Health insurance is a big aspect of anyone’s budget. However, without it, the cost of getting needed medical care would many times be absolutely out-of-reach. For example, on average, a routine doctor visit will run anywhere from $300 to $600 and that is just the tip of the iceberg in terms of cost when you consider the immense expense of a hospitalization or a visit to the emergency room. Add to this the fact that having qualifying coverage is now mandated through the Affordable Care Act and health insurance becomes a necessary expense for virtually all Americans. If you are looking into buying health insurance, one factor you want to consider is when it's available.
Well, not exactly. As you may have come across during your research on health insurance, there is a particular time of year that is called the open enrollment period. If you do not buy your health insurance within the confines of the open enrollment dates, you might find yourself having to wait for the next open enrollment date. Of course, there are some exceptions to this rule.
In order to be ACA-compliant as a health insurance company, you have to have a period of time for enrollment. The 2023 Open Enrollment Period (OEP) for Individual and Family Plans begins on November 1st and ends on January 15th. These dates can vary a bit by state. If you miss these open dates, in many cases, you will be forced to wait until the next open enrollment period.
It’s understandable as life sometimes just doesn’t go as planned. Therefore, if you find yourself in need of enrolling in a health insurance plan but are outside of the open enrollment dates, there is some hope. While ACA-compliant health insurance plans must only be purchased on the exchange during the open enrollment, there are some special enrollment requirements that can still give you access to plans outside standard open enrollment.
During this Special Enrollment Period, you could qualify if you meet specific circumstances, allowing you to buy individual and family health insurance policies outside of the private health insurance open enrollment period. The qualifying circumstances are as follows:
These situations are factors that just come along with life and can change your family dynamics as well as your taxable income. Therefore, if you have experienced any of the following, you could qualify for the special enrollment period:
Another way to qualify for the special enrollment period that isn’t open to everyone on the exchange is to experience a change of residence when it includes one of the following factors:
The final set of circumstances that might give you access to a special enrollment time outside of the designated enrollment period involves you losing your current insurance plan. This can happen for a variety of reasons. If you have any of the following situations that led to your losing insurance coverage, you might qualify for the special enrollment period:
We have covered several scenarios and circumstances that could give you special enrollment access for buying health insurance. However, if you don’t qualify for any of these, it’s important to not give up. You still need some kind of coverage in most cases, until you can once again access open enrollment. Thankfully, you are not without options as you can do the following to get you through until the next open enrollment period:
Short-term plans do not meet the Affordable Care Act’s requirements for minimum essential coverage. They also don’t typically cover pre-existing conditions. Consequently, your premiums could be based on your past medical needs and be more costly if you have had a lengthy medical history. In other words, unlike ACA plans, these plans can penalize you for being sick or having a history of sickness. These plans are also not guaranteed, which means that you could be turned down if you are considered too much of a risk. Regulations limit short-term plans to 182 and 354 days in duration. These are designed to get you by until you can enroll in a better plan during open enrollment. Not necessarily to be used as a permanent solution for your health insurance needs.
Another way to get by until you can once again access qualifying plans during the open enrollment period is to opt for an alternative insurance plan through a private medical sharing company or health savings plan. These types of plans typically don't cover routine doctor visits and often only help with a portion of the overall cost of any medical expense, but they can at least ensure you don’t get penalized for not having health insurance at the end of the year. They are considered by many catastrophe-only plans. These aren’t considered true medical insurance plans in many cases as they are instead a cost-sharing format. They do not follow the legal guidelines laid out by the ACA and can turn you down or increase your costs due to poor health. These alternative plans can be used instead of ACA plans, but it’s important to ensure that any alternative health plan you purchase or medical sharing you join protects you against any potential penalties for not having insurance. You also sometimes are unable to write off your monthly cost for your plan, which is another factor to consider.
If you do qualify for special enrollment and have experienced any of the life circumstances mentioned above, it’s important to do so now. Don’t put off enrollment as you could find yourself facing a penalty at tax time or worse, find yourself on the receiving end of an extremely large medical bill that you are now 100% responsible for paying. Therefore, if you do qualify, get your ACA coverage as quickly as possible.