If you missed the Affordable Care Act (ACA) annual open enrollment period you may still have options.
For coverage beginning Jan. 1, 2021, the open enrollment period for most states is from November 1, 2020, through December 15, 2020.[0]
However, some states that operate their own ACA exchanges have opted to extend open enrollment through the use of special enrollment periods as follows:
- California: Nov. 1, 2020 to Jan. 31, 2021[1] – California passed legislation to enact a permanent 3-month health insurance open enrollment period.[2]
- Colorado: Nov. 1, 2020 through Jan. 15, 2021 – Colorado passed legislation to enact a “market stabilization special enrollment period” that permanently extends the standard open enrollment period.[3]
- Massachusetts: Nov. 1, 2020 to Jan. 23, 2021.[4]
- Minnesota: Nov. 1 through Dec. 22, 2020.[5]
- Nevada: Nov. 1, 2020 to Jan. 15, 2021.[6]
- New Jersey: Nov. 1, 2020 to Jan. 31, 2021.[7]
- New York: Nov. 1, 2020 to Jan. 31, 2021.[8]
- Pennsylvania: Nov. 1, 2020 to Jan. 15, 2021.[9]
- Rhode Island: Nov. 1, 2020 to Jan. 23, 2021.[10]
- Washington D.C.: Nov. 1, 2020 to Jan. 31, 2021 – A “special enrollment period for future open enrollment periods” motion was passed in May, 2019 to permanently extend the open enrollment period to three months.[11]
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 necessarily mean you have to go without any 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.[12]
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.[13]
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.[14]
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.
You may have to supply documentation to confirm that you’re eligible.[15]
Enroll in ACA major medical coverage during a special enrollment period.
Option 2: Other Minimum Essential Coverage
Individual major medical health insurance is only one form of minimum essential coverage (MEC). Examples of additional forms of ACA-compliant MEC include, but are not limited to:[16]
- Employer-sponsored group health insurance
- Medicare
- Medicaid
- TRICARE
- The Children’s Health Insurance Program (CHIP)
- Student health plans
See a comprehensive list of health insurance that counts as minimum essential coverage.
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’re eligible, one of these programs may be a good option for individual minimum essential coverage especially 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.
Visit HealthCare.gov for examples of minimum essential coverage and to determine if you are eligible.
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.[17] 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 (though 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.
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 premiums and other limitations[18]
- Are able to qualify to enroll in a short term policy
- Don’t need coverage for pre-existing health conditions
Facing a Temporary Coverage Gap? If you live in a state that has extended their open enrollment period (see above), you may be facing a temporary coverage gap if you enroll in ACA coverage after December 15.
You may want to consider applying for short term health insurance to help with unexpected qualifying medical expenses between when your current policy terminates and next year’s policy goes into effect.
Short term policies can begin as soon as the day after you are approved for and you’ve paid your first premium. Policies can last for as few as 30 days. Get a short term medical quote to compare policies and costs.
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.
Compare short term insurance costs and coverage.
Shop Short Term Medical Insurance
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.
