Anyone who has ever purchased their own health insurance, or at least looked into the possibility, is no doubt familiar with the term "open enrollment." It refers to a period of time from November through January each year when you can buy new health insurance coverage, or make changes to that which you already have. If you miss the enroll-by date and this window closes, you will have to wait until the next open enrollment period to meet your needs. There are a few exceptions that you should be aware of moving forward.
Can I Buy Health Insurance at Any Time?
Generally speaking, the open enrollment period is when consumers can purchase Obamacare-compliant health insurance for themselves or for their family members.
In 2023, for example, the Open Enrollment Period (also commonly referred to as the OEP) for both individual and family plans begins on November 1 and lasts all the way until January 15. It can vary a bit from state to state, so be sure to check the conditions of your own marketplace for the most accurate information.
In most cases, you would need to wait until the next Open Enrollment Period to actually purchase a policy of your own.
What Happens If I Want to Buy Health Insurance Outside the Open Enrollment Period?
One of the most important things to understand about all of this is that ACA-compliant (Affordable Care Act/Obamacare) health insurance plans can only be purchased on your state's exchange if you meet certain enrollment requirements after the Open Enrollment Period has ended. If you're still in the OEP, you can purchase any policy you'd like.
During the Special Enrollment Period, those with special circumstances can purchase both individual and family health insurance policies outside the private health insurance Open Enrollment Period. Officials understand that sometimes your needs will change suddenly and they're sympathetic to that fact.
Some of the qualifying life events that allow you to purchase health insurance outside of this period include situations like:
- You've just gotten married.
- You've recently gotten divorced.
- You and your spouse have had a new baby.
- Someone who is on your current policy has recently passed away.
Changing your primary residence can also allow you to purchase health insurance outside of the Open Enrollment Period. You'll still need to make sure that certain conditions are met, however, like:
- You've moved to a new zip code or county.
- You're moving to the United States for the first time and need health insurance.
- You're a student who is moving either to or from school.
- You're a seasonal employee and need health insurance coverage while you're here.
- You're in the middle of some type of transitional living situation like you're going from a shelter to an apartment.
Finally, the loss of your current insurance plan is also enough to allow you to purchase a new one on the exchange throughout the year. This could happen if you previously used employer-provided healthcare and you've quit or lost your job, for just one example.
The conditions that would need to be met in this situation include ones like:
- The end of your job-based coverage.
- The loss of your current individual or family plan due to some set of circumstances that is no fault of your own.
- The loss of Medicaid, Medicare, or CHP coverage.
- The loss of coverage that you have previously obtained through a family member.
What if I Don't Qualify for Special Enrollment?
In the event that you do not qualify for special enrollment through those conditions outlined above, don't worry: you still have options. In this situation, you would absolutely still need some kind of coverage to carry you through until the next Open Enrollment Period. This is totally understandable and you are not the only person to have ever found yourself in this situation.
Should this describe your situation, you can always enroll in a short-term medical plan. Short-term plans, however, do not meet the Affordable Care Act's requirements for minimum essential coverage so keep that in mind. They're called short-term plans for a reason - they're not meant to become your primary source of healthcare coverage moving forward so you'll still have to act once that Open Enrollment Period begins again.
These types of plans also do not typically cover things like pre-existing conditions. Likewise, premiums can be based on your medical history. These are both reasons why, while short-term plans are certain solutions, they're not necessarily ideal.
These plans are also not a guaranteed issue - meaning that depending on the situation, your application may be turned down. All of this is important to keep in mind so that you can set reasonable expectations for yourself.
Finally, you should note that regulations currently limit short-term plans to periods of 182 and 364 days in duration. After that, you'll need to purchase some other type of more permanent healthcare coverage, likely via an exchange, so that it complies with the Affordable Care Act and offers you the coverage you need to stay as healthy as possible.
In the End
While the Open Enrollment Period for obtaining health insurance each year is several months, it's still easy to put it off too long and suddenly find that essential window closed.
Yes, you have options in terms of what you can do to get coverage outside of the OEP - but it's still important to enroll as soon as you can to make sure this is taken care of, whether you qualify for special enrollment or not.
To find out more information about when the best time is to buy health insurance or to get answers to any other questions you may have, please don't hesitate to contact us today.