April 7th, 2020 BY Jennifer Davis
Over 6.6 million Americans filed for unemployment benefits last week, shattering previous records and plunging the economy into deeper chaos. And while the country battles a novel virus, millions of people now face the prospect of illness without any healthcare coverage
What should you do if you’re among the millions of jobless Americans and you’ve lost your health insurance as a result?
We discussed ways to get covered during the pandemic in a previous post. Today, we’re talking about special enrollment periods in general.
Contrary to popular belief, you can’t buy health insurance whenever you want — even during a global health crisis.
And with plenty of misinformation going around, it’s time to clear up some health insurance enrollment facts, starting with open enrollment.
What is open enrollment and why does it exist?
The Affordable Care Act changed what health insurance looks like and when you can sign up for it, among other things.
Typically, if you want major medical coverage but don’t have the option to get it through your job, you have to buy it during what’s called the open enrollment period. “Major medical” means full, comprehensive benefits that meet ACA regulations.
The open enrollment period runs in the fall, from November 1 through December 15 in most states. This is set at the federal level.
Open enrollment applies to all private health plans, whether you get one from an insurance company directly, a private health insurance marketplace, or the federal or state-based marketplace depending on where you live.
But state-based marketplaces have more flexibility in setting enrollment dates. Some, like Covered California, run open enrollment periods for three full months. Others may extend enrollment for a couple of weeks.
If you live in a state with its own public exchange, your open enrollment period may last longer. To date, the District of Columbia and these 12 states have their own exchanges:
- New York
- Rhode Island
The open enrollment period exists to make sure that people sign up for health insurance before they get sick or need expensive care. Under the ACA, insurance companies can’t deny you coverage or charge you more for a health plan if you have a pre-existing condition.
But to make sure that people don’t just buy into a health plan when they need it and then drop it after an expensive claim, the government sets an enrollment period each year. It’s to encourage people to pay monthly premiums ahead of an illness.
It’s like any other kind of insurance: You don’t buy auto coverage after an accident. The same idea applies to health insurance.
An annual signup period ensures that companies can calculate premiums accurately for their members and spread costs around more evenly for the year.
What happens if you miss the open enrollment period?
If you don’t get health insurance during the open enrollment period, don’t qualify for a government program like Medicaid or can’t get coverage through work, then you won’t be able to buy major medical coverage until the next signup period starts in November.
But like most things in life, there are exceptions to the rule.
Enter the special enrollment period, a chance to buy health insurance when you experience a qualifying life event.
Things happen in life that might change the kind of coverage you need. If you get married, for example, then you might need a different health plan to cover your spouse.
Lots of things count as qualifying life events. The government groups these into four categories:
- Loss of coverage, like losing your job or turning 26 and aging out of a family plan;
- Changes in household, such as getting married or having a baby;
- Changes in residence, e.g. moving to a new location; and
Of course, “other” is broad. It covers things like becoming a U.S. citizen, getting out of prison and other situations that don’t fit into the main three categories. You may qualify for other reasons, too, such as financial hardship or domestic violence.
Point being? If you don’t have health insurance or want to change your coverage, you may qualify for a special enrollment period. And it never hurts to check.
Generally speaking, you’ve got 60 days from the date of the event to get coverage. But always check to make sure for your specific case.
Extra special enrollment due to COVID19
Special enrollment periods already existed under the ACA. The current global pandemic didn’t create them. But in response to the threat of COVID19, some states have reopened their health insurance exchanges for an extra special enrollment period.
We mentioned above that states with their own public exchanges can set their own enrollment dates. Those same states are the ones now giving people another chance to get health insurance for the year.
As of today, the following states and Washington, D.C. have special enrollment periods ending on different dates:
- California (June 30)
- Colorado (April 30)
- Connecticut (April 17)
- Maryland (June 15)
- Massachusetts (May 25)
- Minnesota (April 21)
- Nevada (April 15)
- New York (May 15)
- Rhode Island (April 15)
- Vermont (April 20)
- Washington (May 8)
The District of Columbia’s special enrollment period ends on June 15. To check if you qualify for coverage in these states, visit your state’s health insurance exchange site.
As of last week, the federal government decided not to allow a special enrollment period at the federal level. But if you lose your job (and job-based coverage as a result), that counts as a qualifying life event for a typical special enrollment period.
And since 87% of people who buy ACA plans qualify for subsidies, you may find affordable coverage. Per the Kaiser Family Foundation, over 4 million uninsured Americans qualify for subsidies that essentially make health insurance premiums free.
What about enrollment for other kinds of health insurance?
The open enrollment and special enrollment periods we’re talking about in this article only apply to private health insurance that you get on your own (i.e., not from your job).
These signup periods don’t apply if you qualify for things like Medicare, Medicaid, the Children’s Health Insurance Program (CHIP) or other government-based insurance, like TRICARE.
Enrollment in government programs varies. If you think you qualify for a state or federal program, check the signup requirements. Medicare has certain enrollment dates, for instance, while Medicaid is available year-round.
As for a product like short term health insurance, enrollment dates don’t apply here either.
Short term health plans don’t cover the same benefits as major medical coverage. They also don’t have to adhere to Affordable Care Act rules and provide only temporary benefits when you’re in a pinch. But you can sign up for these plans anytime.
Note that short term health plans may not cover coronavirus testing and/or treatment. Check plans carefully before enrolling.