What Are My Health Insurance Options If I Missed Open Enrollment?

The Open Enrollment Period (OEP) is the one time of year when the state and federal Health Insurance Marketplaces are open. During Open Enrollment—which typically lasts from November to mid-December—you can enroll, re-enroll, or change your plan for the year ahead.

It’s an important time of year on the health insurance calendar, but it’s also easy to overlook, given the mad rush that always comes up around the end of the year and the holiday season. With holiday parties to throw, winter vacations to take, and a new year to get ready for, it’s easy for insurance to fall off the radar.

If you missed the chance to purchase a new individual health insurance plan during Open Enrollment, do you have any options? With a little exploration, including a helpful consultation with Matt Peebles, your health and life insurance consultant extraordinaire, you can head into the New Year fully prepared to make the most of your fresh start. Here are a few key things to keep in mind:

Qualifying Life Event/Special Enrollment

Under current healthcare laws, most people can only purchase major medical coverage during the Open Enrollment Period. But there are certain circumstances that allow you to qualify for a special enrollment window, during which time you can shop for individual coverage.

If you experience what is known as a Qualifying Life Event (QLE) at any point during the year, then you are allowed to shop for qualified, Affordable Care Act-compliant plans outside of the Open Enrollment time period.

Broadly speaking, a QLE is a change in your situation which affects your health coverage. Common examples include:

  • Family or household changes (such as getting married or divorced, or having a child)
  • Employment changes (such as losing health benefits through a job, or experiencing a significant change in income)
  • Changes in residence (such as moving to a new city or state)
  • Loss of coverage (due to your current plan being discontinued, for example)

Typically, experiencing a Qualifying Life Event opens a 60-day Special Enrollment Period. During this window of time, individuals are free to shop for new insurance coverage. In some cases, you may have a slightly longer Special Enrollment window, depending on the circumstances of your QLE. Here’s one example: individuals who turn 26 years old and lose coverage through their parents have a 120-day window to purchase a new policy.

Curious about what specific experiences or events may count as Qualifying Life Events? We’ve got the answers. Don’t hesitate to get in touch with Matt Peebles and the Enrollment Specialists to discuss any specific questions or concerns you may have.

Open Enrollment FAQs

Short-Term Plans

If you missed your opportunity to purchase comprehensive health insurance coverage during the OEP, you may still be able to fill in the gaps, at least temporarily.

Short-term health insurance plans are available from many different insurance carriers, and these plans can offer protection for a relatively long period of time—from three months to just under a year—depending on the plan. Some of these plans may be less expensive than many of the Marketplace plans, but they may be more costly for those with pre-existing conditions.

If you missed Open Enrollment or are going through a transitional period in your life, short-term plans may be an appealing option. These plans tend to offer significant flexibility, including the ability to drop your coverage at any time, and usually come with manageable out-of-pocket costs and full access to a health network.

While these temporary plans may be the right fit for some people, they won’t be the solution for all. So, it’s important to understand all of the ins-and-outs of short-term health insurance before deciding to go this route for coverage. The Enrollment Specialists specialize in answering these kinds of questions and issues. Matt and the team can field all of your questions, and help you determine which health insurance solution will ultimately work best for your unique needs.

Group Health Coverage

If your employer offers group health insurance, perhaps as part of a benefits package, you may be able to enroll in this plan outside of the national Open Enrollment time period, if you don’t already belong to it.

You see, each business’s group health plan will come with its own unique open enrollment period. This is the yearly window during which the employer must allow employees who qualify to join the plan, or allow them to choose to waive their access to coverage. For employees who already belong to their company’s group health plan, this time window allows them to make changes to their coverage, add dependents, or sign up for new plan offerings (such as an additional dental plan, for instance). Typically, this open period for changes starts a few weeks prior to the renewal date for your employer’s group health plan policy.

If you are a small business owner yourself, you can also set up a group health plan to cover yourself and your employees at any time of the year—no need to wait for Open Enrollment.

Getting started with group health coverage is often easier, and a whole lot more affordable, than many business owners think. Generally, you will qualify for group health if:

  • You are able to provide information that proves that you have a legitimate business
  • You have at least one employee, besides yourself or a spouse, who chooses to enroll in the plan
  • You are willing to contribute to your covered employees’ monthly premiums (typically, employers cover 50 percent or more of their employees’ premiums)

Every business is unique, and it’s important to find the group health insurance policy that will work best for your company. Schedule a time to sit down with Matt and the Enrollment Specialists, and we’ll help you create the group health insurance plan that will provide the most value you for you and your employees.

Accident and Critical Illness Insurance

If you already have a health insurance plan and want to bolster your coverage, or if you’re looking for a level of protection in the event of an accident or a sudden illness, there are coverage options out there that may help provide you and yours greater peace of mind.

Accident insurance, for instance, can assist you with paying out-of-pocket medical expenses after a severe accident. No matter what sort of medical insurance you have already, accident insurance provides more coverage and cash benefits to help pay for accident-related costs. Whatever level of coverage you already have, accident insurance can help you ensure that your bases are covered so you can focus on your health and wellness in a trying time.

In a similar vein, critical illness coverage is additional medical insurance that pays a lump-sum benefit upon diagnosis of a critical illness or condition. This additional coverage can help you avoid the financial challenges a major illness can create. If you already have medical insurance, critical illness coverage can be a great supplement, giving you more freedom to get the treatment you need while protecting yourself from loss of income so that you can focus on your recovery.

It is crucial to note that these protections do not qualify as ACA-compliant health insurance plans on their own. But, if you already have coverage and are looking to improve upon it, even outside of Open Enrollment, these may be important options for you to keep in mind. Accident and critical illness coverage could help protect your peace of mind, save you money, and ensure you have access to medical care at a particularly difficult time.

Want to talk about all of your options? Curious what choices are available when it comes to accident and critical illness coverage? With his extensive knowledge of all things health insurance and his laser-focused attention and capacity for details, Matt can help make these important discussions easier, at every step of the way.

You Don’t Have to Go It Alone

When it comes to health insurance, there are so many options out there that it can feel overwhelming just to get started. To make matters harder, health insurance laws and regulations are often changing. It seems that if you don’t eat, sleep, and breathe insurance, navigating your coverage options can be complicated—and it seems that it’s only getting more dense and confusing by the day.

So remember, you don’t have to go it alone: During Open Enrollment, and at every time of the year, working with an experienced health insurance consultant can help make everything about buying and having health insurance simpler. That’s where the Enrollment Specialists come in.

Led by our own health insurance superhero Matt Peebles, the Enrollment Specialists are here to help you find the right health insurance for your one-of-a-kind needs, and on a schedule that works for you. As the Enrollment Specialists, we don’t believe in cookie-cutter care. We’ll take the time to really get to know you, your family, or your business, and we’ll work closely with you to make sure things are streamlined and simple, along every step of the journey.

And Matt truly is your health insurance hero. If you missed Open Enrollment, or have any questions or concerns about your current policy or ones you want to know about, he’s the guy to set you down on the right track to health insurance happiness.

Even better? With Matt on your team, you’ll always be able to say, “I Got A Guy” for all things health insurance. Whenever you have any questions or need assistance, the entire life of your policy, Matt will always be just a quick phone call or email away. That’s right. With Matt, you’ll always be able to get a hold of a real person who you know and trust, and never have to worry about dealing with a call center or a faceless, online chatbot.

And as health insurance consultants, we don’t charge you anything for a quote, to talk through your options with you, or even to sign you up for a policy. Have questions? Just call us.

Don’t miss out on having coverage in 2019 and beyond. Let the Enrollment Specialists help you know your best options. Ready to get started? Have any more questions about Open Enrollment, QLEs, or any other aspects of health insurance? Drop us a line today to get the conversation started.


(Visited 15 times, 1 visits today)