Orlando Harmon
Open Enrollment is a window of time that happens once a year, typically in the fall, when you can sign up for health insurance, adjust your current plan, or cancel your plan. If you miss this period, you may have to wait until the next one to make any changes. However, there are some ways to get health insurance outside of the Open Enrollment period. One way is to qualify for a Special Enrollment Period (SEP), which is a period of time (usually 60 days) during which you can buy a health plan even if it's outside the normal Open Enrollment Period. Certain life events, such as getting married, losing your job, or losing your health coverage, can qualify you for a Special Enrollment Period. Additionally, you may be able to purchase short-term health insurance or standalone dental or vision insurance outside of the Open Enrollment Period.
| Characteristics | Values |
|---|---|
| Open Enrollment Period for Individual and Family plans | November 1 to January 15 or 16 |
| Special Enrollment Period | 60 days after a qualifying life event |
| Qualifying life events | Getting married, moving, losing health coverage, losing job, losing Medicaid or CHIP eligibility, expiring COBRA coverage, having a baby, adopting a child, placing a child for foster care, death in the family, turning 26, etc. |
| Short-term health plans | Available in most states except DC and 14 other states |
| State-run programs | Basic Health Programs in New York, Minnesota, and Oregon; The ConnectorCare program in Massachusetts; The Covered Connecticut program; New Jersey Easy Enrollment Health Insurance Program |
| Subsidies | Available in some states |
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What You'll Learn
Qualifying for a Special Enrollment Period
A Special Enrollment Period is a period of time outside of the Open Enrollment Period when you can buy a health plan. This 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 you would during the Open Enrollment Period.
You may qualify for a Special Enrollment Period if you or anyone in your household lost qualifying health coverage in the past 60 days or expects to lose coverage in the next 60 days. Losing health coverage through a parent, spouse, or other family member may also qualify you. This could be due to losing dependent status or reaching the maximum dependent age in your state.
Additionally, you may qualify for a Special Enrollment Period if you experience a serious medical condition, natural disaster, or other state-level emergency that prevents you from enrolling on time. You can also qualify if you gain a new dependent or become someone else's dependent due to a court order.
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Losing health coverage
A Special Enrollment Period is a period of time, usually 60 days, during which you can buy a health plan, even outside the normal Open Enrollment Period. Losing health coverage is one of the qualifying life events that can trigger a Special Enrollment Period. This includes losing health coverage through a parent, spouse, or other family member. For example, if you lose coverage because you are no longer a dependent, or because of divorce or legal separation, you may qualify for an SEP. You may also qualify if you lose your job-based health insurance in the middle of the year. In this case, you are eligible to enroll in a plan through the exchange or directly through a health insurance company.
Additionally, losing Medicaid or CHIP coverage can trigger an SEP. If you lose Medicaid or CHIP coverage because of a change in household income, or because your child ages out of CHIP, you may qualify for a Special Enrollment Period. It is important to note that losing coverage because you did not provide the required documents does not qualify you for an SEP.
If you are unsure whether you qualify for a Special Enrollment Period, you can check online or contact a licensed insurance agent for guidance.
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Losing Medicaid or CHIP eligibility
You can also apply for a Marketplace health plan outside of the Open Enrollment Period. You can apply for a Marketplace plan any time after your Medicaid or CHIP coverage ends, and you will have 60 days after submitting your application to enroll in a plan. Your coverage will start the month after you complete your enrollment. Most people qualify for savings to lower what they pay for their monthly premium and when they get care.
Additionally, you can re-apply for Medicaid or CHIP through your state, as you may still qualify. You can also consider a job-based plan or Marketplace coverage if your employer offers health insurance. If you are 65 or older, you can sign up for Medicare.
It is important to note that Medicaid and CHIP programs can vary from state to state, so it is recommended to contact your state's Medicaid agency to understand your options and eligibility.
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Getting a standalone dental or vision insurance plan
If you missed the Open Enrollment deadline and do not qualify for Medicaid, CHIP, or a Special Enrollment Period, you might consider a short-term health plan. However, it is important to note that short-term plans do not meet the Affordable Care Act's requirements for minimum essential coverage.
Standalone dental and vision insurance plans can be purchased outside of the Open Enrollment Period. These plans are available for purchase directly from health insurers and may offer greater flexibility in terms of coverage options, benefit structures, and pricing. When shopping for standalone dental or vision insurance, carefully review the details of each option, paying attention to the benefits, deductible, copays, and any plan limitations to ensure you have well-rounded coverage.
Standalone dental insurance plans can typically be purchased separately through the Marketplace or directly through the insurer. Dental insurance is treated differently for adults and children under 18. While dental coverage for children is classified as an essential health benefit, it is not considered an essential health benefit for adults under the Affordable Care Act. Similarly, vision coverage for children is classified as an essential health benefit, but it is not required for adults.
It is important to note that separate dental or vision plans will have a separate premium in addition to the premium paid for your Marketplace health plan. Many dental plans also have waiting periods for basic and major services, which can vary by state.
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Getting a short-term health plan
If you missed the Open Enrollment deadline and do not qualify for a Special Enrollment Period, you might consider a short-term health plan. Short-term health insurance is available in most states. However, it should be noted that short-term plans do not meet the Affordable Care Act's requirements for minimum essential coverage. They are not as comprehensive as the ACA-regulated policies that you can purchase during open enrollment or during a special enrollment period.
Short-term health plans are medically underwritten. This means that they are not required to comply with certain federal market requirements for health insurance, principally those contained in the Affordable Care Act. As such, you should carefully check your policy to be aware of any exclusions or limitations regarding coverage of pre-existing conditions or health benefits. For example, the majority of short-term plans do not cover outpatient prescriptions.
Short-term health insurance can provide some coverage if your other alternative is to remain uninsured. It can be a temporary solution to help fill gaps in coverage until you can choose a longer-term solution. You can get coverage as soon as the day after your application. However, when the short-term plan ends, you would no longer have access to an ACA-compliant plan. Instead, you would have to wait until the next open enrollment.
Post-claims underwriting is common in short-term plans. This means that the insurer may accept your application based on what you disclose when you apply, but they can – and likely will – carefully go back through your medical history if and when you have a significant claim. If they find anything indicating that the current claim might be related to a pre-existing condition, they can rescind your coverage or deny the claim.
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Frequently asked questions
A Special Enrollment Period (SEP) is a period of time outside of Open Enrollment when you can enroll in or change your Marketplace plan due to a qualifying life event. This includes getting married, having a baby, losing health coverage, or a change in income level.
Qualifying life events include, but are not limited to, the following:
- Losing health coverage, such as job-based, individual, or student plans.
- Losing eligibility for Medicare, Medicaid, or CHIP.
- Reaching the maximum dependent age and losing coverage through a parent's plan.
- Getting divorced or legally separated.
- The death of a family member on your Marketplace plan.
The 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 make changes to your current coverage.
If you do not qualify for a Special Enrollment Period, you may consider the following options:
- Short-term health plans: These plans can provide temporary coverage but do not meet the Affordable Care Act's requirements for minimum essential coverage.
- Standalone dental or vision insurance plans: You can purchase these plans outside of the Open Enrollment Period.
- State-specific programs: Some states offer programs such as Basic Health Programs or state-funded health insurance programs that allow eligible residents to enroll outside of the Open Enrollment Period.
