I Missed Open Enrollment Now What?

Jan 17, 2025

What to Do If You Missed Open Enrollment for Health Insurance

Health insurance is one of the most important aspects of maintaining your well-being, but if you missed the Open Enrollment period, you might be feeling frustrated or anxious. Open Enrollment is the designated time each year when individuals can sign up for or change their health insurance plans. Missing this window typically means you have to wait until the next open enrollment period unless you qualify for a special exception.

However, all is not lost. There are still ways to get the coverage you need outside of Open Enrollment. Here’s what to do if you missed the deadline for signing up for health insurance.

1. Check If You Qualify for a Special Enrollment Period (SEP)

If you missed Open Enrollment, the first thing you should do is check if you qualify for a Special Enrollment Period (SEP). SEPs allow you to enroll in a health insurance plan outside the regular Open Enrollment period under specific circumstances, such as major life changes. Here are some common events that might trigger an SEP:

• Marriage or Divorce: If you recently got married or divorced, you may qualify for an SEP to enroll in or change your coverage.
• Birth or Adoption of a Child: If you had a baby or adopted a child, you can sign up for health insurance or add them to your plan during an SEP.
• Loss of Other Coverage: If you lost health insurance coverage due to job loss, aging off a parent’s plan, or losing eligibility for Medicaid or other programs, you may qualify for an SEP.
• Change in Residence: Moving to a new state or county that offers different health insurance options could trigger an SEP.
• Death of a Spouse or Dependent: The death of a family member covered by your health insurance can make you eligible for an SEP.
• Loss of Eligibility for Medicaid or CHIP: If your income changes and you no longer qualify for Medicaid or the Children’s Health Insurance Program (CHIP), you may be eligible for an SEP.

If any of these situations apply to you, you can apply for health insurance through the Health Insurance Marketplace (or directly through an insurer if you're outside the Marketplace) during your SEP. Generally, you must apply within 60 days of the qualifying event to take advantage of this opportunity.

2. Apply for Medicaid or the Children's Health Insurance Program (CHIP)

If you missed Open Enrollment and don’t qualify for an SEP, you may still be eligible for Medicaid or the Children’s Health Insurance Program (CHIP), depending on your income and circumstances. These programs are available year-round, meaning you can apply at any time.

• Medicaid: Medicaid provides free or low-cost health coverage for individuals and families with low incomes, including pregnant women, children, elderly adults, and people with disabilities. Eligibility is based on income, household size, and state guidelines, so you should check with your state’s Medicaid program to see if you qualify.
• CHIP: CHIP offers health coverage for children in low-income families who do not qualify for Medicaid. CHIP eligibility varies by state, but in general, children up to age 19 are covered.

Both Medicaid and CHIP provide important coverage for those who need help with medical costs, and you can apply for them anytime during the year. You can apply for these programs through your state’s Medicaid agency or the Health Insurance Marketplace.

3. Look for Short-Term Health Insurance Plans

If you missed Open Enrollment and can’t get health coverage through an SEP or Medicaid, short-term health insurance might be an option. Short-term plans are designed to provide temporary coverage for people who are between major medical plans, such as if you are waiting for your next employer-sponsored plan to start or if you’ve recently missed enrollment.

However, there are some important caveats:

• Limited Coverage: Short-term plans typically offer less comprehensive coverage than ACA-compliant plans. They may not cover essential health benefits, pre-existing conditions, or maternity care.
• Short Duration: As the name implies, short-term plans are temporary and often last for up to 12 months. They are not a permanent solution but can help bridge the gap in coverage.
• Availability: Short-term plans are not available in every state. Some states have restrictions or prohibit the sale of these plans altogether due to their limited benefits.

While short-term health insurance is not a long-term fix, it can be an affordable option if you need to fill the gap in coverage until you can enroll in a more comprehensive health plan.

4. Consider Catastrophic Health Insurance

For individuals under 30 or those who are exempt from other ACA coverage, catastrophic health insurance is another option outside of the regular Open Enrollment period. Catastrophic plans are designed to protect you in the event of a serious illness or injury. They generally have low premiums but high deductibles and limited coverage.

Catastrophic plans cover essential health benefits after you meet a high deductible, but they’re not ideal for those who need regular medical care. They’re mostly intended for younger individuals who want to be protected in case of a major emergency but don’t need a full-featured health insurance plan.

You can apply for a catastrophic plan through the Health Insurance Marketplace during a Special Enrollment Period or in some cases, if you meet the eligibility requirements.

5. Check If You Qualify for Coverage Through Your Employer

If you missed Open Enrollment for an individual plan, you may still be able to get health coverage through your employer. Many employers offer health insurance as a benefit, and you may be able to enroll in a workplace plan if:

• You start a new job: If you’re newly employed or just started with a new company, you may be able to enroll in the employer’s health plan.
• Your employer offers a Special Enrollment Period: Some employers allow employees to enroll in or change their benefits outside of the typical enrollment period due to qualifying life events (e.g., marriage, birth of a child).

Check with your HR department to see if they are offering an off-cycle enrollment period or if you can get coverage at any other time throughout the year.

6. Consider Health Savings Accounts (HSAs) and Other Alternatives

If you’re unable to get health insurance through traditional means, Health Savings Accounts (HSAs) can be an option if you’re covered by a high-deductible health plan (HDHP). An HSA allows you to save money tax-free for medical expenses and can be a useful tool for those with minimal healthcare needs or for people who want to save for future healthcare costs.

However, to contribute to an HSA, you must be enrolled in a high-deductible health plan, which may not be ideal for everyone. Check with your bank or insurance provider to see if they offer an HSA as a standalone service.

7. Plan Ahead for Next Year’s Open Enrollment

If none of the above options work for you, it’s important to mark your calendar for the next Open Enrollment period. Open Enrollment for the Health Insurance Marketplace typically occurs once a year, often in the fall, and is your next opportunity to enroll in a new plan or make changes to your existing coverage.

In the meantime, if you’re eligible for employer coverage or Medicaid, make sure to explore those options for potential coverage before the next enrollment period. Additionally, try to review your healthcare needs so that you’re prepared to choose a plan that best meets your needs when Open Enrollment comes around again.

Conclusion: Don’t Panic, Explore Your Options

Missing the Open Enrollment deadline for health insurance doesn’t mean you have to go without coverage. There are multiple options available, such as qualifying for a Special Enrollment Period, applying for Medicaid or CHIP, or looking into short-term health plans. In any case, it’s important to act quickly, as there are typically time limits for each option.

Taking proactive steps can help you secure coverage, so you’re not left without important healthcare benefits. If you're unsure which option is best for you, consider speaking with a licensed health insurance broker who can guide you through your options and help you find a plan that meets your needs.

If you missed Open Enrollment book your appointment today and let us help you get Health Insurance Coverage!