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What to Do If You Miss Open Enrollment
Did you miss Open Enrollment? The “open enrollment period” refers to the period of time of a few weeks at the end of every year when people are encouraged to enroll in a health insurance plan through a website operated by the U.S. Centers for Medicare and Medicaid Services.
By mid-October, TV and radio announcers, social media, well-meaning friends—just about everyone—start reminding you to visit healthcare.gov to select an eligible plan under the Affordable Care Act (ACA). Open Enrollment lasts several weeks—from the first of November through mid-December.
If you enrolled during Open Enrollment in the past, you’ll receive daily email reminders about visiting the healthcare.gov website. And you may hear public-service announcements on radio or television or from your local politicians.
But what if you miss Open Enrollment? Maybe you meant to enroll, but kept putting off the task until it was too late. Or maybe you miss Open Enrollment because your start date for your new job is delayed, and you suddenly realize that you don’t have any insurance.
Life has a habit of throwing us a curve ball even when we have the best intentions. And it happens a lot more often than we like to think about.
Whatever the reason may be for which you miss Open Enrollment, don’t be too hard on yourself because you probably aren’t doomed to spend the next year without coverage. We have some suggestions to help you bridge any gaps in coverage, and it likely won’t cost you a fortune.
Special Enrollment Periods
First, you may want to determine if your employer offers coverage and has a different enrollment period, then see if you’re still eligible to enroll. Otherwise, you may be able to extend your opportunity to sign up for a plan on healthcare.gov if you qualify for a Special Enrollment Period (SEP).
A SEP is not a specific time frame throughout the calendar year; it’s basically any period outside of Open Enrollment in which you may be deemed eligible to obtain insurance. If you’ve experienced one of a number of qualifying life events, you may enroll for coverage in the marketplace.
For most events, you have 60 days following the event to sign up for a plan, but it’s recommended that you start the process as early as possible during the SEP. These events are known as a “qualifying life event,” and there are quite a few that grant you eligibility.
Qualifying Life Events
Any one of a number of specific changes in your circumstances is recognized as a “qualifying life event” – a catalyst that allows you to get insurance through the marketplace.
The most common qualifying life event is the loss of existing insurance coverage. This can be an individual plan, student coverage, or job-based insurance.
For example, your employer may have stopped offering coverage, you were terminated, or you had coverage from a spouse’s job and they’re longer eligible for insurance. Or you may be turning 26 and aging out of your parent’s plan.
Another qualifying event is if you lose eligibility for Medicare, Medicaid, or Children’s Health Insurance Program (CHIP). Or any change in income that affects the type of healthcare coverage you qualify to receive.
Other qualifying life events include:
- Changes in household
- Getting married or divorced
- Having a baby or adopting a child
- Death in the family
- Changes in residence
- Moving to a different zip code or county
- Student moving to or from the place in which they attend school
- Seasonal worker moving to or from the place in which they both live and work
- Moving to or from a shelter or other transitional housing
- Becoming a U.S. citizen
- Leaving incarceration in jail or prison
- AmeriCorps members starting or ending their service
- Gaining membership in a federally-recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
If You’re Not Eligible for a SEP
If you’re ineligible for a SEP because your lack of insurance isn’t due to one of the qualifying life events, you don’t have to go without coverage. You have the option of enrolling in short-term healthcare coverage.
Customized health plans are available for a short period of time, designed to bridge the gap between major medical coverage and uninsured status. Lawmakers have recently changed provisions to allow consumers to renew or extend coverage on eligible temporary plans.
The good news is that many times short-term health plans have smaller premiums than comprehensive healthcare plans. The bad news is that most don’t cover preexisting conditions.
If you’re concerned about having been denied coverage for a health condition in the past or for which you’re currently receiving treatment, you may want to look into guaranteed-issue coverage. While it may cost more than other plans, you’ll have healthcare coverage until you can find a long-term solution.
In conclusion, even if you miss Open Enrollment, don’t despair: you still have options for healthcare coverage.
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