What to Do if You Miss ACA Open Enrollment

Even though the Tax Cuts and Jobs Act effectively repeals the tax penalty for not having health insurance, individual plans are still an important safeguard against unexpected medical bills. Moreover, they also cover many preventative procedures, such as annual wellness visits and vaccinations.

But the open enrollment period, the time insurance carriers must accept you regardless of any pre-existing conditions, was shorter this year than in years past, running from November 1 through December 15. If you miss your enrollment deadline, you may still have options.

Special Enrollment Periods
First, you may qualify for a special enrollment period (SEP). This may apply if you go through a qualifying life event. If you qualify for a SEP, you have up to 60 days after the date of the event to enroll in an individual health insurance plan under the Affordable Care Act. Examples of qualifying life events include:

• Marriage, divorce, birth of a child, death in the family, or adoption
• Change in residence
• Loss of health coverage (i.e. layoff from employment)

You may also qualify for a 60-day SEP if one or more of these qualifying life circumstances apply:

• You become an American citizen
• You are released from incarceration
• You lose eligibility for Medicaid or the Children’s Health Insurance Program

Group Plans
If you don’t qualify for a SEP, you may be able to get ACA-qualified health insurance by becoming an employee at a company that sponsors a group health plan.

Generally, you can enroll in your employer plan during an initial enrollment period, which can occur at any time of the year. As long as you take the opportunity to enroll when you’re first eligible, during the initial open enrollment period set up by your employer, you won’t have to wait until the annual period.

Short-term Health Plans
In a pinch, you may be able to qualify for a short-term medical (STM) insurance policy. These will provide very basic insurance coverage for a limited period of time, which varies by state. Federal rules now allow for up to 364 days and up to three renewals, but many states are enacting much more restrictive guidelines.

STM plans generally cover emergency room visits, hospitalizations, lab and X-ray fees, and outpatient surgical procedures. They exclude preventative services and prescription drugs, except during a hospitalization.

STM plans are not ACA-compliant. They provide less coverage and often exclude pre-existing conditions. There’s no guaranteed issue provision, which means carriers can turn you down based on your medical history.

While these plans are not a substitute for an ACA-compliant insurance policy, they may be appropriate while you’re between jobs or waiting for a qualifying life event or open enrollment period to come around.

Critical Illness Insurance
You may also be able to obtain critical illness coverage. This will pay a lump-sum cash benefit if you are diagnosed with a condition covered in the policy, such as cancer. While you can expect a medical records check and potentially a medical exam, there’s no open enrollment period for these plans, and you can enroll in them at any time during the year.

If you miss open enrollment period this year, don’t give up! You should still protect yourself against unexpected medical costs as best you can. Call us today and let us help you explore your options.

We Are Here for You!

Texas Insurance & Financial Services, Inc. is your trusted advocate. As an independent insurance agency, TXINS represents a wide network of A-rated insurance companies, which allows us to find the best insurance policy to fit your needs and budget. We don’t believe in cookie cutter policies and will customize a plan specifically for you. Your overall satisfaction is our top priority.

TXINS offers complimentary insurance reviews to ensure you are getting the right coverage for yourself, your family, or your business. To schedule your review, contact us today at 800-541-9849 or via email. Together, we will ensure you are protecting what matters most.