Traditional Healthcare, the Affordable Care Act, must include the 10 Essential Health Benefits:
- Ambulatory patient services (outpatient services)
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
Open enrollment for Traditional Healthcare, the Affordable Care Act aka Obamacare, is every year from Nov. 1st – Dec. 15th.
You must enroll or make plan changes in this time frame for the upcoming year.
Outside of the open enrollment period, you can only enroll if you have a qualified special election reason to. If you qualify for an SEP, you usually have up to 60 days following the event to enroll in a plan. If you miss that window, you have to wait until the next Open Enrollment Period to apply.
Below is a list of the most common SEP events:
- losing health coverage do to no fault of your own
- being denied Medicaid or CHIP
- getting married
- having a baby
- adopting a child, or placing a child for adoption
- gaining citizenship
- leaving incarceration