Understanding qualifying life events and Special Enrollment Periods.
Updated April, 30 2019.
The Affordable Care Act (the law known commonly as the ACA or Obamacare) created a nationwide open enrollment period.
- For 2020, open enrollment will run from November 1, 2019 through December 15, 2019.
- For 2019, open enrollment ran from November 1, 2018 through December 15, 2018.
- For 2018, it ran from November 1, 2017 through December 15, 2017.
Here is a list of the 2019 open enrollment dates listed by state.
Keep in mind that if your state runs its own Marketplace, your enrollment period may be different. Check to see if your state has an extended enrollment period here.
During open enrollment anyone can purchase individual and family health insurance on their own. But can you get coverage outside open enrollment?
However, if you experience a major life-changing event (termed a “qualifying life event” under the law), you may be eligible for a personal special enrollment period outside of open enrollment.
Watch our video about signing up for Obamacare
What are some qualifying life events?
Qualifying life events that may trigger a special enrollment period for yourself and your family outside of open enrollment include the following:
- Marriage or divorce
- The birth or adoption of a child
- The loss of employer-based health insurance coverage
- Moving to a new city outside your old plan’s coverage area
- Changes in income that may make you eligible for Obamacare subsidies
Be aware that you may need to provide documentation showing that you experienced one of these (or other) qualifying life events in order to purchase a major medical plan outside of open enrollment.
How long will I have to enroll outside of open enrollment?
If you experience a qualifying life event, you will typically have a sixty-day window during which you can enroll in a major medical plan outside of open enrollment and apply for Obamacare subsidies if you meet the income criteria.
Supplemental forms of health insurance
Outside the open enrollment period, you can only purchase Obamacare-compliant health insurance if you experience a qualifying life event. However, even if you can’t get an Obamacare-compliant health insurance plan, there are supplemental insurance products available that can offer some level of protection. Although they will not meet your coverage requirements under the Affordable Care Act, and you may still be subject to a tax penalty depending on where you live (the individual mandate penalty no longer applies in 2019, but some states have their own health insurance penalties), this level of protection may still be better than having no coverage at all.
Some alternate forms of coverage may include, but are not limited to, the following:
- Short-term health insurance plans: Short-term plans typically provide coverage for periods of 30 days up to 12 months at a time. They typically will not cover pre-existing conditions or preventive medical care, but they can limit your financial liability for medical bills in case of accidents or other unexpected medical emergencies.
- Accident insurance: Accident insurance plans provide you with a cash payout if you suffer from specific injuries. The payout is made to you rather than to your medical provider, and you can use the money for whatever you choose.
- Critical illness insurance: These plans work like accident insurance but are designed to provide you with a cash payout in case you are diagnosed with a covered serious illness.
- Dental or vision insurance: Dental or vision insurance plans typically provide you with some coverage or discounts for a specific set of dental or vision services within a specific period of time.
An eHealth analysis identifies average monthly prices for supplemental insurance and other products often included in medical insurance packages.
In eHealth’s analysis reports the following average monthly premiums:
- Accident insurance: $24 for individuals, $44 for families
- Critical illness insurance: $34 for individuals, $63 for families
These prices are only historical averages from eHealth products in 2017 and may not reflect the prices or plans available for your specific circumstances.
The average premiums for eHealth customers shopping for short-term coverage were $113 for individuals, $277 for families during the 2019 open enrollment period.
Whether you’re looking for coverage outside of open enrollment during a special enrollment period or are looking for supplemental insurance you can find coverage through eHealth.
To get help finding the right plan for you, enter your zip code where requested on this page to see a quote.