If you missed the open enrollment period and are wondering what to do next about your health insurance needs, you may still have options available to you.
Take Advantage of Special Enrollment Periods (SEP)
Outside of Open Enrollment Periods, a Special Enrollment Period is a window of time after you experience a qualifying life event that affords you the opportunity to apply for coverage under the ACA. A Special Enrollment Period lasts for 60 days after a qualifying life event, permitting you the opportunity to purchase a health plan outside of the time frame of the Open Enrollment Period.
Qualifying life events are:
- Losing coverage through an employer. If your employer chose to stop offering coverage, you lose your job, or you no longer meet the requirements for your employer-provided plan, you qualify for an SEP.
- COBRA coverage ending. If you enacted to maintain your health coverage through COBRA and your COBRA coverage period ends, you qualify for an SEP. COBRA coverage ending due to non-payment of premiums is not considered a qualifying life event and therefore will not allow you to enter an SEP.
- Your individual coverage ending. If you previously purchased an individual plan or a plan through the Marketplace and your plan is discontinued, you moved, or you elect to not renew a plan that ends mid-year, you qualify for an SEP.
- Losing eligibility for Medicaid or CHIP. If you lose your eligibility for either Medicaid or CHIP, you qualify for an SEP.
- Losing coverage through a family member. If you turn 26 and lose coverage through a parent, or a family member whose plan you were on loses coverage through that plan, you qualify for an SEP. In New York State, unmarried and uninsured children who are 29 years old or younger and that reside in New York are eligible to enroll as part of a parent’s group plan by paying an additional premium.
- Changes in household size. Getting married, having a baby or adopting or fostering a child, losing coverage through divorce or separation, or losing coverage due to death, all constitute qualifying for an SEP.
- Moving. If you moved to a new zip code or county, to or from school, to or from a shelter, or to the United States, you qualify for an SEP, though you may have to provide proof of past coverage (except in the event you moved to the U.S.).
- Leaving incarceration.
- Becoming a U.S. citizen.
- You are or become part of a federally-recognized Native American tribe.
Healthcare.gov will help determine if you qualify for an SEP and assist you with enrolling in a plan.
Look Into Medicaid or CHIP
Medicaid and CHIP are two state-run programs that qualify individuals and families for free or low-cost healthcare plans. Pregnant women, the elderly, people with disabilities, and individuals or families below a certain income level all qualify for coverage through Medicaid. Medicaid has no open enrollment period, and you are free to apply at any time.
Medicaid and CHIP are both federally-regulated, but coverage differs from state-to-state. You may apply for these programs either through the Marketplace or by calling your state Medicaid agency.
Change Your Employment Status
Without proper healthcare coverage for yourself and your family, you leave yourself exposed to the responsibility for all healthcare costs accrued throughout the year. There are still options for getting coverage despite not qualifying for an SEP or Medicaid. A leading one of course, is to get coverage through an employer. While it doesn’t make sense to change jobs solely for health insurance coverage, a promotion from part-time to full-time at most employers will qualify you for group coverage through your employer. If a career change is in your future, you may find that a new job offers group coverage as well.
Get Short-term Health Insurance
This option is designed to be a temporary solution for those without health insurance, providing coverage for up to three months for individuals and families. Short-term health insurance is designed to protect you against the costs borne from unexpected illnesses and injuries and is often fast and easy to apply for. However, since short-term health insurance policies are not ACA-compliant, they do not include coverage for pre-existing conditions. In addition, these policies are not renewable or considered to be sufficient coverage to avoid a penalty under the requirements of the existing law to maintain health insurance. However, keep in mind that there’s a three-month grace period after any sufficient coverage ends before you are subject to the penalty, as long as you acquire coverage before the end of the three-month period. Short-term plans offer individuals and families peace-of-mind in comparison to remaining uninsured and responsible for the full brunt of healthcare costs.
While the ACA’s future is uncertain, there is still a need to protect yourself and loved ones from unforeseeable medical costs. If you’re without health insurance now, determining if you qualify for an SEP or Medicaid/CHIP, or obtaining coverage through an employer or short-term health insurance provider, is imperative to your well-being and financial peace-of-mind.