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Miss open enrollment? You’ve got options.

If you miss open enrollment, your health insurance options will be limited, but you can still get coverage – including short-term plans

  • By
  • healthinsurance.org contributor
  • January 10, 2017

Open enrollment for 2017 will end on January 31, 2017. For most people, that means the opportunity to purchase individual health insurance will be very limited starting February 1, for the rest of the year. But there will still be coverage options available.

Native Americans can enroll year-round, as can people who qualify for Medicaid. And applicants who experience a qualifying event gain access to a special open enrollment window to shop for plans in the exchange (or off-exchange, in most cases) with premium subsidies available in the exchange for eligible enrollees (note that HHS stepped up enforcement of special enrollment period eligibility verification in 2016, and will further increase the eligibility verification process in 2017; if you experience a qualifying event, be prepared to provide proof of it when you enroll)

But without a qualifying event, health insurance is not available outside of general open enrollment, on or off-exchange. (Nevada is an exception: off-exchange plans in Nevada are available for purchase year-round, but the carrier can impose a 90-day waiting period before coverage takes effect).

Unfortunately, this fact has caught many people by surprise over the last few years. And although the open enrollment period for 2017 coverage followed the same schedule as the one for 2016 coverage, the first three open enrollment periods (2014, 2015, and 2016) all had different start and end dates, which further added to the confusion. The first open enrollment period was six months long; the second and third were both three months, but the dates were different. For 2018, HHS will stay with the same dates that were used for 2016 and 2017 – November 1 to January 31 (although it will change after that, and a lot is still up in the air in terms of what happens to the ACA under the Trump Administration).

Millions of Americans have already secured coverage for 2017 during the current open enrollment period (people can continue to enroll through the end of January), and many more will obtain coverage later in the year during special enrollment periods triggered by qualifying events.

But for those who don’t enroll by January 31 and aren’t expecting a qualifying event later in the year, the options for the rest of 2017 will be limited to policies that are not regulated by the ACA. This includes short-term health insurance, some limited-benefit plans, accident supplements, critical/specific-illness policies, dental/vision plans, and medical discount plans.

Closest thing to ‘real’ insurance, but duration now capped at three months

Some of these policies are a good supplement to regular major medical health insurance. But most of them are not a good option to serve as stand-alone medical coverage – except short-term health insurance, which is available in all but five states.

Short-term coverage is the closest thing you can get to “real” health insurance if you find yourself needing to purchase a policy outside of open enrollment without a qualifying event. Prior to 2017, most short-term plans were capped at six months in duration, although in some states, short-term plans were available with a duration of 364 days.

Through 2016, the federal definition of a short-term plan was a duration of fewer than 12 months. That changed on January 1, 2017, however, and federal rules now cap new short-term plans at no more than three months in duration. HHS is not taking regulatory action against short-term plans that start before April 1, 2017, even if they have a duration longer than three months, as long as they’re scheduled to end by the end of 2017. But short-term plans issued April 1, 2017 or later will have to limit coverage to no more than three months.

HHS proposed the regulation to cap short-term plans at three months in an effort aimed at “curbing abuse” of short-term plans. HHS noted that short-term plans are exempt from having to comply with ACA regulations specifically because they’re supposed to only be used to fill gaps in coverage — but instead, people have been using them for up to a year at a time, which effectively removes healthy people from the ACA-compliant risk pool, destabilizing it over the long-run.

Although premium subsidies are not available for short-term plans, the retail prices on these policies are very affordable, and they do still serve as a good stop-gap if you just need a policy to cover you for up to three months when you’re in between other policies. However, if your income makes you eligible for the Obamacare premium subsidies, it’s essential that you enroll through your state’s exchange during open enrollment (or a special enrollment period triggered by a qualifying event like losing access to your employer-sponsored health insurance); otherwise, you’re missing out on comprehensive health insurance and a tax credit.

Some short-term plans have provider networks, but others allow you to use any provider you choose. Unlike ACA-compliant plans, short-term policies have benefit maximums. But the limits tend to be more reasonable than the infamous “mini-med” plans that barely covered a few nights in the hospital.

Lifetime maximums of $750,000 to $2 million are common on short-term plans. While this is not as good as regular individual insurance plans that no longer have annual or lifetime benefit caps, it’s roughly similar to a lot of the plans that were available just a few years ago in the individual market.

Ease of application

The application process is very simple for short-term policies. Once you select a plan, the online application is much shorter than it is for standard individual health insurance, and coverage can be effective as early as the next day.

There are no income-related questions (since short-term policies are not eligible for any of the ACA’s premium subsidies), and the medical history section is generally quite short – nowhere near as onerous as the pre-2014 individual health insurance applications were.

Keep in mind that although the medical history section generally only addresses the most serious conditions in order to determine whether or not the applicant is eligible for coverage, short-term plans all have blanket disclaimers stating that no pre-existing conditions are covered.

Not ACA-regulated

To be clear, short-term plans are not as good as the ACA-regulated policies that you can purchase during open enrollment or during a special enrollment period. Short-term insurance is not regulated by the ACA, so it doesn’t have to follow the ACA’s rules:

  • The plans still have benefit maximums, and they are not required to cover the ten essential benefits. (Most often, short-term plans don’t cover maternity, preventive care, or mental health/addiction treatment), they do not have to limit out-of-pocket maximums, and they do not cover pre-existing conditions. They also still use medical underwriting, so coverage is not guaranteed issue.
  • And the plans are not renewable. In most states, you have the option to apply for a new policy after the first one ends (the second policy would be capped at no more than three months in duration), but you’ll be going through the application process as a new enrollee, and any health conditions that developed while you were covered by the first policy would be considered pre-existing conditions under the second policy.

Although loss of existing minimum essential coverage is a qualifying event that triggers a special open enrollment period for ACA-compliant plans, short-term policies are not considered minimum essential coverage, so the loss of short-term coverage is not a qualifying event.

In addition, since short-term health insurance is not considered minimum essential coverage, you’ll still be on the hook for the ACA’s shared responsibility penalty if you rely on a short-term plan for your coverage. There’s an exemption from the penalty if you only have a short gap in coverage that lasts no more than two months (you could have a short-term plan during that two months and would not be subject to the penalty).

Be aware that the penalty got much higher in 2016, although it has remained at the same level for 2017 (the flat-rate penalty was scheduled to be indexed for inflation starting in 2017, but the inflation adjustment was zero for 2017). For 2016, and again for 2017, the penalty is the greater of: $695 per uninsured adult (half that amount for a child), up to $2,085 for a household, OR 2.5 percent of household income above the tax filing threshold. The penalty is prorated for the number of months you’re uninsured or covered by a policy that’s not minimum essential coverage (like a short-term plan).

Although short-term plans do not provide the level of coverage or consumer protections that the new ACA-compliant plans offer, obtaining a short-term policy is better than remaining uninsured. Your best bet is to get ACA-compliant coverage during open enrollment, by enrolling no later than January 31. After that, be sure to enroll if you experience a qualifying event (most people don’t take advantage of their qualifying events, perhaps unaware that their opportunity to enroll is limited)

But your best bet is to get ACA-compliant coverage during open enrollment, by enrolling no later than January 31, 2017. If you’re still uninsured after that deadline passes, be sure to enroll if you experience a qualifying event — most people don’t take advantage of their qualifying events, perhaps unaware that their opportunity to enroll is limited.

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