Health insurance is important. When you have the coverage you can easily receive routine checkups, fill prescriptions, visit a specialist, or take care of anything more serious. However, if you’re looking to enroll in health insurance outside of Open Enrollment, you don’t want to have to wait.
In this article, we’re going to go explore what is open enrollment, special enrollment period, and who is eligible for coverage outside of an Open Enrollment Period (OEP).
Table of Contents
- 1 What is Open Enrollment?
- 2 When is Open Enrollment for Health Insurance 2021?
- 3 How to get Health Insurance after Open Enrollment?
- 4 Changing Health Insurance outside of Open Enrollment
- 5 Can I drop My Health Insurance Without a Qualifying Event?
What is Open Enrollment?
The Open Enrollment Period is the period when individuals and families can purchase a new health plan or make modifications to their existing health plan directly through Cigna or on the Health Insurance Marketplace. Plans that are in effect on January 1 have an Open Enrollment Period from November 1 – December 15 of the year before, in most states.
When is Open Enrollment for Health Insurance 2021?
According to healthcare.gov, open enrollment 2021 starts from November 1 through December 15, 2020. Coverage starts January 1, 2021.
If you don’t sign up for a plan by December 15, you can only get 2021 Marketplace coverage if you qualify for a Special Enrollment Period.
If you’re returning to HealthCare.gov and want to continue your current plan for next year, you should inform any changes to the Marketplace, like higher or lower-income, adding or losing household members, or getting offers of other health coverage. Changes may affect your coverage alternatives and the savings you’re qualified for.
When you register, healthCare.gov will also let you know if you meet the criteria for savings that can make Marketplace insurance less costly, or for free or low-cost health coverage through Medicaid or the Children’s Health Insurance Program (CHIP).
How to get Health Insurance after Open Enrollment?
If you forget to sign up for a plan in open enrollment for health insurance, you don’t essentially have to wait until next year’s open enrollment to purchase some kind of coverage – it all is based on your situation and individual conditions. And even if your coverage options are restricted, there are measures you can take to diminish the financial risk you’re subjected to as a consequence of being uninsured.
Here’s how to obtain health insurance after open enrollment has closed:
1- Check If You Qualify for Special Enrollment
Certain life events make you eligible for a special enrollment period. A special enrollment period is a period of time (usually 60 days) during which you can purchase coverage, even if it’s outside the normal Open Enrollment Period. The events which make you qualified for a special enrollment period are known as qualifying life events.
Below given are some qualifying events with examples.
Losing Your Current Health Insurance Coverage
- If you lose your coverage for any explanation (apart from not paying your premiums). Examples include you got laid off, aged out of a parent’s plan, or got divorced.·
- If you are no more qualified for Medicare, Medicaid, or CHIP due to a change in income or household conditions
Changes in Your Family
- If you get married or divorced
- If you have a baby or adopt a child
- If you lose coverage due to the death of your spouse, parent, or guardian
Changes in Residence
- If you shift to a different ZIP code or county (or parish in Louisiana)-
- If you’re a student moving to, or returning from, school/university
- If you’re a seasonal worker moving to or returning from, a job location
- If you’re moving into or out of a shelter (or transitional housing, such as a halfway house)
Other Qualifying Life Events
- Becoming qualified for Medicaid, or being rejected after applying for Medicaid during the open enrollment period
- Becoming eligible for subsidies that will reduce your premiums, if you already have an ACA plan
- Securing membership in a federally recognized tribe
- Becoming a U.S. citizen
- Leaving jail or prison
Following are NOT considered to be qualifying life events:
- Have Being diagnosed with an ailment or getting ill;
- Getting pregnant (although, you can get coverage after you give birth);
- Losing your coverage because you were unable to pay your premiums; or
- Willingly electing to end your existing health coverage.
2- Check if You Qualify for Medicaid?
Pregnant women, the elderly, people with disabilities, and individuals or families receiving below a specific income level can get hold of healthcare coverage through Medicaid. Dissimilar to healthcare plans sold on the state and federal exchanges, Medicaid has no open enrollment period and you can submit an application for coverage at any time of year. Eligibility is decided by family size and income, and eligibility standards differ from state to state. In most states, you can meet the criteria for Medicaid if your annual income is equivalent to, or less than, 138 percent of the federal poverty level (FPL).
If you sign up for Medicaid during the Open Enrollment Period and are rejected, you have 60 days after the rejection to register in another health insurance plan; in this case, your new coverage can be put into effect on the first day of the month after you enroll in a new plan. Still, if you believe you won’t be eligible, think about applying for Medicaid during open enrollment. Even if your state decides you’re ineligible for Medicaid, you’ll be offered a second chance to purchase health insurance.
As soon as you’re informed of your ineligibility, your Medicaid application will be assigned to the health insurance Marketplace. Fill a Marketplace application for private insurance on the Marketplace website, using the same name and information from your state Medicaid application.
3- Consider a Short-Term Health Insurance Plan
Short-term plans offer a feasible solution if you anticipate experiencing a gap in coverage between now and the next open enrollment period (in November of 2021). Generally referred to as short-term health insurance or temporary health insurance, short-term medical (STM) plans to offer consumers a reasonable way to pay for healthcare for a short period of time. (Most STM plans run for 30- to 364-days, but some plans can be bought for up to three years.) While these plans do not cover basic health benefits and therefore are not ACA-compliant, they do cover a wide variety of services and offer a degree of financial security if you want to make an unforeseen trip to the emergency room.
While main medical plans need consumers to register during a dedicated Open Enrollment Period, it is possible to enroll in a short-term health insurance policy during any time of year. For this reason, short-term plans are a common choice for uninsured Americans looking for coverage outside of open enrollment. To be certain, short-term health insurance plans are comparatively cheap –- but not everyone meets the criteria for them. Since these plans are not obliged to cover pre-existing conditions, getting this type of coverage may be impractical if you are sick or suffer from chronic health conditions.
4- Join a Health-Sharing Plan
Faith-based healthcare is accessible through 501(c)(3) nonprofit charities with a religiously-oriented aim and acts as substitutes to health insurance. These plans are regularly stated to as “health sharing ministries” or “healthcare sharing ministries.”( Many states have barred the sale of Christian Ministry plans, so it is crucial to check to see if you can buy in your state)
Contrasting to traditional health insurance, these faith-based are not health insurance plans and do not “insure” people; instead, they disseminate healthcare costs among a large group of people. Members pay into the system and upon getting a bill from their physician, other members of the plan will donate to help pay the bill. Because members may “buy-in” to them at any time of year, faith-based plans offer an alternate source of coverage for those who skip the open enrollment period.
Keep in mind that health-sharing plans will assist you to pay for medical care, but only if that care is coherent with biblical teachings (hence prenatal care for out-of-wedlock pregnancies, alcohol, and drug addiction treatments, sterilization procedures, etc. are not generally covered). Though these plans are not expected to cover basic health benefits authorized by the Affordable Care Act, they’re grandfathered into the ACA, so faith-based plan members were excused from paying the individual mandate fine when it was relevant.
Faith-Based Plans Exempt From ACA Individual Mandate
- Christian Healthcare Ministries
- Samaritan Ministries
- Liberty Healthshare
5- Look Into a Primary Care Membership
Concierge medicine is primary care presented directly to consumers and employers without third-party insurance administration. In methods operating on a concierge membership model, patients pay a monthly or annual retainer–normally between $60 and $100 per month–to their doctor or medical office for a contracted bundle of services.
Though it won’t cover surgery and other specialized care, concierge medicine poses a solution for people without coverage to get routine, preventative care. Cheaper than traditional plans, membership medicine also has a tendency to have more obvious out-of-pocket costs. That said, patients utilizing concierge medicine will still be required to pay out-of-pocket to treat critical illnesses, or catastrophic occurrences such as a heart attack, stroke, and physical trauma. On the good side, nonetheless, these practices provide personalized care, streamlined billing, and priority scheduling to patients.
Changing Health Insurance outside of Open Enrollment
There are numerous “qualifying” reasons to make plan changes outside of open enrollment. The reasons are mentioned above in detail with examples. They involve changes to your legal marital status, including marriage, death of a spouse, legal separation, and divorce or annulment. A few additional reasons are changes in your dependents through birth and death or adoption, or a qualified dependent (such as a young adult) losing or gaining other coverage. Also if there is a move by you or your spouse; a change in your spouse’s benefits; and changes in your or your spouse’s employment status, such as going part-time, quitting, or being laid-off, you’ll also be qualified to make changes to your plan. The change you are making must be attached to the qualified reason. For instance, moving your residence alone isn’t an excuse to change medical or dental insurance plans; only if your old plans are not accessible in the new area would you be eligible to make a plan change.
Can I drop My Health Insurance Without a Qualifying Event?
You can drop your health insurance without a qualifying life event at any time. But it is crucial to keep in mind that once you cancel your policy, you would not be able to enroll again until the next open enrollment period. Throughout this time you would have no health insurance coverage, which is illegal and could prove to be costly if you happen to get wounded.
However, you cannot cancel an employer-sponsored health policy at any time. If you want to revoke an employer plan outside of the company’s open enrollment, it would need a qualifying life event. Under Section 125 of the Internal Revenue Code, if you do choose to cancel without a QLE, then you and your employer would suffer tax penalties.
Changes in life occur every day. Many times when these life events happen, your health insurance plan is the last thought on your mind. Nevertheless, not having sufficient insurance coverage can be physically and financially perilous if an unforeseen accident occur.
Without making a change in time, you could be left with no coverage and won’t be able to add it when you need it. Make it certain that changing your health insurance policy does nothing but bring you peace of mind.