Getting Insured outside Open Enrollment Periods

January 31, 2017

As pleasant as summer can be, it’s usually the wrong season for open enrollment. That’s the designated period of time—usually in the fall—when you can enroll in or make changes to a health insurance plan. But, there are some special circumstances that let you enroll any time.

Job-Based Plans

If you’ve just started a new job, you usually can enroll in a health plan offered by your employer, no matter what the season. Once you’re enrolled, however, most employers only allow you to make changes to your health coverage between open enrollment periods in the case of certain life events. You can make coverage changes whenever the specific life events may happen. Those events may include marriage or the birth of a child, when you may wish to add a new dependent, and enroll yourself if you haven’t already. They also may include loss of coverage under a spouse’s plan, which may prompt you to enroll in your employer’s plan. Other examples of these “qualifying status changes” include divorce, or death of a spouse or dependent. In most cases, you must notify your employer within 30 days of the life event, or else wait until the next open enrollment period.

Health Insurance Marketplace Plans

If you receive health coverage through the federal or state Health Insurance Marketplace, there’s a list of life changes that can qualify you for special enrollment periods. During those periods, you can enroll in or make changes to health coverage, even though it’s not open enrollment time. The life changes include:

  • Loss of health insurance. For example, you may qualify if you lose a job, costing you your job-based coverage. Other examples include losing eligibility for a student health plan or losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP). If you lose coverage through a family member—say, if you turn 26 and can no longer be on your parents’ plan, or you get divorced and are no longer on your spouse’s plan—you may qualify for a special enrollment period. The coverage loss must have happened in the last 60 days, or you must expect it to happen in the next 60 days.
  • Changes in household size. Examples include getting married or having a baby. The change must have happened in the past 60 days.
  • Changes in residence. Household moves may qualify you for a special enrollment period. Examples include moving to a new zip code or county or moving to the United States from a foreign country. (If you move from a foreign country, you must be a US citizen or national or have one of several immigration statuses to use the Health Insurance Marketplace. See our FH Health Insurance 101, Immigration and Health Insurance.)
  • Other qualifying changes. An assortment of other changes may qualify you for a special enrollment period, such as becoming a US citizen or leaving prison.
  • Complex issues. There are several complicated or exceptional circumstances that may qualify you for special enrollment. One example would be if misinformation from an agent or broker kept you from enrolling during the plan’s open enrollment period. Another would be if a hurricane or other natural disaster prevented you from enrolling during open enrollment.

For the complete list of life changes that can qualify you for a special enrollment period, click here. That link also allows you to answer a few questions to see if you qualify.

If You Don’t Qualify for Special Enrollment Periods

If you’re uninsured, it’s not open enrollment season and you don’t qualify for a special enrollment period, you still may be able to get insured. You can enroll in Medicaid or CHIP, programs for people with limited incomes, any time of year. And, you can always buy private short-term health insurance to tide you over until the next open enrollment period. As of 2017, new short-term health insurance must last less than three months. It usually doesn’t have all the benefits that would qualify it as minimum essential coverage, which is what you need to avoid the tax penalty for being uninsured. And, it doesn’t have to cover preexisting conditions. But, for the time you need, it may protect you from catastrophic medical costs.