If I were in an accident, or diagnosed with cancer couldn’t I go into an exchange at that point, pay some sort of late fee, and buy comprehensive insurance?

  • By
  • healthinsurance.org Contributor
  • October 3, 2015

Q. If I were in an accident, or diagnosed with cancer couldn’t I go into an exchange at that point, pay some sort of late fee, and buy comprehensive insurance?

A. No. You you can only purchase insurance – in the exchange or outside the exchange – during the annual open enrollment period, or if you experience a qualifying event at another time of the year.

Open enrollment for 2016 runs from November 1, 2015 to January 31, 2016. Open enrollment for 2017 is expected to follow the same November – January schedule, although it was different for 2014 and 2015, and could change again in the future.

If you are in a skiing accident in February, or are diagnosed with a serious illness in April, you won’t be able to buy comprehensive insurance in an exchange until open enrollment begins again in the fall – and even then, the soonest effective date you’ll be able to get is the first of the following year.

This may sound harsh.

But reform’s architects knew that if they let people sign up whenever they needed care, too many would wait until they were sick or had scheduled surgery before buying coverage. The insurance pool would be filled with people who needed expensive treatments, and coverage would become unaffordable for everyone.

There are exceptions to enrollment rules: for example, if you lose access to another health insurance plan, lose Medicaid because your income rises, marry, divorce, have a baby, or move to an area where different health plans are available, these are considered “qualifying events” which would allow you to buy a plan or switch plans in between the open enrollment periods.

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