FAIR Health Consumer Access

Getting Insured outside Open Enrollment Periods

As pleasant as summer can be, it’s usually not the right season for open enrollment—the period of time when you can enroll in or make changes to a health insurance plan. Open enrollment usually comes in the fall, but there are some special circumstances that let you enroll any time.

Job-Based Plans
If you’ve just started a new job, you usually can join a health plan offered by your firm. The season doesn’t matter. But once you’ve joined the plan, most employers only let you make changes to it between open enrollment periods in the case of certain life events. You can make coverage changes when such life events happen. Those events may include marriage or the birth of a child. At such times, you may wish to add a new dependent, and enroll yourself if you haven’t yet. They also may include loss of coverage under a spouse’s plan. That may prompt you to enroll in your employer’s plan. Other examples of these “qualifying status changes” include divorce, or death of a spouse or dependent. In most cases, you must let your employer know within 30 days of the life event. If you don’t, you have to wait until the next open enrollment period.

Health Insurance Marketplace Plans
Because of the COVID-19 public health emergency, New York State has been maintaining open enrollment for 2022 coverage through its state Health Insurance Marketplace. But other states and the federal government have closed open enrollment for 2022 coverage. Still, there’s a list of life changes that can qualify you for special enrollment periods for Marketplace plans. During those periods, you can enroll in or make changes to health coverage, even though it’s not open enrollment time. The life changes include:

• Loss of health insurance. For example, you may qualify if you lose a job, costing you your job-based coverage. Other examples include losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP). If you lose coverage through a family member, you may qualify for a special enrollment period. For example, you may turn 26 and no longer be on your parents’ plan. Or you may get divorced and no longer be on your spouse’s plan. The coverage loss must have happened in the last 60 days (or more than 60 days ago but since January 1, 2020). Or you must expect it to happen in the next 60 days.
• Changes in household size. Examples include getting married or having a baby. The change must have happened in the past 60 days.
• Changes in residence. Household moves may qualify you for a special enrollment period. Examples include moving to a new zip code or county. Or you may move to the United States from a foreign country. (If you move from a foreign country, you must be a US citizen or national or have one of several immigration statuses to use the Health Insurance Marketplace. See our Insurance Basics article Immigration and Health Insurance.)
• Other qualifying changes. Assorted other changes may qualify you for a special enrollment period, such as becoming a US citizen or leaving prison.
• Complex issues. There are several complicated or exceptional circumstances that may qualify you for special enrollment. One example would be if misinformation from an agent or broker kept you from enrolling during open enrollment. Another would be if a hurricane or other natural disaster prevented you from enrolling during open enrollment.

For the complete list of life changes that can qualify you for a special enrollment period, click here. That link also lets you answer a few questions to see if you qualify.

If You Don’t Qualify for Special Enrollment Periods
What if you’re uninsured, it’s not open enrollment and you don’t qualify for a special enrollment period? You still may be able to get insured. You can enroll in Medicaid or CHIP, programs for people with limited incomes, any time of year. And you can always buy a short-term, limited duration (STLD) health plan to cover you for a limited time. STLD coverage is permitted for up to 12 months. After that, the contract can be renewed for up to two years. STLD plans don’t have to cover the 10 “essential health benefits” required for plans sold on the Health Insurance Marketplace. They don’t have to cover preexisting conditions. And there are other differences from Marketplace plans to keep in mind. See our article Limited Health Plans: AHPs and STLD Plans. But an STLD plan may tide you over for a short time until the next open enrollment period.