How to Get Health Insurance After Open Enrollment

You have options for getting covered outside open enrollment

Fact checked by Betsy PetrickFact checked by Betsy Petrick

Open enrollment is an annual period of time during which you can apply for a health insurance plan on the federal health insurance Marketplace. It runs from November 1 to January 15. Workplace plans also have open enrollment periods that may vary. 

If you lost job-based coverage, moved, or experienced other life changes, you might need a new health insurance plan outside of open enrollment. Even if you just forgot to enroll, you have options for getting temporary coverage. Health insurance is essential for everyone, so it’s important to pick a plan as soon as possible if you’re losing coverage or are uninsured. We’ll go over your options, plus how to compare quotes and how to manage costs. 

Health Insurance Options After Open Enrollment

If you missed your chance to sign up for Marketplace coverage or your employer’s plan during open enrollment, you can still get a health insurance plan. The options available to you will depend on your individual circumstances. 

If you’re an American Indian or Alaska Native, you can enroll in Marketplace coverage at any time of the year. And if you qualify for Medicaid or your children qualify for the Children’s Health Insurance Program (CHIP), you can apply for coverage year-round as well. Otherwise, you’ll need to qualify for a special enrollment period to get Marketplace coverage.

Qualifying Life Events for Special Enrollment

• Marriage: If you got married, you can choose a new plan by the last day of the current month and coverage will start the first day of the next month.
• Birth of a child, adoption, or foster care placement: Your plan can start the day of the event if you enroll within 60 days of the event.
• Change in residence: If you moved to a new ZIP code or to the U.S. from a foreign country, or if you moved to or from the place you attend school, the place you live and work seasonally, or a shelter or other transitional housing, you qualify for a special enrollment period.
• Loss of health insurance coverage: You may have lost your Marketplace plan because someone covered on that plan died or there was a divorce. Or you may have lost job-based coverage, coverage through a family member, your eligibility for Medicaid or CHIP, or your eligibility for Medicare. Note that if you found out you were denied Medicaid after the open enrollment period was up, you can also get coverage during a special enrollment period lasting 60 days after you lose coverage (or, in some states, 60 days in advance of losing coverage). Your coverage will start the first day of the next month after you pick a plan. 
• Employer offer of HRA or QSEHRA: You’ll need to apply for a new plan by phone within 60 days of the offer. Check with your employer regarding your specific circumstances to determine when to enroll. 
• Other changes: If you gained U.S. citizenship, left incarceration, or ended certain service programs, you’re eligible for special enrollment.

Other Circumstances

If you were incapacitated or if your ability to enroll was impacted by a FEMA-designated natural disaster, including COVID-19, you have 60 days from the end of the incident to enroll in a Marketplace plan. Incapacitation can include having a temporary cognitive disability or being hospitalized during open enrollment. You can request your plan to start when it otherwise would have if you were not impacted by the incident. 

Additionally, if you weren’t able to enroll or get the assistance you qualified for because of misconduct, misinformation, misrepresentation, or inaction of someone helping you, or because of a technical error, you qualify for a special enrollment period. There are also a few other unusual circumstances that might make you eligible for a special enrollment period. 

Other Options After Open Enrollment

If you don’t qualify for special enrollment in a Marketplace health insurance plan based on any of the reasons mentioned above, see if you qualify for Medicaid or CHIP, which are available to low-income families. Or, if you turned 65 or have certain disabilities, Medicare may be newly available to you. 

If you don’t qualify for these options, your best bet is to apply for short-term health insurance coverage until open enrollment comes around, or until you qualify for special enrollment. Short-term health insurance plans have significant drawbacks when compared to Marketplace plans—they don’t cover pre-existing conditions and aren’t subject to laws regarding essential health coverage requirements, so the coverage may be relatively limited. But choosing a short-term health insurance plan is better than going uninsured. 

Compare Health Insurance Quotes

When comparing health insurance quotes, it’s important to consider your healthcare needs, which will impact your total out-of-pocket cost. The most comprehensive plans will have higher premiums but lower costs when you need care. If you don’t expect to need any healthcare services, you can opt for a plan with a low premium and a high deductible, but be aware that your healthcare situation could change. 

Below are short-term health insurance quotes from top companies along with Marketplace quotes from the best health insurance companies in Florida. 

*Quotes were collected for a single 35-year-old female non-smoker located in ZIP code 33101 earning $75,000 annually. The lowest premium plan was chosen from each company. 

If you need short-term health insurance coverage, be aware that most policies come with significant out-of-pocket costs. You should trim your budget while you’re on a short-term health plan and put extra money into a savings account each month in case you incur expensive medical bills. 

If you’re applying for a Marketplace plan, there’s a good chance you’ll qualify for financial assistance. In 2024, 92% of Marketplace enrollees received advanced premium tax credits. Keep in mind that you may also be eligible for cost-sharing reductions if you enroll in a silver plan. Still, you should make it a goal to keep your out-of-pocket maximum in a savings account in case you have a medical emergency. Check our guide to the most affordable health insurance companies to learn about budget-friendly options for coverage. 

Managing Healthcare Costs Without Insurance

If you don’t qualify for a special enrollment period and you can’t afford a short-term medical plan, you shouldn’t forgo care for a medical issue. There are ways you can access the health services you need, such as:

• Association health plans: These are group plans offered to members of certain professional associations that provide health benefits. Some may be legitimate, while others may be fraudulent. You should avoid relying on this type of benefit for your healthcare needs. 
• Health discount cards: You can purchase a medical discount card that may save you money at participating medical providers and pharmacies. But keep in mind that if you have a costly emergency, there won’t be a cap to how much you pay. 
• Cost-sharing programs: Medical cost-sharing plans are often faith-based programs that involve monthly payments to a pool of funds that can be accessed by members for covered healthcare needs. But these programs can leave participants with high medical bills and can still be costly. 
• Shopping around or negotiating medical bills: Online resources such as FAIR Health allow you to look up cost estimates across facilities and providers, which can help you choose the most affordable care. Your state may have online tools as well. You can also ask for an itemized bill and negotiate the charges, or use a service like Goodbill, which does that on your behalf in exchange for a share of your savings. 
• Community health clinics: The Health Resources Services Administration (HRSA) funds health centers that offer sliding-scale healthcare services. The lower your income, the less you’ll pay. Find a health center in your state. 
• Prescription drug discount programs: You can get free discount cards from companies like GoodRx which offer up to 80% savings at thousands of pharmacies. Amazon Prime members can also save on prescriptions. 
• Seeking financial assistance from hospitals: In many cases, hospitals are required to offer financial assistance programs to maintain nonprofit status benefits. Not all states have clear eligibility criteria, but some may require the lowest negotiated rate for anyone earning up to 250% of the federal poverty level, for example. 

Many of these alternatives are buyer beware. You should make every effort to access health insurance coverage before turning to these savings strategies. 

How to Apply for Coverage After Open Enrollment

• For Marketplace or Medicaid coverage: Visit Healthcare.gov to get started. If your state has its own healthcare marketplace, you’ll be redirected once you enter your ZIP code. Answer a few questions to make sure you’re eligible for special enrollment or Medicaid. You’ll need Social Security numbers for each person getting covered under the plan. You’ll also need to provide your address, an income estimate, and information about the people in your family and their previous coverage. 
• For short-term health insurance: Collect quotes from the best short-term health insurance companies and determine the best option for your healthcare needs. You can typically enroll in the policy and pay your first premium online. 

When Is Open Enrollment for Health Insurance?

Open enrollment for the health insurance Marketplace begins November 1 each year and ends January 15. To get health insurance coverage starting January 1, you must enroll by December 15. Otherwise, your coverage will start February 1. Employers may have different open enrollment periods for job-based health insurance plans.

What Are Qualifying Life Events for Health Insurance?

A qualifying life event for health insurance coverage is a change in your circumstances that qualifies you for a special enrollment period. These can include losing healthcare coverage, changing residences, getting married, or welcoming a child into your family. You’ll typically have 60 days after the event to enroll in a new plan.

Can You Get Health Insurance With a Pre-Existing Condition?

Yes, you can get health insurance with a pre-existing condition on the federal Marketplace or your state’s exchange. The Affordable Care Act prohibits health insurance companies from denying coverage to people with prior health conditions. However, short-term health insurance companies are not held to the same standard and can deny coverage for pre-existing conditions.

Can Health Insurance Companies Deny Coverage?

Thanks to the Affordable Care Act, health insurance companies on the federal Marketplace or your state’s exchange can’t deny you coverage because of your health. The only reason you might be denied coverage is if you try to enroll outside of open enrollment and you don’t qualify for a special enrollment period.

How Do I Get Financial Assistance for Health Insurance?

When you apply for health insurance on Healthcare.gov, your income estimate will determine your eligibility for financial assistance. If it’s offered, you’ll be able to enroll at a lower cost. You can also use this tool to find out if you’re eligible for Medicaid in your state and learn how to estimate your income. 

Read the original article on Investopedia.