Affordable Care Act
How Do You Buy Health Insurance Outside of Open Enrollment?
Published on February 03, 2016
Updated August 30, 2019
You cannot enroll in health insurance outside of open enrollment unless you qualify for a special enrollment period. However, you do have some options – like short-term health insurance – to get some coverage until the annual open enrollment period.
There is only a short window at the end of each year to enroll in a major medical health insurance plan. This window typically runs from November 1st through December 15th which allows you to enroll in health insurance beginning the following year.
If you are looking to enroll in health insurance outside of this window, you must experience something called a qualifying life event which then triggers a 60-day special enrollment period.
What are qualifying life events?
A qualifying life event is a sizable change in your situation – like experiencing a change in family structure, losing coverage, or moving – that can make you eligible for a Special Enrollment Period, allowing you to enroll in a health insurance plan outside of the Open Enrollment Period.
Keep in mind that you will have to prove that you experienced a qualifying life event in order to become eligible for a special enrollment period.
Here are some examples of common qualifying life events and the paperwork you may need to provide as proof:
- I lost my coverage under an employer plan: Some insurers require a letter from your former employer that confirms your loss of coverage as well as the date and the reason it occurred. The letter should include the names of the employee and dependents affected. Some insurers will accept a letter showing eligibility for COBRA if it provides the same details listed above.
- I used up my COBRA coverage: If you were previously insured through COBRA, some insurers require you to provide a copy of the letter you should have received stating that your COBRA coverage has now been exhausted. Keep in mind if you end your COBRA coverage early, it is not considered a qualifying life event.
- I had a child or adopted a child : Some insurers require a copy of the child’s birth certificate and/or placement or adoption papers, with a court seal. Keep in mind that pregnancy is not a qualifying life event, but the birth of a child is.
- I added a new dependent child to the household: When a child moves in with you for reasons other than birth or adoption, you may need to provide a copy of a court order (in case of a divorce or custody settlement) or school admissions documentation or transcripts.
- I moved to a new insurance coverage area:You may be required to show copies of utility bills from both your former and the new residence, dated within sixty days of the date of your move. Mobile phone bills and bank statements are typically insufficient.
- I was just married, or divorced: A copy of the marriage license (translated into English, if necessary) or a court-stamped copy of the divorce decree may be required.
- My income changed and I’m eligible for subsidies now: You may be required to provide documentation of your eligibility for subsidies. This is generally obtained through the government health insurance exchange serving your state.
Keep in mind that not all major life events are qualifying life events. Additionally, if you lose your coverage due to failure to pay your monthly premiums, that is not a qualifying life event.
What can I expect during my Special Enrollment Period?
Here’s what you can expect after you experience and provide proof of a qualifying life event:
- You have sixty days to enroll.If you experience one of the qualifying life events described above, you will typically have a sixty-day window to enroll in a new health insurance plan.
- Having your paperwork handy can speed things up. It can be difficult to obtain the paperwork you may need from former employers or utility companies proving that you have experienced a qualifying life event. Work to obtain these things as quickly as possible after your qualifying life event so that your sixty-day special enrollment window doesn’t close before you can sign up for a new plan.
- It can take a few weeks to confirm your eligibility:The time required for an insurance company to confirm your eligibility to enroll may vary from insurer to insurer. It may take 2-3 weeks in some cases, or even longer at busy times of year. Note that your coverage will generally not take effect immediately after approval, but may require 2-6 weeks from the date your application is approved.
- Short-term coverage is an option: If you are concerned about the 2-6 week waiting period for your coverage to start, you have the option to enroll in a short-term health insurance plan in most states. These plans often have short approval periods – some plans have next day approval periods – and can provide you with some amount of coverage while you’re waiting for you to be approved for a major medical plan. You can cancel your short-term coverage easily and without penalty once your major medical insurance coverage starts. Keep in mind that while short-term plans provide some coverage, the do not provide as comprehensive coverage as marketplace plans.
What if I want health insurance but don’t qualify for a special enrollment period?
If you don’t qualify for a special enrollment period but what some coverage until you can enroll at the end of the year, you can purchase a short-term health insurance plan in most states.
Short-term health insurance plans are cost-effective solutions for those who need health insurance for a short period of time or want some coverage until they can enroll in health insurance for the next coverage year.
eHealth.com has plenty of short-term health insurance options an supplemental insurance to help keep you – and your family – covered until the next Open Enrollment Period.
To learn more about your coverage options today, visit eHealth.com and filter your search for what kind of coverage you’re looking for.