Can I Get Insurance After Open Enrollment?

by Team eLocal
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It’s easy enough to do: You go about your busy life week in and week out, then, when you finally look up, you realize you’ve forgotten that important date circled in red on the calendar — the health insurance open enrollment deadline. Uh oh.

Can you get insurance after open enrollment? The rules on enrolling outside of the typical enrollment period vary based on the type of health insurance you want.

What Is Open Enrollment?

Health insurance plans have an open enrollment period during which you can enroll in a new plan, change your coverage or cancel. Unless you have a qualifying life event, this is the only time you can make these changes to your healthcare coverage.

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When Is the Open Enrollment Period for Marketplace Health Plans?

The open enrollment period for the marketplace is Nov. 1 of the year before through Jan. 15 of the coverage year. For example, for coverage in 2023, the enrollment period runs from Nov. 1, 2022, through Jan. 15, 2023. A few states have different periods, usually running longer.

Can You Get or Change a Marketplace Health Insurance Plan Outside the Open Enrollment Period?

You can get or change your health insurance after open enrollment if you have a qualifying event. This is one of several specific life events that change your health insurance situation.

What Is a Special Enrollment Period?

A special enrollment period is the period of time after a qualifying life event when you can change your coverage. Your special enrollment period usually lasts 60 days. If you don't make the changes during those 60 days, you'll have to wait until the next open enrollment period.

What Is a Qualifying Life Event?

A qualifying life event is something that changes your situation and affects your need for health insurance. If one of these events happens outside of the open enrollment period, you can make changes to your coverage. Examples of qualifying life events include:

  • Marriage
  • Divorce
  • Having a baby
  • Adopting a child
  • Death of a family member
  • Losing current health insurance
  • Moving to a new area
  • Income changes that could affect your coverage
  • Gaining U.S. citizenship

When Is Medicare Open Enrollment?

The open enrollment period for Medicare runs from Oct. 15 to Dec. 7. If you have a Medicare Advantage Plan, the open enrollment period for that coverage is Jan. 1 to March 31.

Can I Get or Change Medicare Coverage Outside the Open Enrollment Period?

You can enroll outside the open enrollment period when you first become eligible for Medicare, which is usually when you turn 65. You have a seven-month enrollment window — three months before the month you turn 65, the month of your birthday and three months after the month you turn 65. You can also make changes to some of your Medicare coverage if you have a qualifying event.

When Is Open Enrollment for Employer-Based Health Insurance Plans?

Open enrollment periods for employer-based plans can vary. They're typically near the end of the year for the following plan year and usually last a week or two.

Can I Get or Change Employer-Based Health Insurance Outside the Open Enrollment Period?

New employees can typically enroll in the employer plan when they get hired. Many employers have a waiting period of 30 days or longer. You might have to enroll outside of a certain period once you become eligible or wait until the next open enrollment period. You can also make changes if you have a qualifying life event. Check with your company's HR department if you think a change in your situation qualifies you for a special enrollment period.

Types of Health Insurance That Don't Have Open Enrollment Periods

If you need health insurance but don't qualify for a special enrollment period, a short-term health insurance plan is an option. These plans don't have open enrollment periods, so you can start one at any time. They're meant to be temporary plans and typically only last up to a year, although some are available for longer periods. They aren't Affordable Care Act-compliant and often don't offer as much coverage as a traditional plan, but they're usually cheaper.

Faith-based health-sharing plans are also available for enrollment throughout the year. These aren't traditional insurance plans, though. The money you pay each month goes into a group fund, which then goes toward paying some or all the medical bills of other members. These plans don't cover all expenses, and you have to cover part of your expenses before the group fund will cover your expenses, similar to a deductible on a traditional plan.

Concierge medicine, or a primary care membership, is another option. You pay a monthly fee to a provider who works on this model, and you get certain services provided for that amount. However, any extra care, such as surgery, critical illnesses or major health events such as a heart attack, aren't included, and you'll pay for those yourself.

What to Do If You Need Insurance After Open Enrollment

Do You Qualify for a Special Enrollment Period?

If you need insurance after open enrollment, find out if you qualify for a special enrollment period under the type of insurance you want to get. The qualifying events might vary slightly, so check with the administrator of the plan you want.

Look at Other Types of Healthcare Coverage

If you don't qualify, consider a short-term policy or health-sharing plan until the next open enrollment period. The coverage usually isn't as extensive with those plans, but they can protect you from massive medical bills if you need care until you can enroll in a new plan. Review the terms of these alternative options to ensure you know what you're getting and what they'll cover.

Make a Game Plan for the Next Open Enrollment Period

Find out when the next open enrollment period starts for the health insurance plan you want to get. Make sure you're prepared to enroll as soon as that period starts to avoid missing out on the opportunity again. Remember, the coverage won't likely start until the following year, so you'll need to continue your alternative coverage until then. For example, your employer might have an open enrollment period in November, but your new plan won't actually start until Jan. 1. You'll still need coverage for November and December.

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