How Can You Get Health Insurance Coverage Outside Open Enrollment

2016 plans are only available with a qualifying event

Open enrollment for 2016 ended on January 31, but you need to buy health insurance now. There are two options:

  • Check if you qualify for a Special Enrollment Period. The next open enrollment period will begin November 1, 2016, for coverage effective January 1, 2017, and will end January 31, 2017. But you can enroll in or change plans for 2016 if there has been a Qualifying Life Event (such as a marriage, divorce or loss of employer coverage).

  • Check if you may qualify for Medicaid or CHIP. The government programs cover those with low incomes and disabilities. The enrollment via these programs is year round.

Indian tribes and Alaska natives have an exception to the above options. Members of federally recognized tribes and Alaska Native shareholders are eligible to enroll in ACA coverage any time of the year.

Qualifying events that trigger your own Special Enrollment period

Ever since the Affordable Care Act came into effect, Individual and Family health insurance coverage became similar to the options offered by employer-sponsored health insurance. Therefore, the individual market now uses annual open enrollment windows and allows for special open enrollment period initiated by qualifying events.

If you are eligible to buy health insurance during special open enrollment period – you generally have 60 days – during which you can enroll or switch to a different plan.

But you don’t have to wait for open enrollment if you have a qualifying event that triggers your own special open enrollment window.

The first step is to understand whether you have a qualifying event.

Here is a quick checklist:

  • Loss of qualifying health coverage in the past 60 days OR expects to lose coverage in the next 60 days.
  • Getting married or divorced
  • Gaining or losing a dependent including having a child, adopting a child, or placing a child for adoption or in foster care
  • Moving to a new residence or location
  • Having a change in disability status
  • Loss of employer-sponsored health coverage
  • COBRA insurance coverage period ends
  • Becoming a US citizen
  • Certain income changes
  • Certain errors or exceptional circumstances are reviewed on a case-by-case basis

qualifying events checklist

Can you prove your eligibility?

Please note that the U.S. Department of Health & Human Services (HHS) has been reviewing the eligibility criteria for Special Enrollment very closely, amid concerns from insurers that enforcement was too lax in 2014 and 2015. So now it is more important to be prepared to submit proof of the qualifying event to the exchange.

In case you are unable to apply for an ACA-compliant policy, you can consider getting a short-term policy. This, however, is not considered as minimum essential coverage, and you might have to pay a penalty if this coverage is for more than three months.

Other disadvantages are as follows:

This is most suitable for those who have less than three months for the remainder of the year until the next open enrollment begins.



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