What Happens If You Miss Open Enrollment for Health Insurance?
So, let’s say you miss open enrollment for health insurance . Maybe you’re a master procrastinator. Maybe you screwed up and lost track of time. Whatever your reason for missing the January 15 deadline, your first priority is not to panic.
If you miss open enrollment for health insurance, you don’t necessarily have to wait until next year’s open enrollment to acquire some kind of coverage – it all depends on your situation and individual circumstances. And even if your coverage options are limited, there are actions you can take to minimize the financial risk you’re exposed to as a result of being uninsured.
Here’s how to get health insurance after open enrollment has ended:
OPTION 1: Check If You Qualify for Special Enrollment
Certain life events qualify you for a special enrollment period. A special enrollment period is a period of time (usually 60 days) during which you can buy coverage, even if it’s outside the normal Open Enrollment Period. The events which make you eligible for a special enrollment period are known as qualifying life events.
|Qualifying Life Event||Examples|
|Losing Your Current Health Insurance Coverage||– If you lose your coverage for any reason (apart from not paying your premiums). Examples include: you got laid off, aged out of a parent’s plan, or got divorced.|
– Losing eligibility for Medicare, Medicaid, or CHIP due to a change in income or household circumstances
|Changes in Your Family||– If you get married or divorced |
– If you have a baby or adopt a child
– If you lose coverage due to the death of your spouse, parent, or guardian
|Changes in Residence||– If you move to a different ZIP code or county (or parish in Louisiana)-|
– If you’re a student moving to, or returning from, school/university
– If you’re a seasonal worker moving to or returning from, a job location
– If you’re moving into or out of a shelter (or transitional housing, such as a halfway house)
|Other Qualifying Life Events||– Becoming eligible for Medicaid, or being denied after applying for Medicaid during the open enrollment period|
– Becoming eligible for subsidies that will lower your premiums, if you already have an ACA plan
– Gaining membership in a federally recognized tribe
– Becoming a U.S. citizen
– Leaving jail or prison
**Note that the following are NOT considered to be qualifying life events:
- Being diagnosed with an illness or getting sick;
- Getting pregnant (although, you can get coverage after you give birth);
- Losing your coverage because you failed to pay your premiums; or
- Voluntarily electing to drop your existing health coverage.
Becoming eligible for Medicaid, or being denied after applying for Medicaid during the open enrollment period.
OPTION 2: Do You Qualify for Medicaid?
Pregnant women, the elderly, people with disabilities, and individuals or families earning below a certain income level can get healthcare coverage through Medicaid. Unlike healthcare plans sold on the state and federal exchanges, Medicaid has no open enrollment period and you can apply for coverage at any time of year. Eligibility is determined by family size and income, and eligibility guidelines vary from state to state. In most states, you can qualify for Medicaid if your annual income is equal to, or less than, 138 percent of the federal poverty level (FPL).
If you apply for Medicaid during the Open Enrollment Period and are denied, you have 60 days following the denial to enroll in another health insurance plan; in this case, your new coverage can take effect the first day of the month after you enroll in a new plan. Even if you think you won’t qualify, consider applying for Medicaid during open enrollment. Even if your state determines you’re ineligible for Medicaid, you’ll get a second chance to buy health insurance.
Once you’re notified of your ineligibility, your Medicaid application will be transferred to the health insurance Marketplace. Complete a Marketplace application for private insurance on the Marketplace website, using the same name and information from your state Medicaid application.
OPTION 3: Consider a Short-Term Health Insurance Plan
Short-term plans provide a viable solution if you expect to experience a gap in coverage between now and the next open enrollment period. Commonly referred to as short-term health insurance or temporary health insurance, short-term medical (STM) plans provide consumers with an affordable way to pay for healthcare for a brief period of time. (Most STM plans run for 30- to 364-days, but some plans can be purchased for up to three years.) While these plans do not cover essential health benefits and thus are not ACA-compliant, they do cover a wide range of services and provide a degree of financial security if you need to make an unexpected trip to the emergency room.
While major medical plans require consumers to enroll during a dedicated Open Enrollment Period, it is possible to enroll in a short-term health insurance policy during any time of year. For this reason, short-term plans are a popular choice for uninsured Americans seeking coverage outside of open enrollment. To be sure, short-term health insurance plans are relatively cheap –- but not everyone qualifies for them. Because these plans are not required to cover pre-existing conditions, securing this type of coverage may be impossible if you are ill or suffer from chronic health conditions.
OPTION 4: Join a Health-Sharing Plan
Faith-based healthcare is offered through 501(c)(3) nonprofit charities with a religiously-oriented purpose, and serve as alternatives to health insurance. These plans are often referred to as “health sharing ministries” or “healthcare sharing ministries.”( Many states have banned the sale of Christian Ministry plans, so it is important to check to see if you can purchase in your state)
Unlike traditional health insurance, these faith-based are not health insurance plans and do not “insure” people; rather, they distribute healthcare costs among a large pool of people. Members pay into the system and upon receiving a bill from their physician, other members of the plan will contribute to help pay the bill.
Because members may “buy in” to them at any time of year, faith-based plans offer an alternative source of coverage for those who miss the open enrollment deadline.
Note that health-sharing plans will help you pay for medical care, but only if that care is consistent with biblical teachings (thus prenatal care for out-of-wedlock pregnancies, alcohol and drug addiction treatments, sterilization procedures, etc. are not usually covered). Although these plans are not required to cover essential health benefits mandated by the Affordable Care Act, they’re grandfathered into the ACA, thus faith-based plan members were exempt from paying the individual mandate penalty when it was applicable.
OPTION 5: Look Into a Primary Care Membership (“Concierge Medicine”)
Concierge medicine is primary care offered directly to consumers and employers without third-party insurance administration. In practices operating on a concierge membership model, patients pay a monthly or annual retainer–typically between $60 and $100 per month–to their doctor or medical office for a contracted bundle of services.
While it won’t cover surgery and other specialized care, concierge medicine offers a solution for people without coverage to receive routine, preventative care. Cheaper than traditional plans, membership medicine also tends to have more predictable out-of-pocket costs. That said, patients using concierge medicine will still need to pay out-of-pocket to treat critical illnesses, or catastrophic occurrences such as a heart attack, stroke, and physical trauma. On the plus side, however, these practices offer personalized care, streamlined billing, and priority scheduling to patients.