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What to Do If You Miss the Open Enrollment Period

The Affordable Care Act (ACA) changed how and when Americans purchase health insurance.

Due to the law, Americans can only purchase or change private insurance plans purchased through a Marketplace during a specific open enrollment period.

The 2014-2015 enrollment period began on Nov. 15, 2014 and ends Feb. 15, 2015.

Understanding Open Enrollment

Many workplaces require that employees purchase insurance during specific times, but open enrollment is fairly new for the private insurance market. When the ACA required all Americans to have coverage or face a tax penalty, the open enrollment period was also added.

It’s important to make a note of open enrollment period each year. It can change from year to year, and it’s generally the only time you can change or update coverage. Be sure to review your renewal offer, as well as see what new coverage is available in your state to make sure your insurance plan still meets your needs.

Designating a specific period to purchase insurance helps ensure that Americans don’t buy insurance only when they are sick and then cancel it when they’re well.

Understanding Health Insurance Premiums

In order for an insurance system to be affordable for policyholders, everyone must pay into the system in the form of premiums. By paying these premiums over time, it helps to ensure that there are healthy individuals paying into the system to balance out the cost of people who are sick and use their insurance to cover payments for treatment. If only sick people purchased insurance, or if people could drop insurance when they were well, prices would increase dramatically and quickly.

Finding Coverage Outside Open Enrollment

Some health insurers may accept applications and offer enrollment outside of the established open enrollment period. This is an insurer-specific decision and, if available, would only be for coverage purchased outside of the Marketplace and not eligible for premium tax credits. Be sure to confirm with the insurer whether the plan offered qualifies as minimum essential coverage — the coverage required to avoid the tax penalty for not having insurance.

Sometimes health insurance changes are necessary outside of the specific open enrollment period. The ACA recognizes that certain circumstances require insurance updates, and allows for specific special enrollment periods. Some of the life events that qualify for a special enrollment period are:

  • Giving birth, adopting a child, or placing a child for adoption
  • Marriage or divorce
  • Losing a job or otherwise losing existing health insurance coverage
  • Gaining citizenship
  • Moving to a new state
  • Getting released from jail

Special enrollment periods vary but generally last from the date of the qualifying event to 60 days afterward. If you miss this window of opportunity, you will have to wait until the next open enrollment period to enroll in, or update, your coverage. Unfortunately, this means you may have a gap in health coverage and be required to pay the tax penalty for being uninsured.

Certain types of coverage, specifically Medicaid and the Children’s Health Insurance Program (CHIP), do not have limited enrollment periods. You can apply for and receive these coverage types any time of the year if you qualify for them.

Being aware of open enrollment periods, whether in your workplace or in the Marketplace, is very important. Take advantage of those times to review your current policy and make any needed changes. If you miss open enrollment, however, you may still have options if you qualify for a special enrollment period. Otherwise, you will have to wait until the next open enrollment period to make any changes.