Insurance · Laws and Regulations

Under the ACA, what is the 'open enrollment period' for marketplace coverage?

Correct answer

An annual period (typically November 1 through January 15 federally, varying by state) when individuals can enroll in or change marketplace plans without a qualifying life event

  1. A Year-round
  2. B An annual period (typically November 1 through January 15 federally, varying by state) when individuals can enroll in or change marketplace plans without a qualifying life event
  3. C Only during summer
  4. D Lifetime enrollment

Why this is the answer

ACA marketplace plans have an annual open enrollment period, typically November 1 through January 15 in states using the federal exchange (HealthCare.gov). State-based exchanges may set different periods. During open enrollment, anyone can enroll in or change plans without restriction. Outside open enrollment, enrollment requires a 'qualifying life event' (QLE) that opens a special enrollment period (SEP) — examples: marriage, divorce, birth or adoption of a child, loss of other coverage, moving, change in income affecting subsidy eligibility. SEPs are typically 60 days from the QLE. The structure prevents adverse selection (people waiting until they are sick to enroll). Medicaid and CHIP have year-round enrollment; Medicare has its own annual enrollment periods.
Source: NAIC Model Outline, Open Enrollment

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