Even when the open enrollment period for the coverage sold on Affordable Care Act (Obamacare) exchanges has ended, it’s still possible to enroll in many types of health insurance. Whether you’re a parent who needs health insurance for your family or you need individual health insurance, many options exist, including both government programs and ones offered through private companies.
You may even be eligible to buy insurance on the ACA exchanges outside the open enrollment period if certain special circumstances apply. Some of the options available are affordable health insurance plans designed for people who need major medical coverage in the interim while waiting for the next open enrollment period. Other options include “off exchange” plans similar to the best health insurance offered on the marketplace. Let’s talk about how to get health insurance outside the open enrollment period from private and government sources.
ACA Compliance and Why It Matters
When you buy insurance on an ACA exchange, you know that the plan is compliant with the Affordable Care Act. This means that your plan will cover pre-existing conditions and include the 10 essential benefits mandated by Obamacare, including hospital and physician services, outpatient care, emergency services, prescription drugs, laboratory services, rehabilitation, pediatric care, mental health care and maternity care. Plans that aren’t in compliance with the ACA may offer limited benefits. These plans also tend to cost much less as a tradeoff. If comprehensive coverage is important to you, look for plans that comply with the ACA, which are usually only available during open enrollment in the fall.
Special Enrollment Periods
If you’ve missed the open enrollment deadline, you may still qualify for a special enrollment period (SEP) that enables you to buy insurance on the exchanges outside the annual open enrollment period. Several significant life events can allow you to qualify for a special enrollment period, including change of marital status, moving, losing health insurance if you lose your job, or adopting or having a child. You can check to see if your situation qualifies by going to HealthCare.gov or your state’s insurance marketplace, or speaking with a licensed agent.
Consolidated Omnibus Budget Reconciliation Act (COBRA) Insurance
If you lose your employer-based health insurance, you may be eligible for COBRA coverage, which lets you stay on your previous group plan but with the proviso that you’re responsible for both employer and employee parts of the premium. That means you’ll be paying the full amount for your coverage instead of letting your employer pick up some of the tab. Although COBRA coverage can be expensive, it’s a convenient option if you’re waiting for a period of a few months for new coverage.
Other Government Programs
Several government programs are available to provide health insurance to specific groups of people, including veterans, people with disabilities, children and those living below the federal poverty level. You can enroll outside the open enrollment period in the following programs:
Children’s Health Insurance Program (CHIP)
States offer inexpensive healthcare coverage for children and some pregnant women for families who earn too much money to qualify for Medicaid but are still in financial need under the Children’s Health Insurance Program. If your children (or you) qualify for CHIP, you can sign up for this coverage anytime during the year. Some states may have tighter eligibility requirements for this program and Medicaid.
Medicaid
If you can demonstrate financial need or have certain disabilities, you may qualify for Medicaid, which is a joint state and federal program. States get federal funding for their Medicaid programs, but each state sets its own guidelines on who qualifies and how the program is implemented. The specific income thresholds vary by state, but any family or individual below 100 percent of the federal poverty level and anyone eligible for supplemental security income (SSI) is typically eligible for Medicaid.
Many states expanded their Medicaid programs under the Affordable Care Act, so you may have access to this program if you didn’t before. It doesn’t hurt to check if you can’t afford traditional private coverage.
Veteran’s Administration (VA)
The Veterans Health Administration offers free or inexpensive coverage for veterans and their families. Navigating VA health benefits can be complicated, so find your local VA office and speak with an agent there for information.
Off-Exchange Plans
During open enrollment, you can sign up for health insurance on or off the Obamacare exchanges. Private marketplaces, like ours, give you access to a broader picture of coverage from lots of different companies. Plus, private marketplaces usually sell ACA-compliant plans, so you won’t have to worry about finding subpar health insurance.
Unfortunately, if it’s outside the open enrollment period and you don’t qualify for a special enrollment period, private marketplaces won’t be able to sell you an ACA-compliant health plan. Open enrollment applies to all private coverage, whether you buy it from a government exchange or a private marketplace like ours. If you need coverage, your best bet might be short term health insurance.
Short Term Health Insurance Plans
If you’re between jobs or waiting for the new open enrollment period and only anticipate a short period without coverage, consider short term health insurance plans. These are offered by private insurers and provide specific coverage that could help you keep medical costs in check while you wait to enroll in a more comprehensive policy. These plans are usually inexpensive and often lack the essential health benefits of ACA compliant plans, but they serve a very different purpose. Rather than trying to cover everything, they focus on cost-effective coverage of large medical expenses.
The Trump administration recently made some changes to short term coverage, allowing people to enroll in these plans for nearly 12 months at a time and renew them for up to three years in total. These changes could make them even more attractive if you need a safety net for a longer period but aren’t quite ready to commit to a full health plan. (If you want to learn more about short term health insurance, check out this site.)
A Plan for Every Person
Even if you’re young and healthy, you need health insurance. A sudden illness or accident can mean financial disaster. Leaving a condition, whether chronic or acute, untreated can mean major adverse effects, such as a small, easily excised lump turning into metastatic cancer. With all the government and private options available, there’s no need to risk your physical and financial health by going without insurance or healthcare.
