Find out when you can buy individual health insurance, and what to do if you need coverage outside of open enrollment.
Can I buy health insurance at any time? The Affordable Care Act introduced more healthcare consumers to the idea of purchasing plans on their own outside of a group plan offered by an employer. It’s a change in tactics, so there are some common questions a licensed insurance broker hears regularly such as when are individual and family insurance plans available for purchase? Is it a year-round process or is there a time window for buying? In order to answer the question “Can I buy health insurance at any time?” you must understand how open and special enrollment works.
Can I buy health insurance at any time?
First, the original question “Can I buy health insurance at any time?” — the answer is yes and no. There are established windows of opportunity for consumers looking to purchase Obamacare-compliant health insurance for themselves or for a family called open enrollment period. This is the time to buy Obamacare-compliant, Qualified Health Plans (QHP)’s without complication. But there are circumstances in which you are able to get those plans outside of open enrollment periods, like if you’re eligible for special enrollment due to a qualifying life event (QHP). We’ll discuss some of these special instances later on.
A more practical question is “Can I buy health insurance right now?” The answer will depend on your specific circumstances and the time of year. The private health insurance enrollment period typically runs from November 1st to December 15th. It’s important to double check those dates because they are subject to change depending on the year.
During open enrollment, the answer to the question “Can I buy health insurance at any time?” is generally yes, as long as you do it before the open enrollment deadline is over for individual health insurance. During this window, the exchanges provide Obamacare-compliant insurance plans 24/7. That’s a good time to contact a licensed insurance broker to ensure you get the best deal available and to take advantage of any subsidies offered.
What happens if I want to buy health insurance outside the open enrollment period?
Once that window closes, things change for consumers in need of individual or family health insurance. In order to purchase Obamacare-compliant insurance plans, you must meet the criteria for special enrollment. The federal marketplace Healthcare.gov defines special enrollment as the time outside of the private health insurance open enrollment period that people with special circumstances can buy individual and family policies.
You may be eligible for special enrollment if you have a qualifying life event. Some qualifying events include:
- A recent marriage
- A recent divorce
- A new baby
- A death of someone on the current policy
A change in residence also is a qualifying event such as:
- Moving to a new zip code or county
- Moving to the U.S.
- Students who move to or from school
- Seasonal workers
- Transitional living situations like going from a shelter to an apartment
Loss of your current insurance plan will open the door for special enrollment, too. This change might be due to:
- The end of job-based coverage.
- Loss of the current individual or family plan due to no fault of your own. For example, the insurance provider discontinues coverage or you lose access to a student plan. If you fail to pay your premiums or drop the insurance, you do not qualify for special enrollment. You have to wait until the next open enrollment period to get insurance.
- Loss of Medicaid, Medicare or CHP coverage.
- Loss of coverage through a family member. For example, you turn 27 and are no longer covered by a parent’s plan.
You generally have 60 days after a qualifying life event to apply for a new qualified health insurance plan.
If you are unsure if you meet the criteria for special enrollment, ask your licensed insurance broker to access your ability to buy health insurance.
What if I don’t qualify for special enrollment?
You do still have a few options if you fail to qualify for special enrollment but still need some kind of coverage until the next open enrollment period comes up. eHealth has other options that ease the burden while you wait, such as a short-term health insurance and discount prescription drug plans. These are not Obamacare-complaint, but can be effective alternatives for someone looking for some sort of medical coverage. Keep in mind that these alternatives may include products that are not health insurance products, but rather supplementary products. Non-Obamacare products will not protect you from possibly fees for being uninsured (such fees will generally disappear after 2018). In addition, non-Obamacare insurance plans have other limitations: they are not required to provide the minimum essential benefits of Obamacare, they may exclude coverage for pre-existing conditions, and they do not qualify for government subsidies or tax credits.
If you are still wondering, “Can I buy health insurance at any time?” the answer is that it depends on what you want to buy. You will not be able to get a major medical Obamacare plan outside of open enrollment, but it doesn’t mean you can’t buy products off marketplaces like eHealth that provide you with some form of coverage for your health care needs throughout the year. Check out the variety of alternative products sold on eHealth.com that can offer you some coverage outside of the open enrollment period.