Paul Sanchez
If you missed the Open Enrollment deadline for health insurance, you may still be able to get coverage through a Special Enrollment Period. Special Enrollment Periods are triggered by qualifying life events, such as getting a divorce, losing your job, or losing your Medicaid or CHIP eligibility. These periods typically last for 60 days after the date of the qualifying event, and you can shop for health insurance on a private or public exchange with the same plan options as during the Open Enrollment Period. If you don't qualify for a Special Enrollment Period, you might consider a short-term health plan, although these plans do not meet the Affordable Care Act's requirements for minimum essential coverage.
| Characteristics | Values |
|---|---|
| Can I get medical insurance after open enrollment? | Yes, you can get medical insurance outside of the Open Enrollment Period if you have a qualifying life event. |
| What is a qualifying life event? | Examples include getting married, having a baby, getting divorced, losing your job, moving, or losing your health coverage. |
| How long does a Special Enrollment Period last? | A Special Enrollment Period typically lasts for 60 days after the date of your qualifying event. |
| What if I don't have a qualifying life event? | If you don't have a qualifying life event, you may be able to purchase a short-term health plan or consider other options like a health care sharing ministry plan or direct primary care membership. |
| Are there any other considerations? | Yes, it's important to note that short-term health plans might not meet the Affordable Care Act's requirements for minimum essential coverage. Additionally, the availability and requirements of health insurance may vary from state to state. |
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What You'll Learn
Qualifying for a Special Enrollment Period
Loss of Health Coverage
You may qualify for an SEP if you or anyone in your household has lost or expects to lose qualifying health coverage. This includes losing coverage through a parent, spouse, or other family member. For example, if you lose coverage because you are no longer considered a dependent or if your child ages out of the Children's Health Insurance Program (CHIP). Additionally, if you lose coverage due to a divorce or legal separation, you may be eligible for an SEP, but only if it results in a loss of health insurance.
Change in Income or Eligibility
A change in household income that affects your eligibility for certain programs, such as Medicaid, may qualify you for an SEP. This could be due to an increase or decrease in income that alters your ability to afford health coverage.
Life Changes and Family Events
Certain significant life events can qualify you for an SEP. This includes having a baby, adopting a child, getting married, or experiencing the death of someone on your Marketplace plan, resulting in a loss of coverage.
Relocation
Moving to a new location, especially if it involves relocating to the United States from a foreign country or a different state, may qualify you for an SEP. However, moving solely for medical treatment or vacation typically does not qualify.
Loss of Government Health Coverage
Losing government health care coverage, such as Medicare, Medicaid, or CHIP, can make you eligible for an SEP. In some states, you may be granted an extended period of 90 days for losing Medicaid coverage.
Gaining Citizenship or Legal Status
If you or anyone in your household gains U.S. citizenship, legal presence, or refugee status, you may qualify for an SEP.
Other Unexpected Situations
Other unforeseen circumstances, such as facing a serious medical condition, natural disaster, or other state or national emergencies, may also qualify you for an SEP.
It's important to note that the requirements for qualifying for an SEP may vary by state and specific guidelines. Be sure to review the eligibility criteria and consult official healthcare websites or insurance providers for detailed and up-to-date information.
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Losing health coverage
There are various reasons why you might lose your health coverage, and some of these qualify you for a Special Enrollment Period. For example, you might lose your health insurance if you leave your job, get divorced, lose your Medicaid or CHIP eligibility, or if your COBRA coverage expires. If you lose your job-based health insurance, you can enroll in a Marketplace plan and will qualify for a Special Enrollment Period. This period begins from the date you lost your job-based coverage, and you need to apply within 60 days.
You may also lose your health coverage if your household income decreases, and this could qualify you for savings on a Marketplace plan. Additionally, if you lose your health coverage because you are no longer a dependent, you may qualify for a Special Enrollment Period. This could be because you turn 26 and can no longer be on a parent's plan, or because of a divorce or legal separation. It's important to note that if you voluntarily drop your coverage as a dependent, you won't qualify for a Special Enrollment Period unless you also have a decrease in household income or a change in your previous coverage that makes you eligible for savings on a Marketplace plan.
In some cases, you might lose your health coverage if you fall behind on your monthly premiums. Before your insurance company ends your coverage, you will usually have a grace period of around 3 months to make the outstanding payments and avoid losing your coverage. However, if you don't pay all owed premiums, you may lose your coverage, and this could date back to the first month you missed a payment.
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Short-term health insurance options
Short-term health insurance is available in most states and can be purchased outside of the Open Enrollment Period. It is also known as temporary health insurance and can be a good option if you are unable to obtain coverage outside of open enrollment. However, it is important to note that short-term health insurance plans are not regulated by the Affordable Care Act (ACA) and do not meet its requirements for minimum essential coverage.
Short-term health insurance plans are typically available for a duration of up to four months, including renewals, and can take effect as soon as the day after your application is received. The Biden administration finalized new rules for short-term health plans, which came into effect in September 2024. If you enrolled in a short-term policy before this date, it may have had a longer duration, depending on your location and the specific policy.
Short-term health insurance plans are medically underwritten, meaning they can ask basic medical history questions to determine eligibility. They often use post-claims underwriting, which allows them to review your medical records when you make a claim. This means that if they find any indication that your claim is related to a pre-existing condition, they can deny the claim or rescind your coverage.
Short-term plans may not cover all essential health benefits, and many do not cover outpatient prescriptions. They may also have lifetime and/or annual dollar limits on health benefits. It is important to carefully review the policy to understand any exclusions or limitations, especially regarding coverage of pre-existing conditions and benefits such as hospitalization, emergency services, maternity care, preventive care, prescription drugs, and mental health services.
Short-term health insurance can be a temporary solution to fill gaps in coverage, but it is important to understand the limitations and potential costs associated with these plans.
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Changes to household status
You may be able to get medical insurance after the Open Enrollment Period if you qualify for a Special Enrollment Period. A Special Enrollment Period is a period of time outside of Open Enrollment when you can enroll in or change a Marketplace plan.
If you or anyone in your household has experienced any of the following events in the past 60 days, you may qualify for a Special Enrollment Period:
- Getting married
- Having a baby, adopting a child, or placing a child for foster care
- Getting divorced or legally separated and losing health insurance (divorce or legal separation without losing coverage doesn't qualify)
- Death of someone on your Marketplace plan, causing you to lose your current health plan
- Moving to the U.S. from a foreign country or United States territory (moving only for medical treatment or vacation doesn't qualify)
- Losing health coverage through your employer or the employer of a family member, including if you lose coverage through a parent or guardian because you're no longer a dependent
- Losing Medicaid or CHIP coverage due to a change in household income that makes you ineligible
- Your child aging out of CHIP
- Losing your individual health coverage, such as if your individual or Marketplace plan is discontinued
- A decrease in household income that makes you eligible for savings on a Marketplace plan
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Eligibility for Medicaid or CHIP
You can apply for or re-enroll in Medicaid or CHIP at any time of the year. However, eligibility criteria vary from state to state.
Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of Americans, including some low-income people, families, children, pregnant women, the elderly, and people with disabilities.
To be eligible for Medicaid, you must be a resident of the state in which you are applying for benefits and meet the state's income requirements. To apply, create an account with the Health Insurance Marketplace and fill out an application. If it appears that anyone in your household qualifies for Medicaid, your information will be sent to your state agency, which will contact you about enrollment.
CHIP covers uninsured children and teens up to the age of 19 and, in some states, pregnant people. Like Medicaid, CHIP beneficiaries must be residents of the state in which they are receiving CHIP and meet the state's income requirements. To apply for CHIP, create an account with the Health Insurance Marketplace and fill out an application. If it appears that anyone in your household qualifies for CHIP, your information will be sent to your state agency, which will contact you about enrollment.
In addition to income and residency requirements, there are other eligibility criteria for CHIP. To be eligible, children must be uninsured, US citizens, or meet immigration requirements. Infants born to targeted low-income pregnant women are automatically deemed eligible for Medicaid or CHIP until the child turns one year old.
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Frequently asked questions
Yes, you can get medical insurance outside of the Open Enrollment Period if you have a qualifying life event. This includes life changes like getting married, having a baby, or losing your health coverage. You can also purchase standalone dental or vision insurance outside of the Open Enrollment Period.
A qualifying life event is a life change that allows you to make changes to your health insurance benefits outside of the Open Enrollment Period. Examples include getting divorced, losing your job, or losing your Medicaid or CHIP eligibility.
A Special Enrollment Period typically lasts for 60 days after the date of your qualifying event. During this time, you can shop for health insurance on a private or public exchange and have the same plan options as during the Open Enrollment Period.
You can review the list of qualifying events on the health insurance website or contact your state's Medicaid agency to see if you qualify. Some common reasons for qualifying include losing health coverage or expecting to lose coverage within the next 60 days.
If you do not qualify for a Special Enrollment Period, you can consider a short-term health plan to cover yourself for a short period of time. However, these plans may not meet the Affordable Care Act's requirements for minimum essential coverage.
