Can You Still Get Insurance After Open Enrollment?

Health insurance open enrollment is the annual period when individuals can sign up for, renew, or change their health insurance plans. If this timeframe is missed, new health insurance may not be available until the next open enrollment period. However, certain life events allow individuals to obtain coverage outside this window.

Special Enrollment Periods

A Special Enrollment Period (SEP) is a timeframe outside annual open enrollment for signing up or changing health insurance plans. Triggered by Qualifying Life Events (QLEs) – significant life changes – an SEP provides flexibility and continued access to coverage.

Qualifying Life Events are categorized into groups, each requiring specific documentation for SEP eligibility. Common QLEs include losing existing health coverage, such as job-based coverage, COBRA expiration, or loss of Medicaid or CHIP eligibility.

Proof of coverage loss typically includes a termination letter from an employer, a notice from a previous insurer, or a state Medicaid agency letter. Voluntarily dropping coverage or termination for non-payment usually does not qualify for an SEP.

Changes in household size frequently trigger an SEP. Getting married allows both spouses to enroll in a new plan or add a new spouse to an existing plan, documented by a marriage certificate.

Having a baby, adopting, or placing a child for foster care are QLEs enabling the addition of a new dependent, requiring a birth certificate, adoption decree, or foster care placement documentation. A death in the household resulting in loss of dependent coverage also triggers an SEP, evidenced by a death certificate.

Changes in residence can qualify for an SEP, especially if moving to a new area where existing plans are unavailable or new options become accessible. This includes moving to a different county, state, or even a new ZIP code affecting plan availability. Proof of a new address, like a utility bill or new lease, is typically needed.

Other qualifying events include release from incarceration or gaining U.S. citizenship, requiring release papers or a naturalization certificate. Income changes affecting financial assistance eligibility, such as Marketplace subsidies, can also open an SEP for low-income individuals.

Most Special Enrollment Periods provide a 60-day window to enroll, either 60 days before or after the qualifying life event. Coverage can often begin retroactively to the QLE date or on the first day of the following month, depending on plan selection.

These SEPs primarily apply to health plans obtained through the federal Health Insurance Marketplace (healthcare.gov) or state-based exchanges. While core QLEs are consistent, some state-based marketplaces may offer additional SEP opportunities.

Other Health Coverage Options

Individuals not qualifying for an SEP still have avenues to obtain health coverage outside open enrollment. Medicaid and the Children’s Health Insurance Program (CHIP) offer comprehensive coverage to eligible low-income individuals and families.

Enrollment in Medicaid and CHIP is available year-round. Eligibility is primarily determined by household income, family size, and other state-specific requirements. Individuals can apply at any time.

COBRA (Consolidated Omnibus Budget Reconciliation Act) allows eligible employees and dependents to continue health coverage for a limited time after qualifying events like job loss, reduced hours, or divorce. While providing continuity of employer-sponsored coverage, COBRA can be expensive, with individuals typically paying the full premium plus an administrative fee, often up to 102% of the plan’s cost.

COBRA coverage generally lasts 18 months for the employee and up to 36 months for dependents, depending on the qualifying event. Its high cost often makes it a temporary solution. Individuals receive a COBRA election notice from their former employer, outlining costs and duration.

Short-term health insurance plans provide temporary coverage for a limited duration. For plans issued on or after September 1, 2024, coverage is capped at three months, with a maximum total duration of four months including renewals. They can serve as a stopgap for individuals between jobs or awaiting the next open enrollment period.

A significant limitation is that short-term plans are not subject to Affordable Care Act (ACA) consumer protections. They often do not cover pre-existing conditions, may have benefit limits, and might not cover essential health benefits like maternity care or prescription drugs. These plans are not a substitute for comprehensive, ACA-compliant coverage.

Individuals starting a new job may gain access to employer-sponsored health plans. Enrollment is typically tied to the start of employment. New employees usually have a specific enrollment window, often at least 30 days from their start date, to elect coverage through their employer’s benefits program.

Applying for Coverage

For Marketplace plans, whether through an SEP or year-round income eligibility, the primary entry point is healthcare.gov or a state-specific exchange. Understanding the application process is the next step.

The application process involves creating an account and providing personal information, including household income. If applying through an SEP, select the qualifying life event. Documentation verifying the QLE, such as a marriage certificate or loss of coverage letter, must be uploaded.

After submitting documentation and completing the application, individuals can browse and select a health plan. Complete this process and submit verification within the 60-day timeframe from the QLE to ensure eligibility and timely coverage.

For Medicaid or CHIP, applications can be initiated through the Health Insurance Marketplace website, or directly through your state’s Medicaid or CHIP program website or local office. These applications require detailed information about household income, family size, and residency.

To enroll in COBRA, the process is handled directly through the former employer’s human resources department or benefits administrator. They will provide election forms and premium payment details. Return the completed COBRA election form and make the first premium payment within the designated timeframe to avoid a lapse in coverage.

Short-term health insurance plans are typically purchased directly from insurance companies or licensed brokers. The application process is simpler, often involving a medical questionnaire rather than extensive documentation. After applying, expect to receive enrollment confirmation, a plan kit, and instructions for the first premium payment to activate coverage.