How to Get Health Insurance Outside of Open Enrollment
Learn how to sign up for healthcare insurance if you miss the deadline, see if you qualify for alternative insurance, and find resources where you can get help.
Written By Edumed Staff
Last Updated: 03/12/2020 ——
In 2018, the number of uninsured Americans rose for the first time in 10 years. While the Affordable Care Act has made health insurance more accessible, getting the coverage you need isn’t as easy as filling out an application. Barring an employment or a major life change, the only time to sign up for health insurance is during the open enrollment period, which is typically in December. While missing the open enrollment period may seem like an opportunity lost, there are still ways to get coverage. Explore ways to get health insurance outside of open enrollment, learn about special options that can help you get insured, and find answers to your most pressing insurance questions.
Special Enrollment Period
One of the most common ways Americans sign up for health insurance after open enrollment is via special enrollment.
What is special enrollment?
Special enrollment exists for individuals and their family members who experience a qualifying life change within the previous 60 days, regardless of when it falls during the year.
Who qualifies for special enrollment?
People who have gone through family changes can qualify for special enrollment. These changes include:
Getting divorced or legally separated and losing health insurance
Having a baby
Adopting a child
Death of a primary insured member
If you’ve had a change of residence, you may also be able to qualify for open enrollment. Examples include:
Moving to a new area where different health insurance plans are available
Moving back to the U.S. after being abroad
Students transferring to or from their college location
Seasonal workers moving to or from a job location
Moving to or from a shelter or transitional housing if homeless or housing insecure
Loss of health insurance
People lose health insurance for a variety of reasons, some of which qualify for open enrollment, including:
Losing job-based coverage because of employment termination
Losing individual health coverage from a previous plan
Losing Medicaid, Medicare, or CHIP eligibility
Losing coverage from a family member
Insurer exits the market
Qualifying events that do not fit in the above categories include:
Becoming a member of a federally recognized Native American tribe
Becoming a U.S. citizen
Ending a period of incarceration
Beginning or ending service as an AmeriCorps member
How can you sign up during the special enrollment period?
Generally speaking, how you’ll sign up for insurance during the special enrollment period depends on the type of insurance for which you qualify. For example, if you are expecting a baby, you can contact your employee benefits department or insurance provider beforehand to see what their requirements are for adding him. After confirming that you qualify for the special enrollment period, you’ll receive more instructions on how to sign up.
People who qualify for Medicaid can receive free or low-cost healthcare, and special permissions are available for those who missed the cutoff date.
What is Medicaid?
Medicaid is a state and federal healthcare program that supports specific individuals who meet income and asset requirements. Specialized programs also exist for older adults, people with disabilities, children, pregnant people and parents and caretakers of children. As of November 2019, more than 64 million Americans were enrolled in Medicaid.
Who qualifies for Medicaid?
Each state sets specific guidelines around Medicaid, but a general rule is that if an individual or family makes less than 100% to 200% of the federal poverty level and identifies as pregnant, disabled, elderly, caretaking, or underage, they typically qualify for the program. Those who earn less than 133% of the federal poverty level may qualify for the program as well, despite whether they identify as any of the populations listed above. This is true in states that have enacted a Medicaid expansion.
When can you sign up if you qualify?
Unlike the standard open enrollment period for regular health insurance, individuals who qualify for Medicaid can apply at any time. If unsure whether you meet the income threshold requirements, take this quiz to check your qualification status. Even if you don’t qualify based on income, you should still apply if you meet any of the special population requirements mentioned in the previous section.
How can you sign up for Medicaid?
Requirements to sign up for Medicaid vary by state. An excellent place to start is to do an internet search on your state name and Medicaid. Generally, applicants sign up for Medicaid either by filling out an application on the Health Insurance Marketplace or by applying directly to their state-level Medicaid department.
Medicaid Expansion and You To learn more about how the Medicaid may affect you, and whether your state participates, review this Healthcare.gov article.
Medicaid Overview Learn about how Medicaid and Medicare sometimes overlap and how you can gain both types of coverage.
Children’s Health Insurance Program (CHIP)
CHIP is administered by the U.S. Department of Health and Human Services. Qualifying for CHIP can help parents cover healthcare costs for their children who qualify. Many children would not have insurance if it weren’t for CHIP.
What is CHIP?
CHIP functions as low-cost health insurance for parents whose incomes are higher than Medicaid qualification requirements but too low to cover private health insurance. As of November 2019, more than 6.7 million people were enrolled in CHIP. While Medicaid serves a variety of populations, CHIP exists solely for children and, in limited cases, pregnant women.
Who qualifies for CHIP?
CHIP extends healthcare coverage to qualifying children from birth through their 19th birthday, provided they are either U.S. citizens or lawfully present immigrants. To qualify, a family of four must have an annual income of $49,200 or less. Some states allow for a higher income.
When can you sign up if you qualify?
No open enrollment period exists for the Children’s Health Insurance Program. Because of this, parents, grandparents, guardians, and other authorized caretakers can apply at any time of the year.
How can you enroll a child in CHIP?
Children can be signed up for CHIP online, in person, or by mail. CHIP may go by a different name in your state. For example, in Nevada, the CHIP program is called Nevada Check Up. Online sign-ups for your state’s CHIP can be done at Healthcare.gov, while in-person and mail sign-ups should be done through the state’s CHIP or Medicaid offices. You can also find more information on your state’s department of HHS website.
CHIP Medicaid Coverage Individuals looking for detailed information on benefits, cost-sharing, and CHIPRA can use this page to learn more.
Despite the options available for getting health insurance during special enrollment periods or qualifying for other types of federal or state plans, sometimes other options are needed. That’s when short-term health insurance may help fill the gap in coverage.
What is short-term health insurance?
Short-term insurance exists to help people who don’t qualify for special enrollment but need temporary or emergency healthcare while finding medical coverage. As the name suggests, these programs are not intended to be used for long-term coverage, and most policies last a year or less.
Why is short-term health insurance beneficial?
Several reasons exist for enrolling in a short-term insurance plan. Some people may not be able to use the special enrollment period but still need coverage while between healthcare insurance providers. Others may need this option in the case of a medical emergency. Affordability can also be a factor, as these plans tend to cost less due to covering fewer medical needs. Short-term health insurance, while helpful in some cases, does come with several cons. This form of insurance does not cover pre-existing conditions, sets high deductibles, and lacks comprehensive government oversight.
Who qualifies for short-term health insurance?
While many individuals may qualify for short-term health insurance, it may not be the best fit. Typical applicants include those who recently became unemployed, people who recently turned 26 and came off their parents’ plan, or those who did not enroll for a traditional plan during the eligibility period. Because these plans do not cover pre-existing conditions, a person with these types of health issues may find that short-term insurance won’t meet their needs.
When and where can you sign up if you qualify?
Short-term health plans are offered through private insurance companies rather than the Health Insurance Marketplace. As such, they do not follow guidelines set forth by the Affordable Care Act. Individuals seeking this type of insurance can apply directly to a provider in their area.
In addition to the various types of insurance profiled throughout this guide, several alternative options exist to meet specific needs. Some of these include:
Also known as healthcare sharing programs, these plans typically cost less than traditional insurance and focus on pooling funds within the group of members to cover costs. While these plans are open to many different types of groups, the fact that they are self-regulated means members may not be able to receive coverage for procedures, doctors, or medications outside common beliefs. For instance, a member of a Christian healthcare sharing program may be denied coverage for services deemed to go against faith tenets. These programs are not government-backed, meaning they can also run out of money and cease providing coverage. Enrollment times vary depending on the co-op.
As the name implies, travel insurance provides coverage for individuals when they are away from home. Standard travel insurance covers things such as medical emergencies, canceled or interrupted trips, transportation delays, evacuations, and issues with lost, stolen, or damaged luggage. The cost of coverage is low and is usually calculated based on age, amount of coverage, ongoing medical conditions, destination, and length of the trip. Enrollment happens before the insured person departs for travel.
Many colleges and universities provide student insurance plans directly through the school or an insurance company. While many students can stay on their parents’ health insurance until 26, some learners may not have access to this type of coverage or may need to seek their own for other reasons. Costs are rolled into other expenses, meaning degree seekers can use their student loans to cover health insurance. Enrollment usually happens before the start of the school year and may be available in-between semesters as well.
Other Health Insurance Option Resources
Co-Op Health Insurance Plans Wondering about the pros and cons of this alternative type of health insurance? FirstQuoteHealth takes a look at whether these types of plans will work for you.
Student Health Plans Healthcare.gov gives an overview of various healthcare options available to students, including school insurance.
Health Insurance Enrollment FAQs
Is health insurance required by law?
As of January 1, 2019, the federal government no longer mandates health insurance coverage. Some states still require individuals to hold health insurance or pay a tax penalty.
What will happen if I don’t have health insurance?
As the cost of health insurance continues to rise, foregoing coverage may sound appealing to those who need to cut costs. While the federal government and many states have now stopped penalizing individuals without health insurance, this is not true in all cases. California and Rhode Island, for instance, impose individual mandate penalties for the uninsured. It is also worth noting that if someone gets injured or sick and does not have health insurance, medical costs could leave them in an awkward financial position.
Can I get immediate health insurance coverage?
If you do not qualify for a special enrollment period, you cannot apply for insurance through the Health Insurance Marketplace. You may, however, qualify for Medicaid. You could also apply for short-term insurance.
Why can’t I just pay for my own medical care?
A 2019 research study found that 66.5% of all personal bankruptcy filings in the U.S. were due to issues around medical care or medical complications. While the idea of paying out-of-pocket for medical care may sound appealing, the reality is that these costs are simply far too high for the average person to cover without health insurance.