Left feeling lost and confused about health insurance after open enrollment? You’re not the only one! But don’t worry – there are options. In this blog, discover special enrollment periods, short-term health plans, Medicaid and CHIP programs, and supplemental health insurance plans. Get informed now!
What is Open Enrollment and Why is it Important?
Open Enrollment is the time of year when you can shop and get health insurance without any limits. It starts on November 1st and ends on January 15 in most states.
During this time, you can buy an individual health plan regardless of any prior medical conditions or life changes like getting married, having a baby, or moving.
It is important because, outside of this period, you may not be able to buy insurance unless you meet certain criteria like losing your job or retiring, becoming a US citizen or having a major change in income. Open Enrollment is likely your only chance during the year to get health insurance.
What happens after Open Enrollment ends?
Once Open Enrollment ends, it’s not possible to purchase a health insurance plan through the health insurance Marketplace until the next Open Enrollment period. You may be able to alter or renew your existing plan during a Special Enrollment period, depending on when your coverage begins.
If Open Enrollment has passed, other options are available. Plans can be bought or changed outside of the Marketplace at any time of the year, but it’s usually more expensive and fewer options are available. Also, if you have qualifying life events (like getting married), you’ll be eligible for a Special Enrollment period. Several states offer high-risk pools that give different kinds of coverage for those denied private health insurance due to pre-existing conditions.
If none of these work, and you go without health insurance, under federal law, some types of care may not be covered due to pre-existing conditions or lack of previous continuous coverage. But, Medicaid or CHIP may help with this. Additionally, if any services are needed that aren’t exempt from the ACA mandate, such as preventive care, but aren’t covered by Medicaid or CHIP, uninsured individuals may be subject to tax penalties depending on their household income level and composition when filing taxes. Therefore, it’s important to explore other alternatives before ending enrollment in case you qualify for another form of health insurance coverage outside Open Enrollment periods.
How To Get Health Insurance After Open Enrollment?
If you’re looking to enroll in a health insurance plan after the Marketplace open enrollment deadline, here are a few options:
- Marketplace Special Enrollment Periods
- Medicare Special Enrollment Periods
- Medicaid or CHIP
- Short-term Health Insurance Plans
- Supplemental Health Insurance
1. Marketplace Special Enrollment Periods
The enrollment period exclusive to the Health Insurance Marketplace, commonly known as the Marketplace Special Enrollment Period, denotes a specific timeframe within which individuals can enlist in health insurance, unlike the typical Open Enrollment Period. It transpires due to certain circumstances, such as involuntary job loss, marriage, childbirth, or relocation, among other situations.
In the duration of the Special Enrollment Period, individuals may enlist in a health plan offered by the Marketplace or alter their current plan. It’s of utmost importance to bear in mind that eligibility for this period hinges on the individual’s particular circumstances, and certain deadlines and documentary requisites must be met for enrollment or changes to coverage to take place.
2. Medicare Special Enrollment Periods
Missed the deadline for Medicare open enrollment? No sweat – you might be eligible for a Special Enrollment Period (SEP)! It’s available year-round and could apply if you’ve had:
- Job loss, divorce, or other insurance coverage termination.
- Moved to an area not covered by your current plan.
- Enrolled in a Medicare Savings Plan.
But note: During a SEP, you may not be able to switch between certain Medicare plans – e.g. Medicare Advantage & Original Medicare. Reach out to your local Social Security office to verify your eligibility. They’ll let you know what special circumstances or restrictions apply to your situation and plan. Ask questions before applying, so you can make the best decision for you!
3. Medicaid or CHIP
After Open Enrollment ends, you can get health insurance if you have a limited income. You can apply and enroll for Medicaid and CHIP programs through the federal Health Insurance Marketplace. To qualify, you must meet certain income standards set by your state.
Medicaid is a national program that helps low-income people, families, disabled people, and pregnant women with health care coverage. The services are either free or partly free for those who are eligible. It also covers family planning, routine checkups for children, mental health care, and prescription drugs.
CHIP stands for the Children’s Health Insurance Program. It gives affordable health care to families who are ineligible for Medicaid but can’t afford private insurance plans. CHIP covers similar benefits to private health insurance, like hospital visits, doctor visits, preventive care, and prescription medicines. Most states provide extra coverage like dental/vision care through CHIP. If you don’t know if your state offers extra coverage, you can contact your local Department of Human Services office or search online resources.
4. Short-term Health Insurance Plans
Short-term health insurance plans are an option for individuals who need coverage and missed open enrollment. These plans are temporary and can provide protection while waiting for the next open enrollment period.
Important to note: They offer limited coverage, don’t follow ACA regulations, and applicants can be declined or charged more due to medical history.
They cost less than major medical health insurance but have limits on copayments, coverage periods, services, and provider networks.
These plans vary by state and insurer and typically feature coverage lengths from one month to twelve months (even longer in some states). Benefits may include:
- Doctor visits
- Lab tests
- Generic prescriptions
- Urgent care visits
- Hospitalization for certain services
Before making a decision, compare options and understand what is covered under the policy. This is essential for making an informed choice that meets your needs.
5. Supplemental Health Insurance
Open enrollment has finished, but people may still buy health insurance. Depending on their needs, they can add on a supplemental plan or get one alone. Supplemental plans are usually cheaper and cover up to 100% of out-of-pocket costs.
When choosing, consider the cost, services, deductibles, any waiting periods, and pre-existing conditions. Rules vary by state, so research carefully to find the best value:
- Any waiting periods
- Pre-existing conditions
Buying health insurance outside of the open enrollment period is a possibility, yet the options may be more limited and costly. Before choosing the right plan, seek advice from a knowledgeable expert to make sure you have all the info you need.
See if you qualify for any subsidies or programs. Think about if buying health insurance during open enrollment could be cheaper and offer better coverage in comparison to a plan bought afterward. Ultimately, find a plan that works for you and your finances:
- See if you qualify for any subsidies or programs.
- Think about if buying health insurance during open enrollment could be cheaper and offer better coverage in comparison to a plan bought afterward.
- Find a plan that works for you and your finances.