If someone misses the Open Enrollment Period for health insurance, they may still be able to purchase a plan outside of the designated time frame.
In order to do this, they will need to experience a “qualifying life event” which triggers a Special Enrollment Period.
Examples of these events may include getting married, having a baby, moving to a new location, or losing current health insurance coverage.
During this 60-day period, individuals can purchase a health plan even if it falls outside of the normal enrollment period.
It’s important to note that going without health insurance leaves the individual at risk for high medical bills.
The government established a Marketplace to help individuals navigate the process of obtaining health insurance, even outside of open enrollment.
What are the options for buying health insurance outside of open enrollment?
Special Enrollment Period (SEP): Available when certain life events occur, such as job loss, marriage, childbirth, relocation, or eligibility for tax credits or cost-sharing reductions.
The SEP typically lasts 60 days before and after the event. You can verify your eligibility and apply through the Health Insurance Marketplace or with an insurer.
Medicaid or CHIP: Public programs providing free or affordable coverage for eligible low-income individuals, children, pregnant women, people with disabilities, and seniors.
There is no enrollment period, and you can apply anytime if you meet your state’s criteria. Check your eligibility through the Health Insurance Marketplace or your state’s Medicaid agency.
Short-term Health Plan: Temporary coverage lasting from 30 days to 12 months. Not regulated by the Affordable Care Act (ACA), these plans do not cover essential benefits, pre-existing conditions, or preventive care.
They may result in tax penalties if you lack other qualifying coverage. Apply year-round with an insurer or through a broker.
Health Care Sharing Ministry: Organizations facilitating voluntary sharing of medical expenses among members with similar beliefs.
Not insurance, they do not follow ACA rules or state regulations, and do not guarantee payment. Certain services or conditions may be excluded. Apply year-round with the ministry or through an agent.
Evaluate each option’s benefits and drawbacks, and consider your health needs, budget, and eligibility for assistance.
Contact a licensed insurance agent or broker for guidance and quotes if you need help finding a plan outside of open enrollment.
What are the consequences of not having health insurance outside of open enrollment?
The implications of lacking health insurance beyond open enrollment can be severe and expensive. Potential repercussions include:
You might face a penalty fee for not possessing minimum essential coverage. This fee differs by state and may depend on your income or a fixed amount per person.
The fee is applied when filing your federal tax return and could lower your refund or raise your tax liability.
You might bear the full cost of medical expenses if you fall ill or get hurt. Without health insurance coverage, you will be accountable for the entire expense of any medical services or treatments you undergo.
This may encompass doctor appointments, hospital stays, surgeries, prescriptions, tests, and more.
These costs could rapidly accumulate and possibly lead to bankruptcy, depending on your condition’s severity.
You might experience restricted access to preventive care and chronic disease management. Lacking health insurance coverage, you may not have the means to afford routine check-ups, screenings, immunizations, and other preventive services that promote health and detect issues early.
Additionally, you might struggle to afford ongoing care and medication for chronic conditions like diabetes, asthma, or heart disease.
This could result in poorer health outcomes and complications over time.
How can I determine the best health insurance plan to buy outside of open enrollment?
Finding the right health insurance plan outside of open enrollment can be overwhelming.
However, by researching and considering options carefully, it’s possible to select suitable coverage.
Understanding qualifying life events triggering a Special Enrollment Period is vital. Afterward, exploring options through private carriers or the Health Insurance Marketplace is recommended.
Personal health needs, desired coverage, and budget should also be taken into account to determine the best plan.
It’s important to study plan details, benefits, and cost-sharing to make an informed decision. Consulting with a licensed insurance agent can also help in this process.
By evaluating options carefully and asking pertinent questions, one can discover a plan that provides the necessary coverage and peace of mind.
How do I know if a health insurance plan outside of open enrollment is ACA-compliant?
ACA-compliant health insurance adheres to Affordable Care Act standards, commonly known as Obamacare.
These standards encompass coverage for essential health benefits, a cap on out-of-pocket expenses, and non-discrimination for pre-existing conditions or other factors.
A plan’s benefits determine its ACA compliance. A plan is likely ACA-compliant if it covers annual checkups, maternity care, and essential health benefits.
However, if the plan relies on an individual’s medical history for access, it is not ACA-compliant. Keep in mind that enrolling in an ACA plan outside of open enrollment requires qualification for a Special Enrollment Period.
To determine eligibility for financial assistance, consult the Marketplace.
Thorough research of plans and benefits enables informed decisions regarding health insurance.
What are the costs associated with buying health insurance outside of open enrollment?
Buying insurance outside the Marketplace means no premium tax credits or savings based on income.
If you buy health insurance outside of open enrollment, you might end up paying higher monthly premiums, deductibles, and out-of-pocket costs.
Weigh the costs against the coverage and benefits of different plans before deciding. Don’t wait until outside open enrollment to purchase a plan without considering the potential financial consequences.
