your income is below 138 percent of the federal poverty level, you may be eligible for Medicaid, which is open for enrollment year-round.

Individuals with no coverage
Individuals with coverage
Coverage for small employers
Post enrollment issues