Even with the Affordable Care Act’s open enrollment period ending, there are still many Americans looking for health insurance outside of the ACA. In 2023, a number of states ended their open enrollment periods as early January 15. This leaves many without access to quality healthcare, or coverage that is affordable and tailored to individual needs. The lack of options can create financial hardship, particularly for those who have recently lost their jobs or faced layoffs due to the pandemic’s economic effects. Fortunately, through state and federal subsidies, resources are available to help provide low-cost health insurance plans.
I Missed Open Enrollment. What Should I Do?
If you missed the open enrollment period for the Affordable Care Act, there are still other insurance options available to you. Depending on your state of residence, you may be eligible to purchase a short-term health plan that provides coverage for up to 12 months. These plans typically include coverage for hospital stays and doctor visits, although benefits vary by plan. You may also qualify for Medicaid or a Marketplace special enrollment period if you experience a qualifying life event like marriage, birth of a child, or loss of other health coverage. Additionally, if you’re self-employed or have access to an employer-sponsored health plan but don’t meet the eligibility requirements, alternatives such as private health insurance can provide healthcare coverage.
Fortunately, there are states where other types of coverage can be obtained outside of open enrollment, see the list below.
Basic Health Programs in New York and Minnesota
In New York and Minnesota, consumers can obtain Basic Health Plans outside of the open enrollment period through the state’s individual health insurance marketplace. These plans are designed to provide affordable coverage for individuals with incomes between 138%-200% of the federal poverty level. They include comprehensive benefits that cover hospital stays, doctor visits, prescription drugs, mental health services, vision care, preventive care services and more. Enrollment in these plans is done on a rolling basis year round. In addition to enrolling in a Basic Health Plan outside of open enrollment period in these states, those who qualify may also be eligible for subsidies or other financial assistance to help lower out-of-pocket costs.
The ConnectorCare Program in Massachusetts
The ConnectorCare Program in Massachusetts can be obtained outside of the open enrollment period by enrolling through the state’s Health Connector website. ConnectorCare plans are available depending on income level and cover items such as doctor visits, hospital stays, preventive care services and prescription drugs. In addition to enrolling in a plan outside of open enrollment period in this state, those who qualify may also be eligible for subsidies or other financial assistance to help lower out-of-pocket costs. Enrollment is done on a rolling basis year round.
The Covered Connecticut Program
The Covered Connecticut Program can be obtained outside of the open enrollment period by applying through the Access Health CT website. Covered Connecticut plans are available depending on income level and cover items such as doctor visits, hospital stays, preventive care services and prescription drugs. In addition to enrolling in a plan outside of open enrollment period in this state, those who qualify may also be eligible for subsidies or other financial assistance to help lower out-of-pocket costs. Enrollment is done on a rolling basis year round.
Special Enrollment Period - Enroll Anytime When You Have A Qualifying Event
You may be able to obtain health insurance through a Special Enrollment Period (SEP) at any time if you have experienced a qualifying Event. What is Special Enrollment Period? A Special Enrollment Period (SEP) is a period of time in which you can enroll in a health plan outside of the regular open enrollment period. Generally, SEP allows individuals who experience certain life events or changes to obtain coverage. The most common Qualifying Events include marriage, divorce, birth or adoption of a child, loss of job-based coverage and certain life changes that lead to termination or change of existing coverage. Depending on the circumstance and the health plan you choose, those eligible for an SEP may be able to receive subsidies or other financial assistance to help lower out-of-pocket costs.
Qualifying Events can include such things as marriage, divorce, birth or adoption of a child, loss of a job and certain life changes that lead to the termination or change of existing coverage. Depending on the circumstances, those eligible for SEP may be able to enroll in plans outside of the open enrollment period and in some cases receive subsidies or other financial assistance to help lower out-of-pocket costs.
In order to qualify for Special Enrollment Period (SEP), you will most likely need to provide proof of your Qualifying Event. This could include documents such as marriage or divorce certificates, birth certificates, adoption paperwork, termination or layoff notices or changes to your existing coverage. Depending on the circumstances and the health plan you wish to join, additional documents may be required for eligibility.
What Plans Can You Get During Special Enrollment Period?
Individuals who are eligible for a Special Enrollment Period (SEP) may have access to the same type of health insurance plans as those available during the regular open enrollment period. Depending on the state and type of coverage chosen, individuals may have the option to choose from platinum, gold, silver, or bronze tier plans—all of which vary in cost-sharing amounts with different levels of cost-sharing throughout each tier. Additionally, there may be other types of health plans available such as catastrophic health plans or high-deductible health plans—each providing varying levels of protection.
Short-Term Health Insurance
Short-term health insurance may be the closest thing to ‘real’ insurance if you missed open enrollment and don’t qualify for a Special Enrollment Period. Short-term health plans provide a limited amount of coverage, usually lasting anywhere from 30 days to 364 days, and are not required to comply with certain provisions of the Affordable Care Act (ACA). As such, these plans typically offer fewer benefits, have higher deductibles and co-pays, and can exclude pre-existing conditions or certain treatments. Therefore it is important to carefully read the plan documents prior to purchasing since coverage can vary greatly between providers.
Fixed Indemnity Plans
Fixed indemnity plans can be a great option for those who have missed open enrollment or who don’t qualify for a Special Enrollment Period. Fixed indemnity plans are health care policies that pay out a set amount of money when you receive medical care, regardless of the cost of the service. With these types of plans, you will typically receive a payout ranging from $50 - $500 depending on the type of service received, including doctor visits, x-rays and lab tests. They also cover hospital stays up to a certain number of days. While fixed indemnity plans do not cover every illness or injury, they provide some peace of mind knowing you could still receive some financial assistance in the event that you need medical treatment.
Native Americans Can Enroll in Medicaid/ CHIP Year-Round
Native Americans and Alaska Natives who are members of a federally recognized tribe or live on a federal Indian reservation may be eligible for Medicaid/CHIP year-round. To qualify, individuals must meet the same income and other eligibility criteria as any similarly situated state resident who is not a Native American or Alaska Native. Additionally, to be eligible for coverage year-round, an individual must also meet one of the following criteria:
- 1) be an enrolled member of a federally recognized tribe;
- 2) be an Alaskan native;
- 3) reside in an approved tribal area; or 4) reside in an approved Alaskan native area.
Bottom Line
For those who have missed open enrollment, getting health insurance can be tricky. But, fortunately, there are still a few options available. The best route depends on individual circumstances and needs, so it is important that individuals carefully evaluate each plan to determine which one will be the most beneficial for them.
If you need help making sense of your health insurance options and finding the best plan for you, FirstQuote Health can provide personalized advice tailored to meet your needs. With access to industry-leading insights, our team of experts is ready to provide guidance and support throughout the entire process.