November and December are a busy time of year as many people are gearing up for holiday celebrations. From food planning to gift-giving, coordinating schedules and decorating it’s easy to forget things, even something as important as open enrollment for health insurance!
Did you miss the Affordable Care Act (ACA) annual open enrollment period for health insurance this year?
For coverage beginning Jan. 1, 2020, the open enrollment period for most states is from November 1, 2019, to December 15, 2019.1
However, some states that operate their own exchanges have extended health insurance enrollment periods as follows:
- California: Oct. 15, 2019 to Jan. 15, 20202
- Colorado: Nov. 1, 2019 to Jan. 15, 20203
- Massachusetts: Nov. 1, 2019 to Jan. 23, 20204
- Minnesota: Nov. 1 to Dec. 23, 20195
- New York: Nov. 1, 2019 to Jan. 31, 20206
- Washington D.C.: Nov. 1, 2019 to Jan. 31, 20207
If you did miss open enrollment, what are your options? Can you still get health insurance after open enrollment? If so, how?
Fortunately, missing open enrollment doesn’t mean you have to go without coverage for the year ahead. You may have a few options, depending on your situation. This article will highlight three of them:
- Special enrollment in major medical coverage
- Other minimum essential coverage
- Non-ACA, limited-benefit health insurance
Option 1: A Special Enrollment Period
If you’ve recently experienced a qualifying life event you may be eligible for special enrollment—the only way to buy individual ACA major medical health insurance outside of the annual open enrollment period.8
Qualifying life events for special enrollment include, but are not limited to:
- Loss of health coverage – This includes losing your job-based plan or aging off a parent’s plan.
- Changes in your household – This includes getting married or divorced, having a baby or adopting a child, or experiencing a death in the family.
- Changes in residence – This includes moving to a new ZIP code or county, moving to or from the place you attend school, or moving to or from a shelter or other transitional housing.9
These are only a few common examples. There are other circumstances that could make you eligible for special enrollment. HealthCare.gov provides more information about qualifying life events for special enrollment and the documents needed to confirm your eligibility.
If you think you qualify for special enrollment, don’t wait! Special enrollment periods are limited to a 60-day period from the time of the qualifying event.10
Is special enrollment right for you?
You may want to consider buying health insurance through special enrollment if you:
- Have recently experienced a qualifying life event
- Want comprehensive, ACA-compliant health insurance coverage that includes coverage for essential health benefits
- Need guaranteed issue health insurance due to a pre-existing condition
- Qualify for and want to take advantage of an ACA subsidy (see if you qualify)
Are you eligible for special enrollment?
To apply for a special enrollment period through the federal Marketplace (healthcare.gov) or your state’s health insurance exchange just begin the health insurance application process. Your eligibility for special enrollment will be assessed if you’re applying outside of the open enrollment period.
Need help? Contact your state’s exchange, find assistance at healthcare.gov or speak to a health insurance agent.
Option 2: Other Minimum Essential Coverage
- Employer-sponsored group health insurance
- The Children’s Health Insurance Program (CHIP)
- Student health plans
Is other minimum essential coverage right for you?
As mentioned above, there are many types of minimum essential coverage. Each program has their own eligibility criteria, enrollment deadlines, and benefits associated with them.
If you qualify, one of these programs may be a good option for individual minimum essential coverage if you don’t qualify for an ACA special enrollment period.
Are you eligible for other minimum essential coverage?
You will need to apply for coverage through the provider or program you’re interested in.
Option 3: Non-Qualifying Health Insurance
Even though the ACA’s individual mandate is still technically in tact, the federal penalty for going without coverage was eliminated effective January 1, 2019.13 Some states have implemented their own state-based health insurance mandates and penalties.
What does this mean for you?
If you missed the annual open enrollment period, you don’t have to worry about paying the federal penalty (a state penalty may still apply depending on where you live). But what do you do about health insurance? Should you just go uninsured and hope you don’t experience an injury or illness for which you need to seek medical care?
Rather than going uninsured, if you qualify, you may want to explore non-qualifying, limited benefit coverage like short term medical insurance. You can apply year-round in most states, however you must qualify in order to enroll since these policies are not guaranteed-issue.
Short term health insurance is temporary coverage that lasts as few as 30 days, and up to 364 days in some states. (It is not available in all states. Learn more about short term medical availability by state.)
Short term plans don’t cover the essential health benefits like preventive care but may cover unexpected medical expenses related to injuries and illness. Short term health insurance also generally does not cover pre existing conditions. Policies tend to be highly customizable, so you can opt for more coverage for a higher premium.
Compare short term insurance costs and coverage.
Is short term health insurance right for you?
If you can get it, ACA-qualifying minimum essential coverage provides the most comprehensive coverage available. However, you may want to check into non-qualifying coverage if you:
- Don’t qualify for a special enrollment period and open enrollment has ended
- Are not eligible for another form of minimum essential coverage such as Medicare or Medicaid
- Are okay with fewer healthcare benefits in exchange for potentially lower monthly premiums14
- Don’t want a comprehensive health insurance policy
- Are able to qualify to enroll in a short term policy
- Don’t need coverage for pre-existing health conditions
Are you eligible for short term health insurance?
The only way to know for sure if you’re eligible is to apply for a policy. Keep in mind you may be denied coverage based on health history.
Want Supplemental or Non-ACA Insurance?
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Want Supplemental or Non-ACA Insurance?
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Is a short term policy enough?
If you’re worried about having enough benefits with a short term policy, you can also enroll in supplemental health insurance to access more benefits.
Hospital indemnity or medical gap insurance can help supplement your short term benefits. These policies will provide either a lump sum (gap policies) or fixed indemnity benefit (hospital policies) for covered healthcare services or critical illnesses. In some states, hospital indemnity insurance is only available as a supplement to an ACA-complaint major medical policy and may not supplement a short term policy.
Telemedicine services, prescription drug and other discounts may help make access to healthcare service providers more convenient, affordable or both, and may be a nice complement to a short term medical policy. Health and medical discounts are not insurance. Get a health and medical discount plan.
Summary + Next Steps
In this blog post we discussed ways to get health insurance after open enrollment.
Consider the options discussed above, determine which you may be eligible for, and begin the application process.
Here are four ways to get started:
- Visit HealthCare.gov for special enrollment and to see if you could qualify for other minimum essential coverage.
- Research non-qualifying insurance like short term medical.
- Call 888-855-6837 to speak with a licensed health insurance agent.
- Find a local agent to help you navigate your options and the application process.