Did You Miss Open Enrollment?

By Marv Law, CLTC

With the exception of a Qualifying Event, we can now only get individual and family health plans once a year during Open Enrollment.   This is similar to being on an employer group plan or Medicare, where there is an open enrollment ever year.  If you miss the open enrollment you must wait until the next annual open enrollment before getting on a health plan.

What can you do if you missed this year’s enrollment period?

If you have a Qualifying Event, then with documented proof of that event, you may enroll between the open enrollment periods. This is called a Special Enrollment Period.  A qualifying event is typically when you’ve lost your health insurance because you:

  1. Left an employer plan through termination of employment or the employer dropped their plan,
  2. Lost your health insurance because you moved to an area that is not serviced by your plan,
  3. Got divorced and you are losing coverage on an former spouse’s plan.

In addition to losing your health insurance under one of those circumstances, the following life changes will also allow an individual to enroll if you:

  1. Got married and you now can join a spouses plan,
  2. Have a new dependent by birth or adoption that can join your plan,
  3. Became a U.S. Citizen or newly lawfully present,
  4. Become newly eligible or ineligible for premium assistance through Covered CA,
  5. Your employer sponsored plan is no longer affordable or does not meet the minimum eligible benefit requirements of the new law.

If you don’t have a qualifying event, another option might be to enroll in a short term medical plan that covers an individual for up to 6 months.  Although these short term plans are subject to the approval of a review of a person’s medical history, enrollment can be anytime of the year, including the months between open enrollments.   Unlike the plans available during open and special enrollment periods, these short term plans typically do not cover pre-existing health conditions and do not meet all the Minimum Essential Benefits of the new plans.  However, though they do provide some valuable coverage when no other coverage is available, they do not meet the minimum requirements of the new law, so these plans are not considered qualified plans and those that use them may still be subject to the penalty fee for not having a qualified health plan.  However, if a person can qualify medically for a short term medical plan, the combined cost of the premiums plus the penalty for not having an ACA compliant plan may be substantially less than an ACA compliant plan.