Haris Ashley
There are several options for obtaining health insurance after open enrollment. Firstly, American Indians and Alaskan Natives can enroll in Marketplace coverage at any time of the year. Secondly, those who qualify for Medicaid or have children eligible for the Children's Health Insurance Program (CHIP) can also apply for coverage year-round. Additionally, special enrollment periods may be available following certain life events, such as marriage, the birth of a child, or a permanent move. Short-term health insurance is another option, although it is not available in all states, and it may not cover all medical needs. Furthermore, some government programs provide health coverage based on income qualifications, and individuals can also seek financial assistance directly from hospitals. Lastly, individuals can explore combining a healthcare sharing ministry plan with a direct primary care membership, although this may still require additional coverage for comprehensive protection.
| Characteristics | Values |
|---|---|
| When to get insurance | Most insurance companies only sell health plans during an open enrollment period that starts in November and ends on January 15. |
| Open enrollment for 2025 plans has ended in most states. | |
| A qualifying life event will likely allow you to enroll. | |
| Qualifying life events include marriage, birth of a child, adoption, foster care placement, moving to a different area, and natural disasters. | |
| American Indians and Alaskan Natives can enroll in Marketplace coverage at any time of the year. | |
| If you lost your job, you can continue your plan for 18 months under the federal law, COBRA. | |
| If you are under 26, you can get on your parent's health plan. | |
| If you are married, check if you can get on your spouse's plan. | |
| If you turned 65 or have certain disabilities, you may qualify for Medicare. | |
| How to get insurance | Visit HealthCare.gov or your state's healthcare marketplace to apply for Marketplace or Medicaid coverage. |
| Apply on Covered California's website or get free confidential help by phone. | |
| Collect quotes from short-term health insurance companies and determine the best option. | |
| Prescription drug discount programs like GoodRx offer free discount cards that provide up to 80% savings at pharmacies. |
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What You'll Learn
Qualifying for special enrollment
Qualifying for a Special Enrollment Period can allow you to enroll in or change a Marketplace plan outside of the usual open enrollment period. To qualify for a Special Enrollment Period, a significant life event must have occurred, and you must meet certain eligibility criteria.
Qualifying life events include:
- Losing your health coverage: This includes losing coverage through your employer, a family member's employer, or a parent/guardian's plan (if you were a dependent). You may also qualify if your current plan is discontinued or you lose eligibility for a student health plan.
- Change in household income: A decrease in household income may qualify you for a Special Enrollment Period, especially if it makes you eligible for savings on a Marketplace plan.
- Having a baby, adopting a child, or fostering a child: Your coverage can start from the day of the event, even if you enroll up to 60 days afterward.
- Moving: Moving to a new state or country may qualify you for a Special Enrollment Period. However, moving only for medical treatment or vacation does not qualify.
- Getting married or divorced: Marriage is a qualifying life event, but divorce or legal separation does not qualify if you do not lose your health coverage.
- Death: If someone on your Marketplace plan passes away, causing you to lose your current health plan, you will qualify for a Special Enrollment Period.
It is important to note that not all life events qualify for a Special Enrollment Period, and specific requirements may vary depending on your state or insurance provider. Additionally, you may need to provide supporting documentation when applying for a Special Enrollment Period.
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Short-term health insurance
It is important to note that short-term health plans are not required to meet the same standards as traditional health plans and are not regulated by the Affordable Care Act (ACA). As a result, short-term plans may have higher deductibles and offer limited benefits. Additionally, short-term plans may have waiting periods before certain conditions are covered and may have maximum payout limits. To qualify for short-term health insurance, individuals may need to fill out a health questionnaire and disclose any pre-existing conditions, which could disqualify them from obtaining coverage.
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Government programs
There are several government programs that provide health coverage. These programs have specific eligibility requirements, which are often based on income, age, and health status. Here are some of the key government programs:
Medicaid
Medicaid is a federal and state program that provides health coverage for people with low incomes, including families and children, pregnant women, the elderly, and people with disabilities. The eligibility criteria and benefits covered under Medicaid vary from state to state. Some states have expanded their Medicaid programs to cover all adults or children below certain income levels. Even if your income is slightly above the Medicaid threshold, you may still be able to obtain affordable private health insurance through the Marketplace.
Children's Health Insurance Program (CHIP)
CHIP is a federal and state program that provides low-cost health coverage for children in families who do not qualify for Medicaid due to their income. CHIP ensures that children from low-income families have access to the healthcare they need.
Medicare
Medicare is a federal program that primarily provides health coverage for people over 65 and individuals with disabilities. There are different parts to Medicare, such as Part C, which offers prescription drug coverage, and Part D, which covers prescription drugs for certain conditions. Medicare Savings Programs can help with costs associated with Parts A and B, such as premiums, deductibles, and coinsurance.
COBRA
COBRA is a federal law that allows individuals who have lost their jobs to continue their previous employer-provided health coverage for up to 18 months. This can be a temporary solution to maintain health insurance while transitioning between jobs or seeking alternative insurance plans.
Other Government Programs
In addition to the major programs mentioned above, there are other government initiatives that provide assistance with specific health conditions or services. For example, the Ryan White HIV/AIDS Program helps individuals with HIV/AIDS medications and treatments, and the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) offers free or low-cost screenings for breast and cervical cancer. These programs often consider factors like income, age, insurance status, and health condition when determining eligibility.
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Employer-based insurance
If you are employed, your employer may offer health insurance as an employee benefit. In fact, according to a survey by the Kaiser Family Foundation and the Health Research and Educational Trust, 60% of employers offer health benefits, with 162 million Americans receiving health insurance through their employers.
Bigger companies are more likely to provide health insurance to their employees. While 95% of employers with more than 50 workers offer health insurance, only about half of employers with three to nine workers provide health benefits. Additionally, workers at smaller firms often have limited insurance plan options, with 86% of companies that provide benefits offering only one insurance plan.
There are several types of employer-based insurance plans. The most common type is a Preferred Provider Organization (PPO), with 60% of enrollees receiving insurance through this type of plan. PPOs generally use a network of doctors and providers who offer discounted services to plan members but work on a fee-for-service basis. While enrollees can go to out-of-network providers, they typically must pay a higher share of the cost. Another type of employer-based insurance is a Health Maintenance Organization (HMO), which 20% of covered workers are enrolled in.
The cost of employer-based health insurance is generally subsidized by the employer, but shared by the worker through various payments, such as premiums, co-payments, and deductibles. In 2009, the average cost of employer-based health insurance for a family was $13,375, with workers contributing an average of $3,515 for family coverage and $779 for an individual policy.
If your employer does not offer health insurance, or if the coverage is not considered affordable or does not meet minimum standards, you may qualify for premium tax credits and other savings on a Marketplace plan through HealthCare.gov.
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Healthcare.gov
Eligibility for Marketplace coverage is generally based on income and residency. If you are a US resident for tax purposes, you are eligible to get Marketplace coverage. This includes US citizens and non-citizen US nationals, such as those born in American Samoa or with parents who are American Samoan. However, if you live in a US territory, you cannot get Marketplace coverage unless you also qualify as a resident of one of the 50 states or Washington, DC.
Additionally, many states have expanded their Medicaid programs to cover individuals below certain income levels. Medicaid provides payment for the treatment of emergency medical conditions for people who meet the eligibility criteria in their state, such as income and residency requirements. Lawfully present immigrants may also qualify for Medicaid and the Children's Health Insurance Program (CHIP) if they meet state income and residency rules. There is typically a 5-year waiting period for qualified non-citizens to receive Medicaid and CHIP coverage, with some exceptions for refugees, asylees, and victims of trafficking.
To get help with the application process, you can search for local agents or brokers on the Healthcare.gov website, who can assist you in enrolling through the Marketplace. These individuals may be able to handle the entire process for you and can provide assistance in languages other than English. It is important to note that you should never share your personal information with anyone offering cash, gifts, or other perks as your information could be used without your consent.
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Frequently asked questions
You can still get a health insurance plan, but your options will depend on your circumstances. If you are an American Indian or Alaska Native, you can enroll in Marketplace coverage at any time of the year. If you qualify for Medicaid or your children qualify for CHIP, you can apply for coverage year-round. Otherwise, you will need to qualify for a special enrollment period.
Qualifying life events include getting married, having a child, adopting a child, or fostering a child. Other events include moving to a new area with different health plans, losing your health coverage, or becoming a citizen, national, or permanent legal resident.
You can apply for health insurance through the official Marketplace on HealthCare.gov. You can also apply through your state's healthcare marketplace if it has one. Additionally, you can apply through an approved enrollment partner, such as an insurance company or online health insurance seller.
You will typically need to provide Social Security numbers, your address, an income estimate, and information about your family members and their previous coverage. It is recommended to have these documents ready before starting your application.
You can consider short-term health insurance, which is available in most states. You can also look into prescription drug discount programs, such as GoodRx, which offer savings at pharmacies. Additionally, many hospitals offer financial assistance programs for those who cannot afford their medical bills.
