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Your guide to buying individual health insurance

Open enrollment has ended (in most states), but millions of Americans can still buy health coverage. Here's what you need to know to buy a plan that's right for you.

Buying individual health insurance for 2019

On December 15, the Affordable Care Act’s annual open enrollment period for 2019 coverage ended in all but a handful of states. It’s the much-heralded end of open enrollment for most people in the individual market – but millions seeking coverage will still find that they’re not out of coverage options.

Seven states and DC extended open enrollment

For starters, individual market plan buyers in seven states the District of Columbia will continue – after December 15 – to shop and buy ACA-compliant coverage in the coming weeks of 2018 and into January 2019. These are the states with extensions – and the effective date of 2019 coverage (dependent on the enrollment date):

Extended ACA open enrollment deadlines

Rhode Island – OEP extended through December 31, 2018

  • Enrollments through Dec. 23 will have a Jan. 1 effective date.
  • Enrollment between Dec. 24 and Dec. 31 will have a Feb. 1 effective date.

Minnesota – OEP extended through January 13, 2019

  • Enrollments until Dec. 15 will have a Jan. 1 effective date.
  • Enrollment between Dec. 16 and Jan. 13 will have a Feb. 1 effective date.

California – OEP extended through January 15, 2019

  • Enrollments through Dec. 15 will have a Jan. 1 effective date.
  • Enrollments between Dec. 16 and Jan. 15 will have a Feb. 1. effective date.

Colorado – OEP extended through January 15, 2019

  • Enrollments through Dec. 15 will have a Jan. 1 effective date (and the deadline was extended to December 19 for people who were unable to get through to the exchange call center on December 15 due to volume).
  • Enrollments between Dec. 16 and Jan. 15 will have a Feb. 1. effective date.

Connecticut — OEP extended through January 15, 2019

  • Enrollments through Dec. 15 will have a Jan. 1 effective date.
  • Enrollments between Dec. 16 and Jan. 15 will have a Feb. 1. effective date.

Massachusetts – OEP extended through January 23, 2019

  • Enrollments through Dec. 23 will have a Jan. 1 effective date.
  • Enrollments between Dec. 24 and Jan. 23 will have a Feb. 1. effective date.

District of Columbia – OEP extended through January 31, 2019

  • Enrollments through Dec. 15 will have a Jan. 1 effective date.
  • Enrollments between Dec. 16 and Jan. 15 will have a Feb. 1. effective date.
  • Enrollments between Jan. 16 and Jan. 31 will have a March 1 effective date.

New York – OEP extended through January 31, 2019

  • Enrollments through Dec. 15 will have a Jan. 1 effective date.
  • Enrollments between Dec. 16 and Jan. 15 will have a Feb. 1. effective date.
  • Enrollments between Jan. 16 and Jan. 31 will have a March 1 effective date.


Texas judge’s ruling does not change anything about 2019 coverage

On December 14, a little more than 24 hours before the end of open enrollment, a federal district court judge in Texas ruled that the entire ACA is unconstitutional. This was not unexpected, and his ruling had been anticipated for several weeks.

The plaintiffs in the lawsuit (18 Republican attorneys general and two Republican governors) argued that because the ACA’s individual mandate penalty no longer exists after the end of 2018, the rest of the ACA is no longer constitutional. This is certainly a stretch, from a legal perspective, but the judge agreed with the plaintiffs.

Despite the headlines about the ACA being ruled unconstitutional, it’s important to understand that this case is far from over, will be appealed immediately, and could eventually make its way to the Supreme Court. Shortly after the ruling was announced, CMS Administrator Seema Verma tweeted that “the exchanges are still open for business” and that “there is no impact to current coverage or coverage in a 2019 plan.”

Extended eligibility thanks to qualifying events

Even if you’re not in DC or one of the seven states with extended open enrollment, you may still have an opportunity to enroll in an ACA-compliant plan (or switch to a different plan) before open enrollment for 2020 coverage. As our updated Insider’s Guide to Obamacare’s Special Enrollment explains, there’s a long list of qualifying events that could trigger a special open enrollment window for you. Among them:

Given the premium increases for 2019, 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.

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). Don’t sign up for an off-exchange plan and miss out on the possibility of much more affordable premiums via a tax credit.

Without a qualifying event, health insurance is not available outside of open enrollment. (Nevada is an exception: off-exchange plans in Nevada are available for purchase year-round, but the carrier can impose a 90-day waiting period before coverage takes effect).

Alternatives to ACA-compliant coverage

New federal rules have expanded consumer access to short-term health plans, lengthening the duration of that coverage in many states. Read more.

We’re big fans of the ACA and always encourage our readers to explore ACA-compliant coverage options first. At the same time, we do recognize that there is a segment of the individual market population that can’t or won’t purchase ACA-compliant coverage:

  • Millions of Americans are caught in the coverage gap in states that haven’t adopted the ACA’s Medicaid expansion.
  • Many Americans are stranded by the family glitch, which makes them ineligible for subsidies.
  • Other Americans with incomes above 400 percent of the poverty level – and thus ineligible for the ACA’s subsidies – simply can’t afford the coverage costs of ACA plans.

The good news: there’s a wide range of short-term health coverage available that could provide a temporary safety net until these consumers get access to less expensive and more comprehensive coverage.

New rule makes longer short-term coverage easier to buy

Consumers who are unable to afford ACA-compliant coverage can now purchase short-term coverage with a much longer duration in many states. Federal regulation changes in late 2018 made 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 up to three years.

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 website 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:


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.