I Missed Open Enrollment for Health Insurance, Now What?
The gist
Open Enrollment Period (OEP) is a specific window of time during which you’re able to sign up for new health insurance or modify or replace your existing plan.
The nationwide OEP is typically Nov. 1 to Jan. 15, but can vary state by state.
If you miss OEP for health insurance, you may have other options, like a Special Enrollment Period (SEP). There may also be other products and ways to minimize your health care costs until the next OEP.
In this article
What are my options if I don’t qualify for a Special Enrollment Period?
What is the simplest way to enroll in a new health insurance plan?
Life seems busier than ever nowadays, right? It seems like we never have enough time to do all the things we need to do, and it’s easy to let some things slip through the cracks. One crucial thing you should never let lapse is your health care coverage. Even if you’re feeling healthy today, a sudden illness, accident, or unexpected trip to the hospital could lead to tens of thousands of dollars in hospital bills — most of which can be offset by having active comprehensive health insurance.
The easiest way to enroll in ACA plans is during the annual Open Enrollment Period, which is a set window during which you can enroll in new insurance or make changes to an existing policy. It runs from Nov. 1 to Jan. 15 for most states (although it can vary — click here for a list of states with slightly longer OEPs).
This time of year, our help desk lights up with the same question: “I missed Open Enrollment for health insurance; what are my options?” First, take a deep breath. We’ll work through this with you.
I missed Open Enrollment for health insurance, now what?
Don’t stress out! We know how complicated this can all seem. If you missed Open Enrollment for health insurance, you have some options.
First, you should see if you qualify for a Special Enrollment Period. This is a special window of time that’s granted to people who have had what’s called a qualifying life event (more on those in a moment). Typically, your Special Enrollment Period will be open for 60 days following your qualifying life event, so make sure to get the necessary paperwork to prove this life event as quickly as possible!
What is a qualifying life event?
If you missed the annual Open Enrollment Period, you may qualify to get covered during a Special Enrollment Period. But to qualify, you must first experience a qualifying life event (QLE). The good news is that there are a fairly wide range of situations that count as qualifying life events. Some of the most common QLEs include:
Loss of employer-provided coverage
Loss of coverage on parents’ plan when you turn 26
Birth or adoption of a child
Marriage or divorce
A death among the family members is covered by your plan
Moving to a new ZIP code or county
Gaining U.S. citizenship
Leaving incarceration
Before requesting your Special Enrollment Period, make sure you have all the documentation of your QLE ready to go. This could be a birth or death certificate, a marriage license, a piece of mail verifying your new address, or paperwork from your work explaining how or why you lost employer-provided coverage.
In most cases, the clock for your SEP starts when your qualifying life event occurs and keeps ticking for 60 days, so don’t delay! Having health insurance throughout the year is essential to keeping your body (and finances, to be honest) healthy.
What are my options if I don’t qualify for a Special Enrollment Period?
If you don’t qualify for a Special Enrollment Period, you may still have certain options for finding partial or incomplete coverage. Typically, these options are more of stopgap for desperate situations, because they’re not required to provide the essential benefits that all comprehensive insurance policies are required to cover.
Some benefits that may not be covered include:
Prescription drug coverage
Pregnancy and childbirth care
Mental health services
Preventive care
Care for pre-existing conditions (that’s any condition that you’re currently being treated for or have been treated for in the past)
Short-term health insurance
One non-comprehensive option is what’s known as short-term insurance, which is coverage that’s typically purchased directly from an insurance company and can be active for as little as one month. This is a bit of a misnomer, as these plans don’t offer those essential benefits shown above. It’s also important to note that short-term plans may not be available in your state, and may be limited in their duration of coverage or the ability to renew. If you’re considering a short-term policy, we recommend taking a close look at the plan’s exclusions and limitations before you enroll to make sure you’re aware of what types of care are not covered. These plans are not ACA-compliant and in general, we don’t recommend them unless there’s no other option.
Fee-for-service or indemnity plans
Indemnity plans are often sold as an alternative to ACA coverage, and are available year-round. They resemble ACA plans, but have a few key differences. The first? They’ll only pay for part of your health expenses (typically either a flat amount or a percentage) — you’re responsible for the remainder. Secondly, like short-term plans, indemnity plans have many exclusions and usually don’t cover things like pre-existing conditions, preventive care, or pregnancy expenses.
We don’t recommend indemnity policies, but understand that they may be a useful stopgap solution until the next Open Enrollment Period (or until you qualify for a Special Enrollment Period). These plans can be purchased through carriers directly.
Medicaid
Depending your income, state, and other factors, you may qualify for Medicaid, which is a government program that provides health insurance at no cost to you. It’s available for enrollment throughout the year.
Supplemental insurance
Supplemental insurance is intended to complement health insurance. But nonetheless, supplemental policies like hospital, disability, dental, vision, or critical supplement insurance can all alleviate out-of-pocket costs related to certain types of health care. Just note that these options may not be available in all states and are only payable in limited circumstances up to specified maximums.
Non-insured medical care
While not insurance, there are companies that offer pay-per-visit or subscription-style medical care, either in person or via telemedicine. Convenience clinics and virtual primary care are two examples of non-insured medical care that you may be able to receive at a lower cost while uninsured.
Cash pay discounts
If you don’t have coverage, ask your providers in advance if they offer cash-pay discounts for the uninsured. Depending on the provider and the type of care, it’s sometimes possible to negotiate a reduced cost if you can’t pay in full at the time of service. Additionally, you may qualify for financial assistance from a hospital (depending on your income).
What is the easiest way to enroll in a new health insurance plan?
Having a comprehensive health insurance policy is incredibly important in this day and age — an unexpected hospital trip could cost thousands of dollars without it. Luckily, Stride’s customizable shopping tool breaks down the process of choosing insurance into simple steps and gives you the information you need to confidently choose plans that work for your life and wallet.
