How to buy health insurance today

The fact that you’re reading this article suggests that you need to buy health insurance coverage soon. So what are your options for buying a health plan in the individual health insurance market today, tomorrow, or at any other point during the year?

It depends on the type of insurance and when you enroll

The first thing you need to know before buying health insurance is that signing up for health insurance coverage isn’t the same thing as having coverage in effect. You may be able to enroll in a health plan today, but that coverage may not take effect for several weeks.

In the ACA-compliant market, private health plans can only have first-of-the-month effective dates (with an exception for new babies or newly adopted children), and depending on where you live and the date that you apply, your effective date could be the first of the second following month (in most states, coverage starts the first of the month after you apply during a special enrollment period; this will be true nationwide as of 2025¹).

But plans that aren’t regulated by the ACA can offer effective dates as soon as the day after you apply. And Medicaid can backdate your effective date to the start of the month you apply, or even earlier in many states. Your effective date depends not just on when you apply, but also on the type of coverage you’re getting.

So what are your options for getting coverage that’s effective ASAP?

1. Enroll during the annual open enrollment period

In most states, open enrollment for individual/family coverage runs from November 1 through January 15. But there are several states (that run their own Marketplaces) where the open enrollment period continues past January 15. The following state-run exchanges had later deadlines to sign up for 2024 coverage:

• California: February 9 (last-minute extension; deadline is normally January 31)²
• District of Columbia: January 31
• Idaho: December 15 (Idaho is the only state where open enrollment ends in December)
• Massachusetts: January 23
• New Jersey: January 31
• New York: May 31³
• Pennsylvania: January 19⁴
• Rhode Island: January 31

During open enrollment, individual/family health insurance can be purchased by nearly anyone. The enrollment window applies both on-exchange and off-exchange, although subsidies are only available to eligible applicants who enroll through the exchange. There is no requirement that you have a qualifying event or have maintained prior coverage. And as is always the case with ACA-compliant coverage, your medical history will not be taken into consideration when you’re enrolling in a new plan or switching from one plan to another.

2. ACA-compliant coverage with a qualifying life event

Even after open enrollment ends, you may still be able to enroll in an ACA-compliant health plan if you’re eligible for a special enrollment period. In most cases, special enrollment periods are triggered by a qualifying life event. If you enroll in a plan through the marketplace/exchange during a special enrollment period, you may be eligible for income-based premium subsidies and possibly cost-sharing subsidies.

Our in-depth guide to special enrollment periods explains how the rules work for each qualifying event, and what you can expect if you’re using a special enrollment period to sign up for health coverage.

It’s important to understand that in many cases, you’re only eligible for a special enrollment period if you already had some sort of minimum essential coverage in place before the qualifying event.

Some people have access to year-round enrollment in various programs, including:

• Medicaid or CHIP, for people who meet the eligibility requirements.
• Basic Health Programs in New York and Minnesota.
• The ConnectorCare program in Massachusetts (for people who are newly eligible or who haven’t enrolled before).
• The Covered Connecticut program in Connecticut.
• American Indians and Alaska Natives.

But in most cases, if you don’t qualify for a special enrollment period, you’ll have to wait until open enrollment (November 1 through January 15 in most states) to buy health insurance coverage. And plans purchased during open enrollment take effect January 1 or February 1, depending on when you enroll. It’s for this reason that some Americans look to short-term health insurance to bridge the gap between signing up and having coverage in effect.

• Related: Qualifying events that can get you coverage
• Related: Insider’s Guide to Obamacare’s Special Enrollment
• Related: Two-dozen frequently asked questions about enrollment

Curious about plans and rates in your state? Call (866) 553-3223 to talk to a licensed agent about your coverage options.

3. The short-term fix

Short-term health insurance plans are not ACA-compliant, but can still provide some level of coverage for unforeseen medical expenses — and you can purchase the plans at any time during the year, if they’re available in your area.

That means you could buy a short-term plan today and — if you’re approved through the underwriting process — you could have coverage in force as soon as tomorrow. The option for an immediate effective date for short-term plans can appeal to consumers who are enrolling in ACA-compliant coverage but who face a wait of days or weeks before that coverage takes effect.

(It’s important to understand that most short-term insurers have a very basic underwriting process at the time of application, and tend to rely instead on post-claims underwriting; this is why such a fast approval process is possible.)

As the name implies, the coverage is temporary. Under a federal rule in effect from 2018 through August 2024, short-term plans in many states can have initial terms of up to 364 days, and total duration, including renewals, of up to three years. Many states have their own rules, however, that limit short-term plans to shorter durations than the federal rules allow.

And new federal rules limit short-term plans to a total duration of not more than four months, for plans issued or sold on or after September 1, 2024. Read about short-term plan availability in your state.

If you’re losing other coverage (like a job-based plan, or aging off a parent’s plan), you almost certainly have access to a special enrollment period that will allow you to buy an ACA-compliant plan — which you can cancel at any time in the future, if you obtain coverage elsewhere. And keep in mind that the American Rescue Plan has made the ACA’s subsidies larger and more widely available than they used to be. It’s also important to understand that if you’re needing coverage because of a medical condition that has arisen, a short-term plan isn’t going to cover anything that was pre-existing before the plan took effect. All of this means that there is little reason for most people to enroll in short-term coverage, and it’s essential to check your options for ACA-compliant coverage before settling for a short-term plan.

• Related: Short-term health insurance
• Related: Finalized federal rule reduces total duration of short-term health plans to 4 months

4. Enroll in Medicaid if you’re eligible

If you live in one of the 40 states that have implemented the ACA’s Medicaid expansion and you earn up to 138% of the federal poverty limit, you may be eligible to enroll in Medicaid. Even better, Medicaid enrollment is year-round.

In addition, CHIP (Children’s Health Insurance Program) enrollment is also available year-round, and eligibility extends to higher income levels than Medicaid.

The good news is that if your application is successful, your Medicaid coverage will be effective either on the date of the application or the first day of the month that you apply. And in even better news for some applicants: Most states still have a three-month retroactive coverage period for Medicaid enrollees who would have otherwise been eligible in the months prior to their application. (States can seek federal approval to eliminate this retroactive coverage availability, and some have done so.)

So if you’ve been eligible for Medicaid but have neglected to enroll for whatever reason, your state might provide you with retroactive coverage when you do enroll. This could be very beneficial if you received medical care in the days or weeks before you submitted your application.

Our federal poverty level calculator (see above) will help you determine whether you meet the Medicaid eligibility level for your state. If you’re not eligible for Medicaid or CHIP, you may be eligible for ACA Marketplace subsidies. This also depends on your income and percentage of the federal poverty level (FPL).

• Related: Frequently asked questions about eligibility for health insurance

5. People with fairly low income can enroll year-round

If your household income is fairly low, you might find you can enroll in health coverage anytime during the year. And depending on the plan you select, you may not have to pay any premiums for your coverage. The specifics vary from one state to another in terms of enrollment opportunities and available coverage.

New York and Minnesota have Basic Health Programs (the Essential Plan and MinnesotaCare), both of which offer year-round enrollment. In Minnesota, the income limit for BHP coverage is 200% of the federal poverty level. That used to be the case in New York as well, but New York’s limit increased to 250% of the federal poverty level starting in April 2024.⁵

Massachusetts has a program called ConnectorCare, available to residents with income up to 300% of the poverty level. ConnectorCare enrollment is available year-round, but only for people who are newly eligible or who haven’t enrolled previously.

Connecticut has a program called Covered Connecticut, which has year-round enrollment. It’s available to adults under age 65 who are not eligible for Medicaid and whose household income doesn’t exceed 175% of the poverty level.

In nearly every state, year-round enrollment in Marketplace plans is available to people who are eligible for Marketplace subsidies and whose household income isn’t more than 150% of the federal poverty level. There are some states where the income limit for this special enrollment period is higher than 150% of the federal poverty level. Here’s more about how this special enrollment opportunity works, including state-specific details.

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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 marketplace updates are regularly cited by media who cover health reform and by other health insurance experts.

1. Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2025; Updating Section 1332 Waiver Public Notice Procedures; Medicaid; Consumer Operated and Oriented Plan (CO-OP) Program; and Basic Health Program. U.S. Department of the Treasury; U.S. Department of Health and Human Services. April 2, 2024. ⤶
2. Covered California Announces More Time to Enroll for Coverage in 2024. Covered California. January 31, 2024. ⤶
3. Press Release: On the Tenth Anniversary of New York’s Marketplace, NY State of Health Announces the Beginning of the 2024 Annual Open Enrollment Period for Health Insurance. NY State of Health. November 2023. ⤶
4. Pennie announcement of a last-minute extension0. January 2024. ⤶
5. ”Governor Hochul Announces Federal Approval to Expand Access to High-Quality, Affordable Health Insurance” New York State Governor Kathy Hochul. March 4, 2024. ⤶