Q. If I didn’t enroll in a health insurance plan by the open enrollment deadline (January 31), what are my options now?
A. In most cases, your options are very limited for the rest of 2017. Open enrollment won’t come around again until late 2017, for coverage effective January 2018.
Nevada allows people to enroll outside the exchange (ie, directly through a health insurance company) year-round, but with a 90-day waiting period if you enroll after open enrollment has ended (and bear in mind that there are no subsidies available outside the exchange).
In the rest of the country, January 31 was the deadline to enroll, regardless of whether you were purchasing a plan through the exchange or outside the exchange.
But depending on your circumstances, there are some exceptions that will allow you to enroll outside of open enrollment.
Medicaid enrollment is available year-round for those who qualify. If your income drops to a Medicaid-eligible level later in the year, you’ll be able to enroll at that point. Similarly, if you’re on Medicaid and your income increases to a level that makes you ineligible for Medicaid, you’ll have an opportunity to switch to a private plan at that point.
Native Americans can enroll in plans through the exchange year-round. Here’s more about special provisions in the ACA that apply to Native Americans.
Special enrollment period
If you have a qualifying event during the year, you’ll have access to a special enrollment period. Qualifying events include marriage, the birth or adoption of a child, loss of other minimum essential coverage, or a permanent move to a new geographical area where the available health plans are different from what was available in your prior location (assuming you already had coverage prior to your move).
Soon after Tom Price took over as Secretary of HHS, the agency published proposed a variety of changes aimed at market stabilization, particularly for the individual market. It’s unclear whether the various proposals and changes made by the Trump Administration will be stabilizing or destabilizing for the markets, but in terms of special enrollment periods, HHS has proposed requiring that all applicants provide proof of their qualifying events before being allowed to finalize enrollments outside of open enrollment. If finalized, this rule would take effect in mid-2017. In general, if you’re enrolling mid-year, be prepared to provide proof of the qualifying event that triggered your special enrollment period.
If you do not have a qualifying event, there is no way to enroll in an ACA-qualified individual health insurance policy outside of normal open enrollment, either on or off-exchange (unless you’re in Nevada, where all off-exchange plans are available year-round with a 90-day waiting period).
This is very different from the pre-2014 individual health insurance market, where people could apply for coverage at any time. But of course, approval used to be contingent on health status, which is no longer the case.
Other plans – and their limits
Unless you have a qualifying event or become eligible for Medicaid or employer-sponsored coverage, the only plans you can purchase outside of open enrollment are those that are not deemed minimum essential coverage.
This includes discount plans, critical illness coverage, dental and vision plans, accident supplements, and short-term policies. Of the plans that are available outside of open enrollment, short-term policies are probably the best coverage option, but they should not be considered a good substitute for an ACA-qualified plan.
Although ACA-qualified policies are all guaranteed issue during open enrollment and special enrollment periods, short-term policies are not regulated by the ACA and continue to be medically underwritten and provide no coverage for pre-existing conditions. As of 2017, short-term plans are limited to less than three months in duration (with enforcement beginning April 1, 2017), but that is a rule that was put in place by HHS under the Obama Administration; it could potentially be changed under the Trump Administration.
Discount plans and supplemental policies tend to be guaranteed issue, but their coverage is gossamer thin and provides no cap on out-of-pocket exposure.
It’s also important to note that short-term / temporary health insurance policies have set expiration dates. And while loss of other health insurance that is considered minimum essential coverage is a qualifying event that triggers a special open enrollment period, short-term policies are not minimum essential coverage. So you will not be able to purchase an ACA-compliant plan outside of open enrollment when your short-term policy expires.
Keep in mind that short-term policies are not renewable. Depending on your state’s regulations, you may be able to purchase a new short-term policy when your existing one expires, but that purchase will require new underwriting, and the new policy will not cover pre-existing conditions, including any that began while you were covered under the first short-term policy.
The plans available outside of open enrollment will provide meager coverage compared with the ACA-qualified plans that are sold on and off-exchange. And purchasing them will not satisfy the individual mandate. If you opt to have coverage through a supplemental or discount plan or a short-term policy, you’ll still be subject to the shared responsibility penalty unless you qualify for an exemption.
In 2016, the penalty for not having health insurance was $695 per adult (half that amount per child) or 2.5 percent of household income, whichever is greater. It has remained at that level for 2017. Eliminating the penalty is a key part of the Republican plan to repeal and replace the ACA, but as of late March 2017, repeal efforts had stalled and the ACA remained intact.