Most Americans understand the importance of healthcare coverage as it relates to them and their loved ones. Proper coverage ensures you have access to medical care and treatment when needed. From a financial perspective, ensuring you have healthcare coverage minimizes the financial burden of receiving care.
Open enrollment applies to both employer-sponsored and on-exchange healthcare plans.
During the open enrollment period, individuals can change their existing plan or add new coverage.
You will probably have to wait till the next period if you miss open enrollment.
You may qualify for a special enrollment period if you experience a qualifying life event (QLE).
If you miss your open enrollment deadline and do not qualify for a special enrollment period, you may acquire some medical coverage through alternatives that are not subject to Affordable Care Act regulations.
While most would agree it's important, as, of 2020, nearly a lot of Americans are still without healthcare. This is because of a variety of factors, including cost and eligibility. However, one of the most common reasons is because of missing the open enrollment deadline.
With shifting legislation, regulations, and what gets communicated on the news, it's hard to navigate the process of getting healthcare coverage. The good news is that there are options for individuals that have missed the open enrollment deadline. You just need the right information and know the proper steps. Let's look at what this enrollment period is and how you may be able to get healthcare coverage after missing the deadline.
What is a healthcare open enrollment period?
This refers to a short period (often less than a month) when you are eligible to enroll in or make changes to your healthcare coverage. Changes you can make during this window include dropping coverage, managing dependents, or enrolling in additional benefits for the first time.
Open enrollment periods occur for people that receive their healthcare policies through their employer or who opt to buy their individual or family health insurance through the Affordable Care Act (ACA) or off-exchange (directly with an insurer).
When does the open enrollment take place?
While this period can vary, open enrollment often happens between 30 and 60 days before the plan is set to renew. Employer-sponsored open enrollment can happen without corresponding with the calendar year. If this is the case, your employer should let you know when your enrollment period is.
Those that purchased their plan through the ACA marketplace or off-exchange will likely also have an open enrollment period. For ACA-compliant plans, the open enrollment window in many states happens between November 1 to January 15, depending on your enrollment date. This varies from state to state, so it's best to verify with your specific exchange to be sure.
Keep in mind that certain Native Americans and healthcare programs such as Medicaid and CHIP are available for enrollment year-round.
What happens if I miss my open enrollment deadline?
With employer-sponsored group plans, missing your open enrollment period may mean you will not be able to partake until the next enrollment period. Although there is some leeway, most employers don't provide accommodations because of the guidelines established by their insurance provider. Missing out on healthcare coverage is also true for those that buy their plans through the ACA marketplace.
You will have to wait until the next open enrollment period unless your current life situation triggers a special enrollment period.
Qualifying events and special enrollment periods
If you experience a qualifying life event (QLE), you will qualify for what is known as a special enrollment period (SEP) to purchase healthcare coverage. These accommodations were built into current ACA legislation to account for events outside of your control or because of the COVID-19 pandemic.
Examples of a QLE include:
- Loss of existing health coverage.
- Changes in the household, such as marriage, divorce, having a child, or a death in the family.
- Changes in residence, such as moving to a different zip code or country.
- Students moving to or from the place where they live and work.
- Moving between transitional housing.
- Changes in income.
- Becoming a US citizen.
- Leaving incarceration.
- AmeriCorps members who begin or complete their service.
If your situation includes qualifying life events, you may be eligible to participate in a special enrollment period and gain coverage.
How to get healthcare coverage without a qualifying life event
Although you could not regain your previous or on-exchange coverage until the next enrollment period, there are a host of healthcare options that the ACA does not regulate. While they do not meet the minimum essential coverage requirements of the ACA, these options could be used as a stop-gap measure.
While most of these plans are meant for supplemental coverage instead of a person's sole health coverage, some could work as a temporary stand-alone coverage solution. Most importantly, they are available year-round.
Some of these alternatives include:
Health Care Sharing Ministry Plans
Usually available in every state, a health care sharing ministry (HCSM) member regularly contributes a payment, or share, to cover the qualifying medical expenses of other members. It's important to note that you will still need to cover routine doctor visits on your own. Some will combine an HCSM with a direct primary care membership - a business model that provides primary care directly between a physician and their patient for a set membership fee.
Farm Bureau Plans
Only available in a few states like Kansas, Tennessee, Indiana, Iowa, South Dakota, and Texas. There are often very high health requirements to qualify.
Short-Term Health Plans
Available in most states, this can serve as an adequate stand-in for the uninsured. This is often considered the closest thing to "true" healthcare coverage you can get. These are often capped at three months but can be extended in some situations up to a year. Be prepared to pay a bit more for this type of coverage. You can enroll for this coverage year-round.
As you can see, it's important to keep track of your open enrollment deadline to avoid the hassle of piecing together coverage from a combination of alternatives. However, if you miss your enrollment period, there are exceptions, such as a qualifying life event, that can afford you a special enrollment period. If you strike out on both the open enrollment and qualifying for a special enrollment period, you can still put together some alternative coverage options as a stop-gap measure.