Frequently Asked Questions about Open Enrollment and Enrollment Waivers

Open enrollment is happening right now! Enrollment is open from November 15, 2014 through February 15, 2015.

During open enrollment you do not need a waiver to buy insurance.  Please contact the Health Connector or a health insurance company or agent to buy insurance during open enrollment.

What does “open enrollment” mean?

Under Massachusetts and federal law there are only certain times during the year when individuals and families may buy nongroup health insurance coverage.  The time when individuals and families can apply – the time when health insurers open plans to new members – is called “open enrollment.”  This is similar to the process employers use to allow their employees to sign up or change plans during specified times only.

Does the open enrollment period apply to all types of health insurance in Massachusetts?

No, the open enrollment rules do not apply to all types of insurance.  For example, eligible people can enroll in MassHealth at any time.  Also, if you qualify for ConnectorCare subsidized health insurance because your income is at or below 300% of the federal poverty level, you may be able to sign up at any time.

What is “nongroup” health insurance?

Nongroup insurance means health insurance that you buy for yourself or your family from the Health Connector or from an insurance company or insurance agent. 

Why doesn’t the law allow people to sign up at any time?

Massachusetts and federal law require open enrollment periods as a way to keep health insurance costs from becoming more expensive.

When is open enrollment?

Open enrollment dates are:

November 15, 2014 through February 15, 2015

I am self-employed or own my own business and want to buy my own health insurance.  Do I have to wait for open enrollment?

You might be able to buy insurance even if it is not an open enrollment period. For more information, visit MAhealthconnector.org for information about Business Express, or contact an insurance company or insurance agent.

Do the open enrollment rules apply to MassHealth?

No.  If you qualify for MassHealth (Medicaid) or other subsidized health insurance you can enroll throughout the year.  Contact MassHealth for more information.

How do I find out if I qualify for MassHealth or other government assistance?

You can contact a Massachusetts Health Connector Navigator, MassHealth or the Health Connector for more information.  You may also contact Health Care for All at 800-272-4232 for help.

What if I have unpaid medical bills or my doctor told me that I need medical care right away?  Who can help me figure out what to do?

The following agencies and organizations may be able to help:

Health Care for All, 800-272-4232

Health Law Advocates, 617-338-5241

Office of the Attorney General, Health Care Division, 888-830-6277

Who can I contact to help me understand the rules about buying health insurance?

If I am losing my current health insurance coverage, do I have to wait until open enrollment?

Probably not, since the law provides exceptions for persons who experience a
“triggering event” or “qualifying event.”  In general, if you apply within 60 days of losing prior coverage, you will be able to enroll.  For more information about triggering or qualifying events, please contact the Health Connector or the Massachusetts Division of Insurance at 617-521-7794.

What is an enrollment waiver?

An enrollment waiver is a letter issued by the Office of Patient Protection, which allows you to buy nongroup health insurance after the open enrollment period has ended. 

Who can apply for an enrollment waiver?

Massachusetts residents can apply for an enrollment waiver.  Before applying for an enrollment waiver, you must first apply to purchase nongroup health insurance. If you are turned down, you may be able to apply to the Office of Patient Protection for an enrollment waiver.

Where can I get an enrollment waiver form?

First you must apply to buy insurance through the Health Connector, a health insurance company, or an insurance agent.  If you cannot buy insurance without an enrollment waiver, then the insurer or agent will give you a denial letter and a copy of the enrollment waiver application form or other access to the form.When enrollment is closed, you can find the enrollment waiver application form on the Office of Patient Protection website.

Should I apply for an enrollment waiver before I apply for health insurance?

No. The first step is to apply for health insurance, because you may be eligible to enroll without an enrollment waiver or you may not be eligible to buy insurance at this time. 

When does the Office of Patient Protection accept enrollment waiver applications?

During 2014, the Office of Patient Protection will accept enrollment waiver applications from April 1, 2014 through November 18, 2014.

Where can I ask questions or get help with the enrollment waiver form?

Please review the information on the Office of Patient Protection (OPP) website.  You can contact OPP at 800-436-7757 or hpc-opp@state.ma.us for information or assistance.  Please do not send personal health information by email.

How can I request a reasonable accommodation?

If you are a person with a disability and you need an accommodation to complete the enrollment waiver application, please contact the Office of Patient Protection at hpc-opp@state.ma.us, at 800-436-7757, or at 617-979-1413 through the 711 Telecommunications Relay Service or through the Voice Relay Service of your choice.

How can I get help in another language?

Contact the Office of Patient Protection at hpc-opp@state.ma.us or 800-436-7757.

Once I fill out the form, will I automatically get an enrollment waiver?

No. You cannot get an enrollment waiver if you have or had health insurance coverage that you voluntarily terminated through not paying premiums or other actions, and have had no insurance for more than 63 days. You may be able to buy insurance during the next open enrollment period.

What does the Office of Patient Protection consider when reviewing an enrollment waiver request?

The Office of Patient Protection looks at the circumstances that prevented you from buying health insurance when you were eligible to buy it or during previous open enrollment periods.

Will I get an enrollment waiver if I can prove that I need medical care?

No. The Office of Patient Protection is not permitted to take into account anyone’s health conditions when reviewing an enrollment waiver request.

Once I fill out the enrollment waiver application form, how long will it take to get an answer?

The Office of Patient Protection is required to respond to you within 30 days.  If the Office of Patient Protection asks you for any additional information, be sure to send it back as quickly as possible.

Can I come in and meet with someone at the Office of Patient Protection?

No, the Office of Patient Protection cannot accommodate walk-in visitors.  Please include all documents and information along with your enrollment waiver request.

What happens if my application for an enrollment waiver is denied?

You will have to wait until open enrollment to buy nongroup insurance.

How does COBRA affect my eligibility for nongroup coverage?

If you have recently left your job you are eligible to apply for nongroup health insurance even if you are offered continuation through COBRA or mini-COBRA.  You can apply for nongroup insurance outside of open enrollment if:

  • you apply for nongroup insurance within 63 days of losing your employer-sponsored coverage, or
  • you apply for nongroup insurance before your COBRA coverage is about to end, or
  • you apply for nongroup insurance within 63 days after your COBRA coverage ends

For more information about how COBRA and mini-COBRA affect your health insurance options, please contact one of the following agencies or organizations:

I am new to Massachusetts. Can I get an enrollment waiver?

If you are within the 63-day period of losing prior insurance coverage, then you may not need an enrollment waiver.  If you are not eligible for coverage through work you may first apply to the Health Connector, a health insurance company or insurance agent for coverage.  If you are told that you are not eligible to buy insurance outside of open enrollment, you can apply for an enrollment waiver.  If you did not buy health insurance during the most recent open enrollment period, or if you do not apply for coverage promptly once you become a resident of Massachusetts, you may have to wait for the next open enrollment period to buy insurance.  Please be aware that when you apply for insurance coverage, insurers may ask you for proof of residency.

I could not afford to purchase health insurance until now.  Can I get an enrollment waiver so I can enroll now and avoid any additional penalty?

While you may apply for an enrollment waiver, you will need to explain why you did not buy insurance during the last open enrollment period.  If your enrollment waiver request is not approved, then you will have to wait until the next open enrollment period to buy insurance.

What if I applied for an affordability waiver (called a “certificate of exemption”) through the Health Connector and did not have to pay a tax penalty because the Health Connector agreed that I could not afford insurance?

You should submit evidence of your Health Connector certificate of exemption (or waiver of the tax penalty) when you apply for your enrollment waiver, along with proof of when your financial status changed.  If you could have applied for insurance coverage during open enrollment and did not do so, then you may have to wait for the next open enrollment period to purchase insurance.

What if I had coverage through ConnectorCare, MassHealth, or another subsidized insurance program, but my coverage ended because my income changed?  Can I get an enrollment waiver so that I can buy nongroup health insurance?

You should not need an enrollment waiver if you are applying within 63 days of losing your prior subsidized insurance coverage. 

I applied for MassHealth, ConnectorCare or other subsidized insurance coverage during open enrollment and received my denial after open enrollment had closed.  Can I apply for a waiver or do I have to wait until the next open enrollment period to apply for health insurance?

You should submit your denial notice from MassHealth, the Health Connector, or other government agency when you file your enrollment waiver request.  You may be eligible to receive an enrollment waiver if you were actively applying for MassHealth or subsidized coverage during open enrollment and received a denial after open enrollment ended.  You may also be eligible for an enrollment waiver if you applied for MassHealth or subsidized coverage within 63 days after your prior health insurance coverage ended.

Can I get a waiver of the state or federal tax penalty?

Tax penalty waivers are different from enrollment waivers.  The Office of Patient Protection cannot waive the tax penalty.  For information about tax penalty waivers, please contact the following agencies:

  • Massachusetts tax penalty:  Contact the Health Connector at 617-933-3164, and ask about the “Certificate of Exemption”
  • Federal tax penalty:  Contact the federal Health Insurance Marketplace Call Center at 800-318-2596

Who can I contact if I have questions about enrollment?

  • For questions about the law that governs open enrollment or eligibility, please contact the Division of Insurance at 617-521-7794
  • For questions about ConnectorCare (the state-subsidized health insurance coverage), nongroup and small group plans and for help enrolling in any of these plans, contact the Health Connector at MAhealthconnector.org or 877‑623-6765.
  • For nongroup or small group health insurance, you may also contact a health insurance company or health insurance agent directly
  • For MassHealth/Medicaid please call 800-841-2900

 

Last updated November 2014