Missing the Affordable Care Act (ACA) Marketplace open enrollment period can feel like a setback, especially if you were counting on securing health insurance for the upcoming year. You might think you’re out of options, but there are several pathways to consider that can help you secure coverage until the next open enrollment period arrives.
Special Enrollment Period (SEP)
One of the primary ways to get coverage outside of the open enrollment period is through a Special Enrollment Period (SEP). SEPs are triggered by specific life events, commonly known as “qualifying life events” (QLEs), that make it possible to sign up for a new plan or change an existing one.
Qualifying Life Events
If you experience a QLE, you have a 60-day window from the event date to enroll in an ACA-compliant health plan. Some common QLEs that allow for a SEP include:
- Marriage or entering into a domestic partnership
- Divorce or legal separation resulting in loss of coverage
- Birth or adoption of a child
- Loss of other health coverage, such as job-based insurance, Medicaid, or CHIP
- Moving to a new residence that impacts your coverage options
This option is ideal if you’ve had a major life change that affects your insurance status. For instance, if you lose coverage through an employer, you can use a SEP to get coverage in the Marketplace without waiting for the next open enrollment period.
Documenting Your Qualifying Life Event
When applying for a SEP, you will likely need to provide documentation of your QLE. For example, if you lost job-based insurance, you may need a letter from your former employer stating your last day of coverage. The type of documentation required depends on the event itself and the Marketplace’s specific requirements. Submitting this documentation promptly ensures a smooth enrollment process.
Medicaid and the Children’s Health Insurance Program (CHIP)
Medicaid and CHIP offer year-round enrollment, which can be a relief if you’ve missed the Marketplace open enrollment and meet certain eligibility criteria.
Medicaid
Medicaid is a joint federal and state program offering low-cost or free health insurance to eligible individuals, particularly those with lower incomes. Eligibility varies by state, as some states expanded Medicaid under the ACA, allowing more adults to qualify based on income alone. Medicaid coverage typically includes essential health benefits, making it a comprehensive option if you qualify.
CHIP
CHIP provides coverage for children in families that don’t qualify for Medicaid but may still need assistance to afford coverage. CHIP eligibility requirements are also state-dependent, and many states cover pregnant women and other family members under CHIP as well. The application process for both Medicaid and CHIP is open year-round, so these programs are worth exploring if you’ve missed ACA enrollment.
For more information about Medicaid and CHIP, you can visit Medicaid.gov or your state’s health department website.
Short-Term Health Insurance Plans
If you don’t qualify for a SEP, Medicaid, or CHIP, a short-term health insurance plan may be another option. Short-term plans are available outside of open enrollment, providing a temporary solution while waiting for the next ACA enrollment period.
Benefits and Limitations of Short-Term Plans
Short-term health insurance plans are designed to offer limited coverage for a short duration, generally between a few months to a year, depending on your state. These plans often have lower premiums, but it’s essential to be aware of the limitations. Unlike ACA-compliant plans, short-term policies are not required to cover essential health benefits, such as maternity care, mental health services, and prescription drugs. Pre-existing conditions are typically not covered, and some insurers may decline coverage based on medical history.
Short-term plans work best as a last resort for people who are generally healthy and only need coverage for unexpected emergencies. However, they do not provide the comprehensive benefits of ACA plans, and they may leave significant gaps in coverage.
COBRA Continuation Coverage
If you recently lost employer-based insurance, you may have the option to continue that coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA). COBRA allows eligible individuals to keep their former employer’s group health insurance plan for a limited time, typically 18 to 36 months, depending on the circumstances.
COBRA Costs and Considerations
COBRA can be a convenient option because it allows you to keep the same provider network and coverage as your previous plan. However, the major drawback is the cost. Under COBRA, you’re usually responsible for the entire premium, including both your portion and your employer’s contribution, which can make this option quite expensive. That said, COBRA may still be a suitable bridge until you can enroll in a new ACA plan during the next open enrollment period.
Health Care Sharing Ministries
For individuals seeking an alternative approach to health coverage, health care sharing ministries can be an option. Health care sharing ministries are organizations, often religiously affiliated, where members contribute monthly fees that go towards the medical expenses of other members.
Pros and Cons of Health Care Sharing Ministries
While monthly costs are generally lower than standard insurance premiums, it’s important to remember that health care sharing ministries are not insurance and are not subject to ACA regulations. This means that they do not guarantee coverage for essential health benefits or pre-existing conditions. However, for those who prefer a community-based approach to health expenses and understand the risks, this may be a temporary alternative until open enrollment.
Other State-Specific Programs and Options
In addition to the federal programs, some states offer their own health coverage options. Certain states operate their own health insurance marketplaces, which may have extended or additional enrollment periods and programs for residents who need coverage.
Check for Extended Enrollment Periods
For example, states like California, New York, and others with state-run health insurance exchanges sometimes extend their enrollment deadlines. Checking your state’s Marketplace or Department of Insurance website may reveal alternative programs or extended open enrollment dates that can provide temporary coverage.
Planning Ahead for the Next Open Enrollment Period
If none of the above options work for you, it’s essential to plan ahead for the next ACA open enrollment period. Missing out on comprehensive coverage can lead to unexpected medical expenses that are difficult to manage, so marking the open enrollment dates on your calendar can help ensure you’re prepared for the next window. Consider setting reminders or signing up for notifications from the federal HealthCare.gov website to stay updated on enrollment information and deadlines.
For more information, visit HealthCare.gov
