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How to buy health insurance today

Signing up for coverage today doesn't mean your coverage will be effective immediately. Here's what you need to know to get coverage in place ASAP.

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?

Can you buy health insurance now?

The mere 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?

White House

An executive order signed by President Biden has authorized a COVID-related special enrollment period on HealthCare.gov, for Americans who don’t currently have health coverage. The SEP will run from February 15 to May 15.

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 the date that you apply, your effective date could be the first of the second following month.

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 in which you apply, or even earlier in many states. Your effective date really 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. ACA-compliant coverage with a COVID enrollment window

Open enrollment for 2021 ACA-compliant individual/family health plans has ended, but consumers nationwide have access to a COVID-related special enrollment period. In the 36 states that use HealthCare.gov, it continues until August 15, 2021. State-run exchanges can set their own deadlines, but many are likely to extend their COVID-related enrollment windows well into the summer, to give people a chance to take advantage of the newly enhanced premium subsidies created by the American Rescue Plan.

In most states — including all 36 states that use HealthCare.gov as their marketplace — plan selections made during the COVID-related special enrollment period will take effect the first of the month following the enrollment, even if you enroll right at the end of the month.

In some state-run exchanges, however, you have to enroll by the 15th of the month to have your plan take effect the first of the following month. And in Maryland, coverage can have a retroactive effective date for people who enroll during the first 15 days of each month.

The COVID-related special enrollment periods offered by state-run exchanges (ie, in states that don’t use HealthCare.gov) have varying deadlines and eligibility rules:

The other three fully state-run exchanges also implemented COVID-related special enrollment periods in 2021, but they have since ended:

Check with the marketplace in your state to see if a COVID-related special enrollment period is still available, and if so, who’s eligible to enroll (ie, only uninsured residents, or a broader group; in virtually all states, enrollment is open to both new and existing enrollees, although some of the state-run exchanges do have additional limitations in place).

2. Enroll during the annual open enrollment period

Open enrollment for 2022 coverage will begin November 1, 2021, just two-and-a-half months after the COVID-related special enrollment period ends in most states. And as noted above, the COVID-related enrollment window will continue past November 1 in some states.

Open enrollment normally ends in mid-December in most states, but HHS has proposed a one-month extension. If that’s finalized, open enrollment will continue through January 15, 2022. That extended enrollment period would then continue to apply for future open enrollment periods.

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.

3. The short-term fix

For millions of Americans, buying a short-term health insurance plan offers the fastest route to having some level of coverage in place. These plans are not ACA-compliant, but can still provide protection from unforeseen medical expenses — and you can purchase the plans at any time during the year, if they’re available in your area.

short-term plan availability by stateThat 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 is particularly appealing to consumers who are planning to buy 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. But federal regulations that took effect in 2018 allow short-term plans to 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. Read about short-term plan availability in your state.

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. There’s also a COVID-related enrollment window that’s ongoing in most states through at least mid-August 2021. 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.

4. ACA-compliant coverage with a qualifying event

Obamacare subsidy calculator

Use our calculator to estimate how much you could save on your ACA-compliant health insurance premiums.

You may be one of the millions of Americans who prefer to buy an ACA-compliant health plan because the plans are comprehensive and for many, affordable — thanks to premium subsidies and cost-sharing subsidies. And as noted above, most Americans have access to a COVID-related special enrollment period in 2021, without a need for a qualifying event.

But after that enrollment window ends, people will need a qualifying life event in order to enroll in metal level coverage with a 2021 effective date.

If you do have a qualifying event, you may be eligible for a special enrollment period and will be able to buy a plan that puts coverage in force without having to wait for the start of 2022.

If you have a qualifying event, in most cases, your coverage will take effect either the first of the next month, or the first of the month after that, depending on how late in the month you enroll. (Typically, if you enroll during the first 15 days of the month, your coverage will take effect on the first day of the next month. Enroll after the 15th and coverage won’t kick in until the first of the following month; starting in 2022, HealthCare.gov will switch to simply using a first-of-the-following-month, regardless of when an application is submitted.)

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. You can read more about the rules for each type of qualifying event here.

Native Americans can enroll in plans through the exchange year-round, although the coverage doesn’t take effect until the first of the next month or the first of the month after that, depending on the enrollment date (as is the case with special enrollment periods, Native Americans must enroll by the 15th to have coverage effective the first of the next month).

After the COVID-related enrollment windows end, you’ll have to wait until open enrollment (November 1 through December 15 in most states, although HHS has proposed an extension through January 15) to buy health insurance coverage if you don’t have a qualifying event. And plans purchased during open enrollment take effect January 1. It’s for this reason that many Americans look to short-term health insurance to bridge the gap between signing up and having coverage in effect.

Curious about plans and rates in your state? Call (267) 214-9195 to talk to a licensed agent about your coverage options.

5. Enroll in Medicaid if you’re eligible

If you live in a state that accepted the ACA’s Medicaid expansion and you earn up to 138 percent of the federal poverty limit, you may be eligible to enroll in Medicaid. Even better, Medicaid enrollment is year-round.

Federal
poverty level
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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 did so under the Trump administration).

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.

This federal poverty level calculator will help you determine whether you meet the Medicaid eligibility level for your state. Your eligibility for ACA subsidies also depends on your income and percentage of the federal poverty level (FPL).

6. NY, MN, and MA residents with fairly low income can enroll year-round

New York and Minnesota have Basic Health Programs (the Essential Plan and MinnesotaCare), both of which offer year-round enrollment and are available to residents with income up to 200 percent of the poverty level.

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

If you’re in one of these states and have an eligible income, you may still be able to sign up for coverage regardless of what time of year it is.


Steve Anderson, healthinsurance.org’s editor and content manager, has been writing about health insurance and health reform since 2008.

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