Open Enrollment and Insurance Enrollment Waivers from the Office of Patient Protection
Massachusetts and federal law limit when you can buy certain health insurance plans. Some people may meet special conditions and can buy insurance at any time. Others must buy insurance during the open enrollment periods. An open enrollment period is a designated period of time each year when consumers can make changes in health insurance coverage or select a new health plan from offered options.
The 2016-2017 open enrollment period to buy your own insurance from the Health Connector (the name of the “Marketplace” in Massachusetts), an insurance company or an insurance agent runs from November 1, 2016 through January 31, 2017.
You may qualify for health insurance, even when enrollment is closed; if you experience certain events, you may have a Special Enrollment Period. Contact the Health Connector, a health insurance company, or a health insurance agent for more information. In some limited situations, you may be able to apply for an enrollment waiver from the Office of Patient Protection.
The Office of Patient Protection will issue waivers until October 1st, 2016. During 2017, the Office of Patient Protection will begin to accept waiver applications on February 1, 2017.
SPECIAL NOTE FOR CURRENT OR FORMER MASSHEALTH MEMBERS: IF YOU ARE TRYING TO RENEW MASSHEALTH COVERAGE, OR IF YOUR MASSHEALTH COVERAGE ENDED IN THE PAST 60 DAYS, PLEASE VISIT MASSHEALTH FOR HELPFUL INFORMATION, AND CALL THE HEALTH CONNECTOR AT 877-623-6765 OR 877-MA-ENROLL. IT IS LIKELY THAT YOU DO NOT NEED AN OPEN ENROLLMENT WAIVER.
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 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. Please visit MAhealthconnector.org for more information.
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?
Enrollment is open from November 1, 2016 through January 31, 2017. Please see MAhealthconnector.org for updates about future open enrollment periods.
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, or contact an insurance company or insurance agent.
Do the open enrollment rules apply to MassHealth?
No. If you qualify for MassHealth (Medicaid) or certain other subsidized health insurance you may enroll any time during the year. Contact MassHealth or the Health Connector 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 qualify for subsidized coverage?
You may qualify for subsidized health insurance through the Health Connector or MassHealth. If you qualify, different enrollment rules apply and you might be able to enroll without a waiver. For example, a family of four with income at or below 300% of the federal poverty level may qualify for a subsidy and may be able to enroll at any time. Those with income between 300% and 400% of the federal poverty level may qualify for a subsidy but may be required to purchase insurance during open enrollment or other special enrollment periods. Go to MAhealthconnector.org for more information.
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?
If you are a Massachusetts resident and you need to buy insurance after enrollment has closed, you may be able to purchase insurance if you have a “qualifying event” (see MAhealthconnector.org for information about qualifying events). If you do not have a qualifying event, then you might qualify for a waiver of the open enrollment period if you meet certain criteria. During 2016, the Office of Patient Protection will accept applications for enrollment waivers until October 1st.
You may qualify for an enrollment waiver if you meet applicable eligibility criteria and (for example):
- You are uninsured and did not intentionally forgo enrollment in health insurance; or
- You lost insurance coverage but did not find out until after 60 days had passed
You must first apply for coverage to a health insurance plan or agent and be turned down before you can apply for an enrollment waiver. You can apply for insurance on-line through the Health Connector or by calling 877-MA-ENROLL. You can also apply to buy insurance directly through an insurance company or insurance agent.
Do I need an enrollment waiver?
You may not need an enrollment waiver if:
- You lost insurance coverage recently (usually within the past 60 days); or
- You are a small business owner buying insurance for your business; or
- other reasons or qualifying events may apply
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.
How do I apply for a waiver?
Complete the Office of Patient Protection waiver application form, attach a copy of your denial notice or denial letter, and send it to the Office of Patient Protection. More detailed instructions are available on the enrollment waiver application form.
When does the Office of Patient Protection accept enrollment waiver applications?
During 2016, the Office of Patient Protection will accept enrollment waiver applications until October 1st.
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 firstname.lastname@example.org 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 email@example.com, or 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 firstname.lastname@example.org or 800-436-7757.
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 period.
Once I fill out the form, will I automatically get an enrollment waiver?
No, you will not automatically get an enrollment waiver, but the Office of Patient Protection will consider your waiver application. You may not qualify for an enrollment waiver if you have or had health insurance coverage that you voluntarily terminated through not paying premiums, or if you chose to intentionally forgo enrollment. If you do not qualify for an enrollment waiver, you may be able to buy insurance during the next open enrollment period.
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 after receiving your request for a waiver. If the Office of Patient Protection asks you for any additional information, be sure to send it back as quickly as possible.
What happens if my application for an enrollment waiver is denied?
Usually, you will have to wait until the next open enrollment period 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 may be able to apply for nongroup insurance outside of open enrollment if:
- you apply for nongroup insurance within 60 days of losing your employer-sponsored coverage, or
- you apply for nongroup insurance 60 days before your COBRA coverage is about to end, or
- you apply for nongroup insurance within 60 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:
- Health Connector, 877-MA-ENROLL
- Division of Insurance, 617‑521-7794
- Search for a nearby Enrollment Assister (eg. Navigators and Certified Application Counselors)
- Health Care for All, 800-272‑4232
I am new to Massachusetts. Can I get an enrollment waiver?
Moving to Massachusetts from another state or another country is considered a qualifying event which may allow you to buy insurance without a waiver. For more information, please contact the Health Connector, an insurance agent, an insurance company, or the Division of Insurance.
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 or the federal government and did not have to pay a tax penalty because I could not afford insurance?
You should submit evidence of your 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 60 days of losing your prior subsidized insurance coverage.
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. Those waivers are handled by different government agencies. If you are looking for a waiver of the tax penalty for being uninsured, contact:
- 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 or other health insurance questions?
- For questions about the enrollment waiver process or the enrollment waiver form, please contact the Office of Patient Protection at 800-436-7757 or HPC-OPP@state.ma.us (please do not send personal health information by email)
- For questions about the law that governs open enrollment or eligibility, please contact the Division of Insurance at 617-521-7794 or email@example.com
- For questions about subsidized or unsubsidized health insurance, and for help enrolling in these insurance 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
- For questions about access to health insurance, please contact a Massachusetts Health Connector Navigator or contact Health Care for All at 800-272-4232
- For small businesses, contact the Health Connector, or contact a health insurance company or insurance agent
- For other health insurance problems, contact the Health Care Division, Office of the Attorney General, 888-830-6277
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
Last updated May 2016