For Assistance Call Consumers for Affordable Health Care:

Marketplace

What is a “Special Enrollment Period”?

Some people may be able to enroll in a Health Insurance Marketplace plan
eve
n if the Open Enrollment period is closed. Examples are if you:

  • get married or had a baby or adopted a child,
  • had a change in immigration status,
  • were recently released from jail,
  • lost health insurance, but not if loss is due to unpaid premiums or voluntarily dropping COBRA.
Note for Parents:

Children under age 26 are allowed to stay on their parent’s health insurance plan; however, if they are going to school or live out-of-state, there may be other options available that provide better coverage in the state where they live. Most health insurance plans have a provider network that is limited to a specific geographical area and therefore may not provide coverage in the state your child is living in. 

Many Mainers qualify for help paying for health insurance through the Marketplace.

Marketplace health insurance is available to people and families who are not offered affordable coverage through work or who don’t qualify for public programs such as MaineCare or Medicare.

The next Marketplace Open Enrollment period to buy health insurance runs from November 1, 2019 – December 15, 2019, for coverage that will start on January 1, 2020.

Open Enrollment is the time of year when people can enroll in or renew their health plans. You won’t be able to buy marketplace health insurance outside of Open Enrollment unless you qualify for a Special Enrollment Period.

You can apply for health coverage in the Marketplace at www.healthcare.gov or by calling 1.800.318.2596 (TTY 1.855.889.4325). Make sure you are visiting healthcare.gov, as there are other healthcare websites trying to sell plans that don’t cover the ten essential health benefits

Those at or below 400% of the Federal Poverty Level (FPL) are eligible for Advanced Premium Tax Credits (APTC).

Those between 138% – 250% of the FPL are eligible for APTCs and Cost Sharing Reductions (CSR).

To determine your eligibility to receive APTC and CSR, you need to look at the number of individuals in a household and the income of the household members.  The chart below are the 2019 FPL guidelines, which are used to determine eligibility for 2020 coverage.

Household Size % of Federal Poverty Line (for 2020 coverage)

100%

138%

250% 400%
1 $12,490 $17,236 $31,225 $49,960
2 $16,910 $23,336 $42,275 $67,640
3 $21,330 $29,435 $53,325 $85,320
4 $25,750 $35,535 $64,375 $103,000
5 $30,170 $41,635 $75,425 $120,680

 

Need Help? You can call Consumers for Affordable HealthCare’s HelpLine at 1.800.965.7476 or find local, in person help by visiting our How to Get Help page.

Below you can also find more information on:

Don’t forget. Marketplace Open Enrollment starts November 1 and ends December 15, 2019 for coverage starting January 1, 2020. Medicare plans and plans offered through employers may have different open enrollment periods. If you don’t enroll in a Marketplace plan during Open Enrollment, you may not be able to buy health coverage for 2020 after December 15, 2019 unless you qualify for a Special Enrollment Period.

Not eligible for Marketplace coverage? You or your family members may qualify for MaineCare.