Jesse Smedley
Jesse Smedley is the Principal Broker for iHealthBrokers and the founder, president, and CEO of Smedley Insurance Group, Inc. and iHealthBrokers.com. Since the inception of SIG in 2007, Jesse has been dedicated to helping people save money on their health insurance by providing them with resources to educate themselves on all their health insurance options, both under age 65 and Medicare beneficiaries. He is featured in many publications as well as writes regularly for expert columns regarding health insurance and Medicare.
Uh oh! You missed open enrollment for a marketplace plan. What are your options (if any)?
Open Enrollment
Ok, so first and foremost remember that in most states open enrollment actually now goes from Nov. 1- January 15. So, this is a little longer than it used to be.
Of course, you need to enroll by December 15th for your coverage to become active January 1st, but you do still have until January 15th in most states.
Now some states actually do have their own marketplace as opposed to healthcare.gov and these states may have slightly different enrollment periods. So it is possible that you may not have even missed your state’s open enrollment.
Some states may start as early October. For others, open enrollment may actually extend through the end of January.
Now, if you have in fact missed your open enrollment, there may be options available to you.
Special Enrollment Period
The easiest way to enroll outside of the open enrollment period is through a special enrollment periods if you qualify based on what the marketplace considers “qualifying life events”
Generally speaking these break down into three categories:
- Change in Location
- Change in Household Size
- Loss of Health Insurance
But there are other, less commonly known occurrences that can trigger a special enrollment period. You can even appeal through healthcare.gov.
Remember, you will only have a 60 day window either before or after the SEP, depending upon the type of qualifying life event to enroll. If you miss that window, you may be out of luck!
Low Income SEP
You may also qualify for a new special enrollment period based on your income.
Currently, if you make less than 150% of the FPL then you are eligible for a special enrollment period. This provides more flexibility outside of the open enrollment period. However, this is a recent change and it is set to expire at the end of 2025.
Other Options
If none of these options are available to you, we would highly recommend that you do not forego insurance entirely. In an ideal world, you would enroll in full coverage, but if regular private insurance is not financially feasible, there are still other options.
Short term health insurance can be a low cost option for those who are in relatively good health. There is medical underwriting so pre-existing conditions will likely not be covered, but you will have access to flexibility and nationwide PPO coverage. For those who are relatively healthy, premiums do tend to be on the lower side.
You could also enroll in a hospital indemnity plan or critical illness plans. Based on the terms of your plan, you would receive a lump sum payout it had to be hospitalized or were diagnosed with a critical illness.
There’s also Medicaid or pregnancy medicaid if you qualify.
