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What Happens if You Miss Open Enrollment for Health Insurance?

What Happens if You Miss Open Enrollment for Health Insurance? | Very Good Coverage

Missing the open enrollment period can be costly. But don’t panic! Here’s what you can do to acquire coverage now that the open enrollment period has ended.

For many people, the deadline for enrolling in or making changes to your 2021 health insurance plan has already passed. And although the Affordable Care Act (ACA) no longer requires you to pay a tax penalty for not having health insurance coverage, the thought of going an entire year without health insurance coverage can be quite overwhelming for most of us and at risk of high unexpected medical bills. Fortunately, there’s still hope at the end of the tunnel.

You can go an entire year without coverage if you miss the open enrollment period. This can leave you with high unexpected medical bills. Luckily, you can still enroll for 2021 through the Special Enrollment Period, through Medicaid, and/or the Children’s Health Insurance Program (CHIP), or through short-term health insurance.

Of course, we all know that the implications of going an entire year without health insurance coverage can be costly. In this brief guide, we’ll walk you through the things you need to do to acquire health insurance coverage now that the open enrollment period for 2021 has ended.

What is an Open Enrollment Period?

An open enrollment period generally refers to a short period of time (usually 45 days) when you are given the chance to explore various health insurance plans in the market, enroll in, or make changes to your current plans.

One of the main changes that you can make to your health insurance plan is by dropping the coverage or provider altogether and going to a new plan. You can also add dependents or even enroll in health insurance for the very first time.

The main idea here is that it’s always not easy to make changes or enroll in a new health insurance plan outside the open enrollment period. This is why it is a crucial period in your health insurance coverage.

The open enrollment period typically begins on 1st November and lasts until 15th December every year. This is the time that you can enroll for health insurance for the upcoming year. For example, the open enrollment period for the 2021 health insurance plan began on November 1, 2020, and ended on December 15, 2020, in most states.

What are the Repercussions of Missing the Open Enrollment Period?

As noted earlier, missing the open enrollment period can be costly. It would mean that you and your loved ones go an entire year without health insurance coverage. And without health insurance coverage, you’re risking having a huge and unexpected medical bill if you or your loved ones get critically ill.

Before 2019, you could be subject to a tax penalty imposed by the ACA. While there is no longer a federal tax penalty for not having health insurance coverage, some states still impose what’s known as an individual mandate penalty for not having health insurance coverage.

These states include:

  • California
  • New Jersey
  • Massachusetts
  • Rhode Island
  • Washington DC

Again, you won’t be able to make any changes or enroll in any health insurance benefits if you miss the open enrollment period. This would mean that you go without coverage and wait until the next open enrollment period, which is usually one year down the line from the last open enrollment period.

What to Do if You Miss the Open Enrollment Period

Whether you’re a master procrastinator, went on holiday and forgot to enroll, or lost track of time, missing the open enrollment period isn’t a good thing. But now that it has happened, the first important thing is not to panic.

You do not necessarily have to wait until next year’s open enrollment period to get health insurance coverage if you missed the current open enrollment. Even though your health insurance coverage options may be limited, there are a few moves that you can make to ensure that you do not go an entire year without health insurance coverage.

This can help you minimize the financial risk that you are exposed to for not having health insurance for the whole year.  However, you have to remember that it all depends on your situation and individual circumstance.

That being said, here are a few ways to get health insurance coverage after the open enrollment period has ended.

Check if You Qualify for Special Enrollment

One of the main ways to buy health insurance coverage after the open enrollment period has ended is through what is known as special enrollment. Simply put, special enrollment is the period that is triggered by a Qualifying Life Event (QLE). Special Enrollment Period (SEP) normally lasts for 60 days from the date of a qualifying life event.

In short, you can enroll in or make changes to your health insurance plan at any time of the year and outside the open enrollment period if there’s a significant or major life event or special circumstance in your life.

Qualifying Life Events

Here are a few situations that are deemed to be qualifying life events.

Changes in your family – They include:

  • Getting married
  • Getting divorced
  • Having a baby or adopting a child
  • Losing coverage because your spouse, parent, or guardian died

Losing your current health insurance coverage – They include:

  • Losing your coverage for reasons such as getting laid off, getting divorced, or being removed from your parent’s plan (failing to pay your premiums isn’t one of them).
  • Losing eligibility for Medicaid, Medicare, or CHIP as a result of changes in income or household situations

Changes in Residence – They include:

  • If you move into or out of a shelter
  • If you’re a seasonal worker moving to or returning to a job location
  • If you’re a student moving or returning to/from school or university
  • If you move to a different ZIP code or county

Other Life Qualifying Events – They include:

  • Becoming a U.S. citizen
  • Gaining membership in a federally recognized tribe
  • Native Americans (you can enroll in or make changes to your health insurance coverage if you’re a Native American)
  • Leaving prison
  • Becoming eligible for subsidies that will lower your premiums but you already have a health insurance plan
  • Becoming eligible for Medicaid

It’s also important to note that the following are not considered life qualifying events.

  • Getting pregnant (but you can qualify after giving birth)
  • Becoming sick or being diagnosed with a medical condition
  • Voluntarily dropping your existing health insurance coverage
  • Losing coverage because you failed to pay premiums

Qualifying for Medicaid

If you’re an elderly individual, pregnant, disabled, or earning below a certain amount of income – 138% of the Federal Poverty Level -, you can be eligible for health insurance coverage through Medicaid. Unlike health insurance plans that are sold in the marketplace, Medicaid isn’t subject to an open enrollment period.

This means that you can apply and qualify for Medicaid at any time of the year. You have to keep in mind that eligibility requirements vary from state to state and may depend on your income levels and family size. If you apply for Medicaid during the open enrollment period and get denied, you still get 60 days after the denial to enroll in another health insurance plan.

With that in mind, your new coverage (after your Medicaid is denied) will take effect on the first day of the month after enrolling in the new health insurance plan. In essence, do not be afraid of applying for Medicaid even if you get denied. You can still get the chance to enroll in the normal health insurance plan.

Consider a Short-term Health Insurance Plan

Short-term health insurance plans offer ideal options to cover the gap as you wait for the upcoming open enrollment period (in November 2021). This can be a viable option if you do not have life qualifying events and do not want to go the entire year without health insurance coverage.

You have to keep in mind that short-term plans aren’t regulated by ACA and are just temporary plans as you wait to enroll for longer health insurance plans. Again, you have to remember that most short-term plans do not cover pre-existing conditions and do not offer guaranteed coverage.

Short-term health insurance plans can be ideal for you if:

  • You’re between jobs
  • You’re a temporary or seasonal worker
  • You’re waiting for the next open enrollment period
  • You recently graduated from college and waiting to be employed
  • You’re employed but waiting for probation to be eligible for an employer-sponsored health insurance plan

Other Options for Health Insurance Coverage

Here are a few other options to consider, though some may depend on their open enrollment deadlines.

Spousal Benefits

You can still be included in your spouse’s plan if he/she is eligible for an employer-sponsored health insurance plan and it still has open enrollment.

Young Adult below the age of 26

You can be added to your parent’s health insurance at any time of the year if you’re aged 26 or younger.

To this end, missing out on the open enrollment period for your health insurance can be costly. You, therefore, have to be proactive by marking your calendar and creating reminders on your phone so that you do not miss the open enrollment period. But if you did, do not lose hope; there are ways to enroll for health insurance outside the open enrollment period.

About THE AUTHOR

Greg McKnight

Read more about Greg McKnight

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