Life Insurance: Enrolling After Open Enrollment

Open enrollment is an annual period when individuals can review, assess, and modify their existing benefits or enroll in new ones. During this time, you can sign up for health insurance, life insurance, dental insurance, and other employee benefits offered through your workplace or the government marketplace. While open enrollment is a great opportunity to sign up for insurance, you may be wondering if you can still sign up for life insurance after this period ends. The answer is yes! You can still sign up for life insurance after open enrollment by taking advantage of special enrollment periods or considering alternative insurance options. Special enrollment periods are triggered by qualifying life events, such as losing your job-based health insurance, changes in your income, moving, getting married, or having a baby. These periods allow you to enroll in health insurance outside of the regular open enrollment timeframe. Additionally, certain programs like Medicaid and the Children's Health Insurance Program (CHIP) permit enrollment at any time, ensuring that individuals can access the coverage they need.

Qualifying life events

A qualifying life event (QLE) is a life-changing situation that can impact your health insurance coverage. Experiencing a QLE may allow you to change your health plan outside of the annual open enrollment period.

There are four basic types of qualifying life events:

Loss of Health Coverage

• Losing existing health coverage, including job-based, individual, and student plans.
• Losing eligibility for Medicare, Medicaid, or the Children's Health Insurance Program (CHIP).
• Turning 26 and losing coverage through a parent's plan.

Changes in Household

• Getting married or divorced.
• Having a baby, adopting a child, or placing a child for foster care.
• Death of a member enrolled in your health plan.

Changes in Residence

• Moving to a different ZIP code, county, or state.
• Moving to or from the place you attend school (if you're a student).
• Moving to or from the place you live and work (if you're a seasonal worker).
• Moving to or from a shelter or other transitional housing.

Other Qualifying Events

• Changes in your income that affect the coverage you qualify for.
• Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder.
• Becoming a U.S. citizen.
• Leaving incarceration.
• AmeriCorps members starting or ending their service.

Special Enrollment Periods

A Special Enrollment Period is a time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you've had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child, or if your household income is below a certain amount.

Special Enrollment Period details vary based on the life change. Here are some common scenarios that may qualify you for a Special Enrollment Period:

Changes in Household

• Marriage: If you get married, you can choose a new plan by the last day of the current month, and coverage will start on the first day of the next month.
• Birth of a Child: Your plan can start on the day of the birth, even if you enroll up to 60 days afterward.
• Divorce or Legal Separation: If you lose health insurance due to divorce or legal separation, you may qualify for a Special Enrollment Period.
• Death: If someone on your Marketplace plan passes away, causing you to lose your current health plan, you'll qualify for a Special Enrollment Period.

Changes in Residence

• Moving to a New Zip Code or County: If you move to a new home in a different zip code or county, you may qualify for a Special Enrollment Period.
• Moving to the U.S. from a Foreign Country: If you're relocating to the United States from another country, you're eligible for a Special Enrollment Period.
• Moving to or from a Place of Education: If you move to or from the place you attend school, you may qualify for a Special Enrollment Period.
• Moving to or from a Seasonal Work Location: If you're a seasonal worker who moves to or from your place of work, you're eligible for a Special Enrollment Period.

Loss of Health Coverage

• Loss of Qualifying Health Coverage: If you or anyone in your household has lost or expects to lose qualifying health coverage, you may qualify for a Special Enrollment Period. This includes losing health coverage through your employer, a family member, or a discontinued plan.
• Loss of Medicaid or Children's Health Insurance Program (CHIP) Coverage: If you lost or were denied Medicaid or CHIP coverage due to changes in eligibility or other reasons, you may qualify for a Special Enrollment Period.
• Loss of Medicare: You may qualify for a Special Enrollment Period if you lose premium-free Medicare Part A. However, losing Medicare Parts B or D only does not qualify.

Other Qualifying Changes

• Gaining Membership in a Federally Recognized Tribe: Becoming a member of a federally recognized tribe or an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder can make you eligible for a Special Enrollment Period.
• Becoming a U.S. Citizen: If you gain U.S. citizenship, you qualify for a Special Enrollment Period.
• Leaving Incarceration: If you're leaving incarceration, you're eligible for a Special Enrollment Period.
• AmeriCorps Service: Starting or ending service as an AmeriCorps State and National, VISTA, or NCCC member may qualify you for a Special Enrollment Period.

It's important to note that the time frame for enrolling during a Special Enrollment Period can vary. Depending on the situation, you may have 60 days before or after the qualifying life event to enroll in a new plan. Additionally, you may need to provide proof of the qualifying life event to your new health plan or insurance company.

Short-term health insurance

The cost of short-term health insurance includes a premium, deductible, coinsurance, and copay. The premium is the monthly fee for coverage, varying based on the level of coverage, deductible, coinsurance, and types of services covered. The deductible is the amount paid out of pocket before the plan starts sharing costs. Coinsurance is the percentage of costs shared with the plan after meeting the deductible, while a copay is a fee paid when visiting a doctor.

Medicaid and CHIP

Medicaid is a federal and state program that, together with the Children's Health Insurance Program (CHIP), provides health coverage to over 77.9 million Americans. This includes children, pregnant women, parents, seniors, and individuals with disabilities.

To participate in Medicaid, federal law requires states to cover certain groups of individuals. Low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI) are examples of mandatory eligibility groups. States have additional options for coverage and may choose to cover other groups, such as individuals receiving home and community-based services and children in foster care who are not otherwise eligible.

The Affordable Care Act of 2010 allowed states to expand Medicaid to cover nearly all low-income Americans under age 65. Eligibility for children was extended to at least 133% of the federal poverty level (FPL) in every state, with most states covering children to higher income levels. States were also given the option to extend eligibility to adults with incomes at or below 133% of the FPL. Most states have chosen to expand coverage to adults, and those that have not yet expanded may do so at any time.

To be eligible for Medicaid, individuals must meet certain non-financial eligibility criteria. They must generally be residents of the state in which they are receiving Medicaid and either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents. Some eligibility groups are limited by age, pregnancy, or parenting status.

The Children's Health Insurance Program (CHIP) is a joint federal and state program that provides health coverage to children in families who earn too much money to qualify for Medicaid but cannot afford private insurance. CHIP offers low-cost or free health coverage for these children, ensuring they have access to the care they need.

To apply for Medicaid or CHIP, individuals must contact their state Medicaid agency. Each state has its own contact information, which can be found on the official Medicaid website. This website also provides resources to help individuals check their eligibility, see if their state has expanded Medicaid coverage, and learn more about the application process.

Employer-sponsored insurance

The open enrollment period for employer-sponsored plans can vary and does not necessarily correspond with the Affordable Care Act (ACA) marketplace enrollment or the calendar year. The period usually occurs in the fall, and the length of the enrollment period can differ depending on the company. Most small employers have two- to four-week enrollment periods, while the ACA requires businesses with 50-plus employees that offer health benefits to hold an open enrollment period.

If an employee misses the open enrollment period, they may not be able to enroll in their company's health insurance plan until the following year. However, there are certain circumstances that allow employees to enroll or make changes to their coverage outside of the open enrollment period. These circumstances include:

• Basic life events: Events such as the birth of a child, marriage or a new domestic partnership, divorce or the end of a domestic partnership, death of a spouse or domestic partner who provided healthcare coverage, death of a dependent, dependent becoming ineligible (usually due to age), or a dependent acquiring other insurance.
• Loss of other coverage: When an employee loses their health coverage, such as through a divorce where they are removed from their former spouse's plan, they can trigger a special enrollment period.
• Change in employment status: Changes in employment status, such as separation or reduction of hours, new hires, changes from part-time to full-time status, or retirement and eligibility for Medicare coverage, can allow employees to make changes to their benefit elections outside of the open enrollment period.
• Other circumstances: Other situations, such as an extended unpaid leave of absence or eligibility for Medicare coverage, may also permit employees to make changes to their coverage outside of the designated period.

These circumstances can trigger a special enrollment period (SEP), allowing employees to make changes to their coverage. During an SEP, employees generally have the same options as they would during the open enrollment period. It is important to note that the rules and regulations for employer-sponsored health coverage and special enrollment periods are outlined in the Code of Federal Regulations.

Frequently asked questions