What happens if you lose open enrollment for health insurance?
So, let’s say you miss open enrollment for health insurance in 2022. Maybe you’re an expert at procrastinating. maybe you screwed up and lost track of time. Whatever the reason you missed the January 15 deadline, your first priority is not to panic.
If you lose open enrollment for health insurance, you don’t necessarily have to wait until next year’s open enrollment to purchase some type of coverage; it all depends on your individual situation and circumstances. And even if your coverage options are limited, there are steps you can take to minimize the financial risk you’re exposed to as a result of being uninsured.
Here’s how to get health insurance after open enrollment ends:
Option 1: Check if you qualify for special enrollment
Certain life events qualify you for a special enrollment period. A special enrollment period is a period of time (usually 60 days) during which you can buy coverage, even if it’s outside of the normal open enrollment period. The events that make you eligible for a special enrollment period are known as qualifying life events.
**Please note that the following are not considered qualifying life events:
- being diagnosed with a disease or becoming ill;
- become pregnant (although you can get coverage after giving birth);
- losing your coverage because you didn’t pay your premiums; or
- voluntarily choose to drop your existing health coverage.
become eligible for, or be denied, Medicaid after applying for Medicaid during the open enrollment period.
option 2: do you qualify for medicaid?
Pregnant women, the elderly, people with disabilities, and individuals or families earning below a certain income level can get health care coverage through Medicaid. Unlike health care plans sold on state and federal exchanges, Medicaid does not have an open enrollment period and you can apply for coverage at any time of the year. eligibility is determined by family size and income, and eligibility guidelines vary from state to state. In most states, you may qualify for Medicaid if your annual income is at or below 138 percent of the Federal Poverty Level (FPL).
If you apply for Medicaid during open enrollment and are denied, you have 60 days after the denial to enroll in another health insurance plan; in this case, your new coverage may be effective the first day of the month after you enroll in a new plan. Even if you think you won’t qualify, consider applying for Medicaid during open enrollment. Even if your state determines that you are not eligible for Medicaid, you will have a second chance to buy health insurance.
Once you are notified that you are ineligible, your Medicaid application will be transferred to the Health Insurance Marketplace. Complete a Marketplace application for private insurance on the Marketplace website, using the same name and information from your state Medicaid application.
Option 3: Consider a Short-Term Health Insurance Plan
Short-term plans provide a viable solution if you expect to experience a gap in coverage between now and the next open enrollment period (in November 2021). Commonly known as short-term health insurance or temporary health insurance, short-term medical (STM) plans provide consumers with an affordable way to pay for health care for a short period of time. (Most STM plans last from 30 to 364 days, but some plans can be purchased for up to three years.) While these plans do not cover essential health benefits and are therefore not ICA compliant, they do cover a wide range of services and provide a degree of financial security if you need to make an unexpected trip to the emergency room.
While most major health plans require consumers to enroll during a dedicated open enrollment period, it is possible to enroll in a short-term health insurance policy at any time of the year. For this reason, short-term plans are a popular option for uninsured Americans looking for coverage outside of open enrollment. Sure, short-term health insurance plans are relatively inexpensive, but not everyone qualifies for them. Because these plans are not required to cover pre-existing conditions, it may be impossible to obtain this type of coverage if you are ill or have chronic health conditions.
option 4: join a shared health plan
Faith-based health care is provided through 501(c)(3) non-profit charities for a religiously oriented purpose and serves as an alternative to health insurance. These plans are often called “health exchange ministries” or “health care exchange ministries” (many states have banned the sale of Christian ministry plans, so it’s important to check if you can buy in your state)
Unlike traditional health insurance, these faith-based plans are not health insurance plans and do not “insure” people; rather, they spread health care costs over a large number of people. members pay into the system and when they receive a bill from their doctor, other plan members will chip in to help pay the bill.
Because members can “buy” them at any time of the year, faith-based plans offer an alternate source of coverage for those who miss the open enrollment deadline.
Note that shared health plans will help you pay for medical care, but only if that care is consistent with biblical teachings (thus, prenatal care for out-of-wedlock pregnancies, alcohol addiction treatment and drugs, sterilization procedures, etc. are not usually covered). Although these plans are not required to cover the essential health benefits required by the Affordable Care Act, they are protected by grandfather rights in the ACA, so members of faith-based plans were exempt from paying the mandatory penalty. individual when applicable.
option 5: look for a primary care (“concierge medicine”) membership
Concierge medicine is primary care offered directly to consumers and employers without the administration of third-party insurance. In practices that operate on a concierge membership model, patients pay a monthly or annual retainer, typically $60 to $100 per month, to their physician or medical practice for a contracted package of services.
While it won’t cover surgery and other specialty care, concierge medicine offers a solution for those without coverage to get routine preventive care. Cheaper than traditional plans, membership medicine also tends to have more predictable out-of-pocket costs. That said, patients using concierge medicine will still have to pay out of pocket to treat critical illness or catastrophic events like heart attack, stroke, and physical trauma. however, on the plus side, these practices offer personalized care, streamlined billing, and priority scheduling for patients.