Can you buy health insurance now?
- In most states, a COVID-related special enrollment period is available starting in February 2021.
- Consumers in most states can buy short-term coverage at any time during the year and coverage can be effective within days – often by the next business day.
- If you have a qualifying event or are Native American, you can buy ACA-compliant coverage today, but probably will have to wait until at least the start of next month before the coverage is in force.
- If you don’t have a qualifying event, you can’t buy ACA-compliant coverage until open enrollment.
- If you meet the Medicaid or CHIP eligibility requirements of the state where you live, you may be able to enroll in Medicaid or CHIP and have coverage in place immediately.
- People with modest incomes in New York, Minnesota, and Massachusetts can enroll in health programs year-round.
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?
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.
1. ACA-compliant coverage with a COVID enrollment window
Open enrollment for 2021 ACA-compliant individual/family health plans has ended, but consumers in most states have access to a COVID-related special enrollment period; some are already underway, and most will start by mid-February.
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 (COVID enrollment window continues through March 15, 2021), 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 have varying deadlines, but many of them run through mid-May 2021. Check with the marketplace in your state to see if a COVID-related special enrollment period is available, and if so, who’s eligible to enroll (ie, only uninsured residents, or a broader group), and when the window ends.
2. 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.
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 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.
- Related: Is short-term health insurance right for you?
- Related: ‘So long’ to limits on short-term plans?
3. ACA-compliant coverage with a qualifying event
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, people in most states have access to a COVID-related special enrollment period in early 2021. But there are some state-run exchanges that have not announced a COVID-related special enrollment period, and in some of the ones that have, the enrollment window is only available to people who are uninsured, as opposed to people who would like to make a plan change.
If you’re looking for a metal plan outside of the annual open enrollment period, and aren’t able to use a COVID-related special enrollment period, you’ll still be able to enroll if you have a qualifying life event. 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).
If you don’t have a qualifying event and your state isn’t offering a COVID-related special enrollment period? As noted above, you’ll have to wait until open enrollment (November 1 through December 15 in most states) to buy health insurance coverage, and the plan won’t take effect until next January. 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.
- 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
- Related: Glossary of open enrollment terms
4. 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.
of Federal Poverty Level
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 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).
- Related: Frequently asked questions about eligibility for health insurance
5. 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.