What Is Open Enrollment?
The annual open enrollment period is a period of time determined by the Affordable Care Act (ACA) during which you can apply for health insurance coverage and be guaranteed the minimum essential coverage (also determined by the ACA) regardless of your medical history, pre-existing health conditions, or financial situation. The deadline to enroll in most health insurance plans for 2022 coverage, was November 1 – January 15, 2022.
If you still need to get enrolled in a plan and intend to apply for a premium subsidy, you’ll need to see if you qualify for a special enrollment period (SEP).
What Is A Special Enrollment Period (SEP)?
Special enrollment periods are typically about 60 days following a qualifying life event during which you can still enroll in a major medical health plan, even if you missed open enrollment. The ACA considers the following qualifying events:
- Losing your job and/or losing COBRA coverage
- Moving to a new coverage area
- Recently changing marital status
- Recently becoming a widow or widower
- Aging out of your parents’ coverage
- Having a baby or adopting a child
If you’ve recently experienced one or more of the above “qualifying life events,” you may still be able to apply for coverage outside of open enrollment.
What If You Don’t Qualify For A Special Enrollment Period?
If you’re unable to get coverage during a special enrollment period, you may want to consider short-term health insurance until you’re eligible for a major medical plan. Short-term health insurance provides fast, flexible coverage for people who need to purchase health insurance outside of the allowed open enrollment period. Short-term also offers alternative forms of coverage for people who don’t think an ACA-compliant major medical plan is a good fit for their budget and coverage needs.
How Does A Short-Term Medical Plans Work?
Some short-term plans can be:
- Better suited to people without pre-existing conditions
- Cost-restrictive
- Not compliant with the ACA
Costs
Most short-term plans aren’t ACA-compliant, meaning you won’t be eligible for financial assistance or tax credits on your plan. Depending on your unique circumstances, short-term insurance may be more expensive than an ACA-compliant plan. Your health insurance agent can help you determine whether or not a short-term plan makes sense for your medical and financial needs.
Coverage
Short-term plans do not cover pre-existing conditions and can deny coverage or charge higher and premiums based on your current health. They may also have limited or no coverage for preventive healthcare.
ACA Compliance
Short-term plans aren’t ACA-compliant, meaning they don’t have to cover the 10 essential benefits established by the ACA:
- Ambulatory patient services (outpatient services)
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
You’ll need to confirm the specifics of your plan with your insurance company to ensure that they cover services like preventative care. Even if you’ve lost or missed your opportunity to enroll in major medical coverage, if your family still needs children’s health insurance, you could consider applying for Medicaid for the children in your family until you and your dependents are eligible for major medical insurance.
