Missed Open Enrollment for Health Insurance?
What is Open Enrollment?
- Open enrollment is a designated window of time each year in which all American adults can enroll in an Affordable Care Act-qualified health insurance policy with guaranteed enrollment.
- Open Enrollment usually lasts from November 1 to January 15th each year in most states. However, some states have different deadlines.
- Generally, you will not be able to enroll in a new health insurance plan outside of open enrollment unless you qualify for a special enrollment period, described below.
If you’ve missed Open Enrollment for whatever reason, here’s what you can do to secure a health plan for yourself and your family.
Compare Pricing on the Best Insurance Plans Available
Option 1: Qualify for a Special Enrollment Period (SEP)
A Special Enrollment Period is a 60-day window outside of Open Enrollment during which you can enroll in an ACA-qualified health plan with guaranteed enrollment.
That means the health insurance company must accept you, even if you have pre-existing conditions.
However, you can only qualify for a SEP if you have a qualifying life event.
These include:
- Marriage or divorce
- Having a baby or adopting a child
- Losing other health coverage
- Moving to a new residence
- Change in citizenship or permanent residency status
- Release from incarceration
- Discharge from active duty in the Armed Forces
- Earn less than 150% of the federal poverty level
If you qualify for a SEP, you can choose any health insurance plan offered in your area.
Depending on your income and size of your household, you may also qualify for an Affordable Care Act subsidy to help you pay your premiums.
If you qualify, this can be a good solution if you have pre-existing conditions that you need coverage for right away, or if you qualify for a subsidy, or both.
If you expect to qualify for a SEP later in the year, you can also enroll in a health sharing plan (described below).
When you do qualify for a SEP, contact a Personal Benefits Manager for a free consultation. We can then decide if you’re better off switching to a traditional ACA-qualified insurance plan and possibly taking advantage of a subsidy, or sticking with a low-cost health sharing alternative.
Option 2: Enroll in a Health Sharing Alternative
Health sharing plans present a flexible and affordable alternative to traditional Marketplace health insurance plans.
Health sharing plans are not insurance products. Instead, they are non-profit, community-based associations of health-minded people who share similar values, and who agree to help share the medical expenses of their fellow members.
Each member contributes a monthly “share” that goes towards covering eligible medical expenses of other members.
With health sharing, you aren’t limited to open enrollment windows. You can enroll at any time of the year.
Advantages of Health Sharing:
- Year-Round Enrollment: No need to wait for an Open Enrollment period.
- Cost-Effective: Generally, health sharing plans are much less expensive than unsubsidized Obamacare policies.
- Flexibility in Providers: Health share plans typically give you far more flexibility to choose your own providers than the HMOs and other managed care plans that dominate the Obamacare exchanges.
If you want to maximize your ability to choose your own doctor, don’t receive a subsidy under the ACA, and you don’t have significant pre-existing conditions, health sharing can be a great option.
Disadvantages of Health Sharing
The chief drawback of health sharing plans is that they typically don’t share costs for pre-existing conditions right away.
Instead, they will have a waiting period – typically up to four years – before they will fully share costs to treat pre-existing conditions. They may also have a waiting period before they will share surgery costs, except for those resulting from accidents and injuries that could not have been anticipated at the time of enrollment.
Health sharing plans also don’t qualify for an Obamacare subsidy. However, this is irrelevant for millions of middle class American households who are left out of the Obamacare subsidies.
And for many who do qualify, the lower monthly costs of health share plans still more than compensates for the lack of subsidy.
Faith-Based Organizations
Many health share organizations are faith-based, though not all of them. Some are non-denominational, and others are completely secular. You can choose the type of plan that suits your values best.
Read More on How Health Sharing Works
Option 3: Purchase a Short-Term Health Insurance Policy
Short-term health insurance is another alternative, particularly in states where it’s available.
These are short-term, limited purpose policies that are not designed to be permanent solutions.
But they can help to get basic coverage in place to last you until you can enroll in a traditional health insurance plan next year, or to act as a “bridge” to an anticipated qualifying life event later in the year that would qualify you for a special enrollment period.
These plans offer temporary coverage, typically for a few months up to a maximum of 36 months.
They do not qualify for a subsidy under the affordable care act.
- Availability. Short-term plans are available in most states, but some states restrict them or even prohibit them altogether. States where short-term insurance is limited or not available include California, Colorado, Connecticut, Hawaii, Massachusetts, New Jersey, New Mexico, New York, Rhode Island, and Vermont.
Why Contact a Personal Benefits Manager?
- Personalized Guidance: A Personal Benefits Manager can help you navigate these options and find the best solution for your specific needs.
- Understanding Your Options: They provide clarity on the differences between health insurance, health sharing plans, and short-term insurance.
- Free Appointment: This service comes at no cost to you, offering expert advice to make an informed decision.
Compare Pricing on the Best HealthShare Plans Available
Missed Open Enrollment? What to Do Now
Missing the Open Enrollment period doesn’t mean you’re out of options.
Whether it’s leveraging a Special Enrollment Period, exploring health sharing plans, or considering short-term health insurance, there are avenues available to secure your healthcare needs.
Don’t go unprotected. Healthcare is expensive. Without health insurance or health sharing protection in place, you could be one unexpected medical incident away from bankruptcy.
Reach out to a Personal Benefits Manager for a free consultation to discuss your options and ensure you’re covered for 2025 and beyond.
Don’t let the complexity of healthcare options overwhelm you. With the right guidance and understanding of available alternatives, you can find a suitable and affordable healthcare solution, even after missing Open Enrollment.
For Further Reading: Health Sharing Vs. Short Term, Limited Duration Policies: Which Is the Better Deal? | How Much Does Health Sharing Save Compared to Health Insurance?
Wiley is President of HSA for America. He believes that consumers should have choice and price transparency, so they can make the best healthcare decisions for their needs. Read more about Wiley on his Bio page.
