How to buy health insurance outside of open enrollment
- Open enrollment has ended, but you can still enroll if you’re eligible for a special enrollment period.
- Consumers are still required to have ACA-compliant coverage.
- Premium and cost-sharing subsidies are still available – and key to affordability.
- For millions who can’t afford ACA-compliant coverage, short-term coverage that could provide a temporary safety net.
- New Trump administration short-term health insurance rules have expanded consumers’ access to the plans.
The Trump Administration has finalized rules that will expand consumer access to short-term health plans and lengthen the duration of that coverage. Read more.
With all of the hype about the importance of ACA’s annual open enrollment, it’s easy to understand why many Americans believe their opportunity to buy affordable health coverage has passed. But for millions, that’s simply not the case.
Millions can buy outside of open enrollment
There’s actually a fairly long list of opportunities to enroll in ACA-compliant coverage outside of open enrollment. So before you give up hope on compliant coverage – and coverage that may very well include a subsidy – you should review our Insider’s Guide to Obamacare’s Special Enrollment.
The list of qualifying events that could result in a special enrollment period for you at any point during the year including:
- A permanent move (in most cases, you must have also had coverage before your move)
- Marriage or the birth or adoption of a child
- Your non-calendar-year plan reaches its renewal date
- A change in your ACA subsidy eligibility
- A change in your citizenship status
- and even more qualifying events
Your reasons to enroll haven’t changed
If you’re wondering whether it still makes sense to enroll, consider this:
- You’re still required by law to have ACA-compliant health coverage. If you don’t, you could face the individual mandate penalty. Yes, the GOP tax bill included repeal of the individual mandate penalty, but that doesn’t take effect until 2019. People who are uninsured in 2018 will still face a penalty. Calculate your penalty.
- Coverage is still guaranteed-issue, regardless of pre-existing conditions.
- Premiums for older enrollees are still capped at no more than three times the premiums for younger enrollees.
- All new major medical plans are still required to cover essential health benefits.
- And the financial assistance provided by the ACA is still available, with premium subsidies that are larger than ever in most areas of the country.
Four Americans who are still enrolling – like their live depend on it
Subsidies can still greatly reduce your plan costs
Depending on your household income, you may still be eligible for premium tax credits (aka, premium subsidies) and possibly cost-sharing reductions (CSR, aka, cost-sharing subsidies).
- Premiums subsidies are still available in the exchange for people with income up to 400 percent of the poverty level. (For 2018 coverage, a single person can earn up to $48,240 and be eligible for the premium tax credit, and a family of four can earn up to $98,400). Calculate your subsidy. In 2017, 84 percent of exchange enrollees received premium subsidies that covered an average of two-thirds of the total premiums.
- The only thing that has changed about premium subsidies for 2018 is that they’re larger than they were in 2017 in most areas, since average premiums increased and the subsidies grow to keep up with premiums.
- Cost-sharing subsidies are also still available in 2018, even though the Trump Administration has eliminated funding for cost-sharing reductions. People with income up to 250 percent of the federal poverty level still have access to Silver plans with reduced out-of-pocket costs.
A few reminders about affordable coverage
Given the premium increases that took effect in most areas for 2018, it’s essential for anyone who is eligible for premium tax credits – or who might be eligible with an income fluctuation later in the year – to enroll through the exchange if and when they have a special enrollment period. Don’t sign up for an off-exchange plan and miss out on the possibility of much more affordable premiums via a tax credit.
In general, the only people who should be enrolling off-exchange are those who are 100 percent certain that there is no way they will qualify for a premium tax credit during the year – keeping in mind that the premium tax credits are available well into the middle class and are larger in 2018 than they were in 2017 in order to offset the higher premiums. (A family of four earning $98,400 is eligible for premium subsidies in 2018.)
Remember that you have an option to either have the premium tax credit paid directly to your insurer each month to offset the amount you have to pay in premiums, or you can pay full price for your coverage each month and claim the full premium tax credit when you file your tax return.
But either way, it’s only available if you enroll in a plan through the exchange. If you buy your plan off-exchange, there’s no way to claim the tax credit at the end of the year, even if your income ultimately ends up at a level that would have been subsidy-eligible.
Short-term health insurance as a temporary safety net
The Affordable Care Act has delivered health insurance for millions who were unable to find affordable coverage on the individual market in the past. And, while we strongly encourage our readers to take advantage of the comprehensive ACA-compliant coverage, we do recognize that there is a segment of the individual market population that is facing daunting rate increases. We realize that their coverage options may be limited.
Many consumers face unaffordable premiums – perhaps because they’re in the coverage gap or because their incomes make them ineligible for subsidies. The good news is that there’s a wide range of short-term health coverage available that could provide a temporary safety net until you can find less expensive comprehensive coverage.
New rule will make longer short-term coverage easier to buy
Consumers who are unable to afford ACA-compliant coverage may soon be able to purchase short-term coverage with a much longer duration. Federal regulation changes finalized this summer and announced this month will make it possible for many buyers to purchase a short-term plan with an initial duration of nearly a year – with renewal options that allow the plan to remain in force for three years.
Availability of those plans will vary from one area to another – and the rules won’t take effect until October 2018.
Related: See if short-term health insurance is right for your situation.
A guide to individual and family health insurance
As much as we love the Affordable Care Act, we know as well as anyone that the individual health insurance market continues to be a source of confusion for many consumers.
Since 1994, this web site has been a guide for consumers seeking straightforward explanations about the workings of individual health insurance – also known as medical insurance. Within this site, you’ll find hundreds of articles loaded with straightforward explanations about health insurance – and the health law – all written by a team of respected health insurance experts.
Our most popular resources include:
- a guide to Obamacare’s open enrollment
- a guide to ACA’s special enrollment periods
- (and a guide to the qualifying events that trigger SEPs)
- our Obamacare premium subsidy calculator
- our Obamacare penalty calculator
- frequently asked questions about insurance
- a health insurance glossary
- state-by-guides to the health insurance marketplaces
- an explanation of short-term health coverage options
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.