Securing health insurance on your own is often a tricky proposition. Especially for those who have received coverage through an employer, understanding the terms, conditions, and other nuances in the insurance enrollment and use can leave people with more questions than answers.
December 15 Has Passed: Are You Out of Options?
Whether it’s the different metal levels that you’re comparing in the federal and state marketplaces and the cost sharing percentages involved with each, the process that goes into understanding premiums, deductibles, copays, and the like, or the different provider options you get from an HMO vs PPO, a lot of reading goes into the selection process.
But with December 15 in the rearview, your options for securing insurance in 2021 may have changed. For those outside of Minnesota (Dec. 22), Pennsylvania/Colorado/Nevada (Jan. 15), and California/D.C./New Jersey (Jan. 31), it may feel like you missed your opportunity to enroll in health insurance. After all, if you’re in the market for insurance, you may have read that on the Federal level and in many states, Open Enrollment for 2021 has closed.
But does that mean that you are out of options—left unable to enroll in health coverage until the next Open Enrollment period? Not at all. Better yet, without the individual mandate, you won’t get penalized for enrolling in “non-compliant” health plans.
Options for Health Insurance outside of Open Enrollment
Whether you find yourself eligible for a special enrollment period or seek an off-market plan, you do have options for securing insurance coverage in the 320 days per year that aren’t considered Open Enrollment.
Special Enrollment Period: Your Option for ACA-Compliant Coverage
There are many reasons to secure insurance on the federal or state marketplaces. Guaranteed health benefits (10 on the federal level and various options on the state level), a somewhat coherent system for choosing plans based on premiums and deductibles, and the availability of tax credits and subsidies alongside the consistency under political change, picking up marketplace coverage could be an acceptable option.
Qualifying Life Events
However, to secure coverage under the ACA, you will have to fit into a certain circumstance. These circumstances, called Qualifying Life Events, represent a change in someone’s situation that allows them to become eligible for a Special Enrollment Period, allowing someone to enroll in health insurance within a certain timeframe after such event happens.
Under the 2010 Affordable Care Act, those looking to enroll for health coverage on the insurance marketplaces have certain options for securing insurance in the event of the following:
- Loss in Coverage: Losing existing job-based, individual, and student health coverage, losing eligibility for Medicare, Medicaid, or CHIP, or losing health coverage after turning 26.
- Changes in Household: Getting married or divorced, having a baby or adopting a child, death in the family.
- Changes in Residence: Moving to a different ZIP code or county, a student moving to or from the place they attend school, a seasonal worker moving to or from the place they both live and work, moving to or from a shelter or other transitional housing
- Other Qualifying Life Events: Changes in income, gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder, becoming a U.S. Citizen, leaving incarceration, or beginning/ending AmeriCorps service.
Off-Marketplace Options: Short-Term, Direct, and More
For those who want a bit more flexibility and freedom, you do have options—if you know what you’re looking for. Whether it’s a short-term plan, a fixed benefit plan, an association plan, or one of the many other options you have, there are ways to get coverage built around your needs.
Something we’ve discussed in recent blogs, these are often viable and affordable, but you need to know the options you’re looking at—as well as the pros and cons for each. From pre-existing conditions to other nuances, it’s important to know how to get the most from each plan. Here are just some of the options you have for non-marketplace plans:
Short-Term Insurance
Short term health insurance is a type of health plan that can provide you with temporary medical coverage when you are between health plans, outside enrollment periods, and need coverage. Offering flexibility, timeframes on your terms, and more, you can learn more about short-term coverage here.
Direct Enrollment
The easiest way to secure coverage similar to a marketplace plan is to see which options are available from the insurer. However, with thousands of options, this is a benefit and a challenge—more options are great, but this also means more things to compare.
Healthcare Sharing Services
Commonly known as a cost-sharing ministry, these are faith-based organizations that incorporate like-minded individuals who agree to help each other with medical bill.
Fixed Benefit Plans
Another option for securing insurance outside of Open Enrollment is to look at a fixed benefit plan. Also known as fixed indemnity plans and GAP plans, these pay a set cash benefit for specific hospital or physician service provided. Often, these plans come without a deductible for services, provide benefits quickly or immediately, and will pay for themselves in one hospital stay.
Get Help with Selection: Insurance Broker Hub
Open Enrollment may have closed, but with the right partner in your corner, you can get the coverage you want and need. Insurance Broker Hub is here for you all year long to help. Whether you’re in need of a marketplace plan or one off marketplace, our thousands of experts have the knowledge and expertise to help.
With over 10,000 satisfied customers, our free service gives you access to an independent network of national brokers who have the experience and expertise to design a plan around your needs and budget. Ready to get started? Simply request a no obligation health insurance quote here.
