Orlando Harmon
If your health insurance policy has ended, you may have to wait for the next Open Enrollment Period to enroll in a new plan, unless you qualify for a Special Enrollment Period. You can qualify for a Special Enrollment Period if you've had certain life events, such as losing health coverage, moving, getting married, having a baby, or adopting a child, or if your household income is below a certain amount. If you've lost your job-based health insurance, you may be able to keep your health plan through COBRA continuation coverage, which lets you pay to stay on your job-based health insurance for a limited time after your job ends. You can also preview plans and estimated prices for a Marketplace plan based on your income. It's important to have health insurance coverage to protect yourself from the financial risks of unexpected medical care.
| Characteristics | Values |
|---|---|
| Reasons for losing coverage | Failing to pay monthly premiums, losing job-based coverage, starting a new job, turning 65, being laid off, or experiencing a life change |
| Options after losing coverage | COBRA continuation coverage, Medicaid, Children's Health Insurance Program (CHIP), Special Enrollment Period, new job-based insurance, Medicare |
| Premium grace period | Up to 3 months to pay all owed premiums and avoid losing coverage |
| Cancelling a policy | Contact insurance company or broker, may require additional documents, confirm policy end dates, no gap in coverage |
| Appealing a cancellation | Contact insurer or Department of Insurance |
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What You'll Learn
You may qualify for a Special Enrollment Period
Additionally, if you or anyone in your household was offered an individual coverage Health Reimbursement Arrangement (HRA) or a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA), you may qualify for a Special Enrollment Period. If you move to the United States from a foreign country or United States territory, you may also be eligible. It's important to note that moving only for medical treatment or vacation does not qualify you for this period.
If you are a survivor of domestic abuse, spousal abandonment, or are married to your abuser, you may qualify for a Special Enrollment Period to enroll in your own health plan separate from your abuser or abandoner. You can answer that you're unmarried on your Marketplace application, and you may be eligible for a premium tax credit and other savings.
If you qualify for a Special Enrollment Period, you typically need to make your first monthly premium payment before your coverage begins. However, in some cases, retroactive coverage may be offered based on a past date that aligns with your qualifying life event.
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COBRA continuation coverage
If you've lost your health insurance, you may be able to keep your job-based health plan through COBRA continuation coverage. The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the option to continue their group health benefits for a limited time—usually 18 months. This temporary extension, or "continuation coverage", is offered in instances where coverage under the plan would otherwise end.
COBRA coverage can be helpful if you wish to continue seeing the same doctors and receiving the same health plan benefits. Your dependents (i.e. spouse, former spouse, or children) are also eligible for COBRA coverage, even if you (the former employee) do not sign up. You have 60 days to enrol in COBRA once your employer-sponsored benefits end, and your coverage can last for 18 to 36 months.
To qualify for COBRA, you must have been enrolled in your employer's health insurance plan when you were employed, and the company must have at least 20 employees. You will likely be required to pay the entire premium for coverage, plus an administrative fee of up to 2%. This can be costly, so consider your budget before choosing this option.
If you qualify for COBRA, it can be a good short-term solution while you explore other health insurance options. It provides flexibility during the transition between losing job-based coverage and beginning other health coverage.
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$199.95 $245.95
Free or low-cost coverage from Medicaid
If you have lost your health insurance, you may be eligible for free or low-cost coverage from Medicaid. Medicaid provides free or low-cost health coverage to people with low incomes, including families and children, pregnant women, the elderly, and people with disabilities.
Each state has its own requirements for Medicaid eligibility, which may include income, household size, family status, disability, age, and other factors. To apply for Medicaid, you must be a resident of the state where you are applying for benefits and create an account with the Health Insurance Marketplace. Even if you do not qualify for Medicaid based on your income, you may qualify for your state's program, especially if you have children, are pregnant, or have a disability.
Medicaid may also be able to help you pay for medical care from the last three months, even if you were not enrolled in Medicaid at the time. Additionally, if you have recently lost your job-based health insurance, you may be able to keep your previous health plan through COBRA continuation coverage. This allows you to pay to stay on your job-based health insurance for a limited time, usually 18 months, after your job ends.
It is important to note that not all medical providers accept Medicaid. Therefore, it is recommended to locate a Medicaid or Children's Health Insurance Program (CHIP) provider by checking with your state's Medicaid agency.
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Appealing your insurance company's decision
If your health insurance company refuses to pay a claim or ends your coverage, you can appeal their decision. There are two ways to do this: an internal appeal and an external review.
Internal Appeal
You can ask your insurance company to conduct an internal appeal, which involves a full and fair review of its decision. If the case is urgent, your insurance company must expedite this process. Insurers are required to inform you of their reasons for denying your claim or ending your coverage, as well as how you can dispute their decision.
External Review
You have the right to take your appeal to an independent third party for an external review. This means that the insurance company no longer has the final say over whether to pay a claim.
It is important to note that you may have to wait for the next Open Enrollment Period to enroll in a new health insurance plan after your previous coverage has ended. However, you may qualify for a Special Enrollment Period if you have experienced certain life events, such as losing health coverage, moving, getting married, having or adopting a child, or if your household income falls below a certain threshold.
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Switching to a different insurance company
If you are switching to a different insurance company, there are a few things you should keep in mind. Firstly, it is important to ensure that there is no gap in your coverage. You should only cancel your previous policy once your new insurance policy is already in effect. Lapses in coverage can result in higher premiums and can leave you vulnerable if you need to make a claim during that period.
Secondly, you should carefully review and compare the terms and conditions of your new policy. Check for any exclusions or hazards that may not be covered in the new policy, as these can differ between insurance companies. For example, most home insurers exclude flood and earthquake coverage, but some may have additional exclusions for certain dog breeds. You should also compare the endorsements or riders offered by each company, as these can increase or broaden your coverage. In addition, look at the deductibles – the amount you will need to pay when filing a claim – and choose an amount that is affordable for you.
Additionally, when switching insurance companies, you may want to consider bundling your policies. For example, you could bundle your home and auto policies with the same company, which could result in a bigger discount. Finally, remember that switching insurance companies is generally a straightforward process and can often be done online or over the phone. You can switch insurance companies at any time and are not required to wait for your current policy to expire.
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Frequently asked questions
If your policy ended and you require medical insurance, you can enroll in a new plan during the Open Enrollment Period. This period typically runs from November 1 to January 15. If you miss this period, you may have to wait until the next year unless you qualify for a Special Enrollment Period. You can qualify for a Special Enrollment Period if you have experienced certain life events, such as losing health coverage, moving, getting married, having a baby, or adopting a child.
To enroll in a new plan during the Open Enrollment Period, you can log into your Marketplace account and update your application. You can then select a plan that meets your needs and enroll by December 15 for coverage to start on January 1 of the following year.
If you recently left your job and lost your employer-based coverage, you may be eligible for COBRA continuation coverage. This allows you to continue your former employer's group plan for up to 18 months at your own expense. Additionally, you can check if you qualify for free or low-cost coverage from programs such as Medicaid or the Children's Health Insurance Program (CHIP).
