Can I Still Get Health Insurance If I Miss the Open Enrollment Period?

Almost all types of health insurance have a period of a few months whereby you can enroll in a new plan or change the coverage under an existing plan. Most of these periods come toward the end of the year. However, there are usually Special Enrollment Periods that allow you to enroll if you experience a qualifying life event.

Under the Affordable Care Act, the open enrollment period began for marketplace plans November 1, 2020 and ended December 15th 2020. However, you can still qualify under the Special Enrollment Period if you…

  • Lost your health coverage in the past 60 days or expect to lose it in the next 60 days.
  • Got a divorce.
  • Got married.
  • Had a baby.
  • Adopted a child or are a new foster parent.
  • Moved outside your current plan’s service area.
  • Had a death in your household.
  • Had a change in household income.
  • Became a U.S. citizen.
  • Were hospitalized for a prolonged illness.
  • Suffered a temporary cognitive disability.
  • Were released from a prison or a detention facility.
  • Were a victim of a natural disaster.
  • Experienced an error made by an insurer, insurance agent, or government entity during your enrollment.

The Special Enrollment Period typically lasts for 60 days, beginning on the first day of your qualifying life event. In certain cases, as with losing health coverage, it is possible to enroll up to 60 days before the event occurs.

 

 If you purchased a plan during the Special Enrollment Period, you must enroll again during Open Enrollment, even if you are keeping the same plan. 

Medicare Parts A and B Sign Up Periods

When you're first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A (hospital insurance) and/or Part B (medical insurance). (See medicare.gov)

If you're eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65 

 

When does Medicare coverage begin? If you sign up for Medicare Part A and/or Medicare Part B during the first 3 months of your Initial Enrollment Period, your coverage starts the first day of the month you turn 65. If your birthday is on the first day of the month, your coverage starts the first day of the prior month.

In most cases, if you don’t sign up for Medicare Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You'll have to pay this penalty for as long as you have Part B and could have a gap in your health coverage.

Once your Initial Enrollment Period ends, you may have the chance to sign up for Medicare during a Special Enrollment Period (SEP). If you're covered under a group health plan based on current employment, you have a SEP to sign up for Part A and/or Part B anytime as long as:

  • You or your spouse (or family member if you're disabled) is working.
  • You're covered by a group health plan through the employer or union based on that work.

You also have an 8-month SEP to sign up for Part A and/or Part B that starts at one of these times (whichever happens first):

  • The month after the employment ends
  • The month after group health plan insurance based on current employment ends

Usually, you don't pay a late enrollment penalty if you sign up during a SEP.

You may also qualify for a Special Enrollment Period for Part A and Part B if you're a volunteer, serving in a foreign country.

Private Employer Plans

When you start a new job, your employer will usually enroll you in its health insurance plan to start at the beginning of a new calendar month, Generally, for changes in plans private employers have their open enrollment periods towards the end of year. Human resources or benefits personnel will circulate a notice as to the deadlines for signing up and offer an explanation of plan options. You will be continuously notified of signup deadlines.
If you miss the deadline, you are generally out of luck until the next enrollment period. You usually keep your current plan in place unless you enroll for changes.

But there are circumstances, basic life events, that will allow certain changes in your plan such as the birth of a child, divorce, marriage, death of a dependent. etc.

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