So, You Missed Open Enrollment. What Happens Now? – Savers Health
Get the health coverage you need to live the full, healthy life you deserve. GET A FREE QUOTE →

News & Blog

So, You Missed Open Enrollment. What Happens Now?

News & Blog

Man with glasses in a white dress shirt sitting in front of a bookshelf reading on a white laptop.

What is open enrollment?

The annual open enrollment period is a period of time determined by the Affordable Care Act (ACA) during which you can apply for health insurance coverage and be guaranteed the minimum essential coverage (also determined by the ACA) regardless of your medical history, pre-existing health conditions, or financial situation. The deadline to enroll in most health insurance plans for 2019 coverage, was November 1 – December 15, 2018.

If you still need to get enrolled in a plan and intend to apply for a tax credit, you’ll need to see if you qualify for a special enrollment period (SEP).

What is special enrollment?

Special enrollment periods are typically about 60 days following a qualifying life event during which you can still enroll in a major medical health plan, even if you missed open enrollment. The ACA considers the following qualifying events:

  • Losing your job and/or losing COBRA coverage
  • Moving to a new coverage area
  • Recently changing marital status
  • Recently becoming a widow or widower
  • Aging out of your parents’ coverage
  • Having a baby or adopting a child


If you’ve recently experienced one or more of the above “qualifying life events,” you may still be able to apply for coverage outside of open enrollment.

If you don’t qualify for a special enrollment period…

If you’re unable to get coverage during a special enrollment period, you may want to consider short-term health insurance until you’re eligible for a major medical plan. Short-term health insurance provides fast, flexible coverage for people who need to purchase health insurance outside of the allowed open enrollment period. Short-term also offers alternative forms of coverage for people who don’t think an ACA-compliant major medical plan is a good fit for their budget and coverage needs.

Are there limitations to short-term plans?

Some short-term plans can be:

  • Better suited to people without pre-existing conditions
  • Cost-restrictive
  • Not compliant with the ACA

Costs

Most short-term plans aren’t ACA-compliant, meaning you won’t be eligible for financial assistance or tax credits on your plan. Depending on your unique circumstances, short-term insurance may be more expensive than an ACA-compliant plan. Your health insurance agent can help you determine whether or not a short-term plan makes sense for your medical and financial needs.


Coverage

Most short-term plans won’t cover preventive care or pre-existing conditions, meaning you can be denied coverage or charged higher copays and premiums.


ACA Compliance

Short-term plans aren’t ACA-compliant, meaning they don’t have to cover the 10 essential benefits established by the ACA:

  • Ambulatory patient services (outpatient services)
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care


You’ll need to confirm the specifics of your plan with your insurance company to ensure that they cover services like preventative care. Even if you’ve lost or missed your opportunity to enroll in major medical coverage, if your family still needs children’s health insurance, you could consider applying for Medicaid for the children in your family until you and your dependents are eligible for major medical insurance.

Navigating the health insurance enrollment process can be tricky, particularly if you’ve missed open enrollment. Working with an insurance agent can cut the time, frustration, and costs of searching or health care coverage. Speak with a Savers Health agent today to find options that work for you, your lifestyle, and your budget.

SELECT LANGUAGE

Looking to review your current health policy? Ready to see options for a new plan?