I Missed Obamacare Open Enrollment. What Now?

Miss open enrollment for Obamacare? You still have options. Image © Hans Neleman/Taxi/Getty Images

If you missed open enrollment on your state’s Affordable Care Act health insurance exchange, you'll need to get health insurance some other way or prepare to be uninsured until the next enrollment opportunity.

And in a few states (DC, New Jersey, Massachusetts, and starting in 2020, Rhode Island and California), you may face a tax penalty for the months you don't have health insurance. You can either budget for this or try to get an exemption so you won’t owe the penalty (as of 2019, there is no longer a federal penalty for being uninsured).

How to Get Health Insurance If You Missed Obamacare Open Enrollment

If you missed open enrollment in the individual health insurance market, you don’t have a lot of other options, but you do have a few. Here are some of your alternatives for getting health insurance.

Special enrollment period: If you have a qualifying event, you may be eligible for a special enrollment period through your state's health insurance exchange or directly through an insurer that offers plans in your area. Special enrollment periods are usually triggered by life-events that change the size of your family or your location, or cause you to lose other health insurance.

For example, you may have a qualifying triggering event if you get married or have a baby. If you or your spouse lose the job that provided your health insurance, your loss of coverage will be a qualifying event. If you no longer qualify for Medicaid coverage because your income went up, losing your Medicaid coverage will be a qualifying event.

Here's a full list of all the qualifying events in the individual health insurance market. Most of them apply both on and off-exchange, although a few only apply in the exchanges. 

HealthCare.gov and many of the state-run exchanges have stepped-up eligibility verification for special enrollment periods, so be prepared to provide proof of your qualifying event. And although a permanent move to a new area (where different health plans are available) is a qualifying event, it only triggers a special enrollment period if you already had coverage prior to the move. This rule change went into effect in 2016, and prevents uninsured people from moving to a new location in order to gain access to health insurance.

Additional rule changes were implemented in 2017, including a requirement that at least one spouse in a newly-married couple had to be insured prior to the wedding (with a few exceptions) in order for the couple to qualify for a special enrollment period. In addition, new rules make it harder to switch to a plan at a different metal level during a special enrollment period

Medicaid: If you’re eligible, you can enroll in Medicaid or enroll your kids in the Children’s Health Insurance Program (CHIP) at any time. You don’t have to wait for open enrollment on your health insurance exchange. To be eligible for Medicaid you must meet low-income guidelines in your state. Some states require you to meet other eligibility criteria in addition to having a low income. Your kids might be eligible for CHIP even if you’re not eligible for Medicaid, as the eligibility guidelines for CHIP tend to be quite a bit more generous than Medicaid eligibility for adults.

If you're in Minnesota or New York and your income doesn't exceed 200 percent of the federal poverty level, you can enroll in the state's Basic Health Program; enrollment in those plans continues year-round. If you're in Massachusetts, your income doesn't exceed 300 percent of the federal poverty level, you're eligible for ConnectorCare coverage. Enrollment is available year-round, if you're either newly-eligible for ConnectorCare or you haven't enrolled in the past.

You can apply for Medicaid, learn about the eligibility criteria, and learn about low-income guidelines in your state by contacting your state’s health insurance exchange. Or, if you prefer to contact your state’s Medicaid program directly, you can look up contact information by clicking on your state at the website of the National Association of Medicaid Directors.

In Minnesota, the Basic Health Program is called MinnesotaCare.

In New York, the Basic Health Program is called The Essential Plan.

In Massachusetts, ConnectorCare is available to people with income up to 300 percent of the poverty level.

Job-based health insurance: If you missed Obamacare open enrollment, you’ll still be eligible for job-based health insurance when you get a job with insurance benefits. Although there’s usually a short waiting period before new hires are eligible for health insurance, the ACA limits it to no more than three months.

Short-Term Health Insurance: If short-term health insurance plans are available in your area, you can enroll at any time. However, short-term policies don't provide all of the consumer protections that more comprehensive policies provide. For example, your pre-existing conditions will most likely be excluded from coverage and the policy will almost certainly have a maximum benefit limit (these aren't allowed anymore under the ACA, but short-term health insurance isn't regulated by the ACA). Short-term health plans also are not required to cover the ACA's essential health benefits, and they still use medical underwriting, which means your application can be rejected altogether depending on your medical history.

HHS implemented new rules starting in 2017 that limited short-term plans to no more than three months in duration, although the Trump administration changed the rules, as of late 2018, to allow short-term plans to have initial terms of up to 364 days and total duration, including renewals, of up to 36 months. More than half the states have stricter rules, however, and there are 10 states where short-term plans aren't available at all, either because the state has banned them or implemented rules that are unappealing to short-term health insurers.

I’m Going to Be Uninsured. What Now?

If none of the above options work for you and you’re going to be uninsured until next year’s Obamacare open enrollment, get to know your local free clinic or Community Health Center. The Affordable Care Act increased funding to Community Health Centers to help them care for folks without health insurance.

Better prepare for being uninsured using this toolkit for going without health insurance.

Will I Have to Pay a Tax Penalty for Being Uninsured?

The Affordable Care Act’s individual mandate says all legal residents of the United States have to have health insurance or pay a tax penalty called the individual shared responsibility payment. However, the penalty was eliminated after the end of 2018—there is still technically a mandate, but no penalty for non-compliance as of 2019.

Some states have taken action to impose state-based individual mandates with penalties for non-compliance. If you live in DC, Massachusetts, or New Jersey, there's a penalty for being uninsured in 2019. Rhode Island and California will start to impose a penalty for being uninsured as of 2020, and other states may follow suit in future years.

All of the state-based individual mandates include exemptions that are similar to the exemptions that applied to the federal mandate penalty. If you're in a state that has its own individual mandate penalty, you'll want to check with the state to see exactly how it works and whether you can qualify for an exemption.

When Is My Next Chance to Enroll in an ACA-Compliant Individual Market Plan?

In most states, open enrollment for 2020 coverage will begin on November 1, 2019 and will end December 15, 2019, with all plans effective January 1, 2019. California, Colorado, and DC have permanently extended open enrollment, and other states with fully state-run exchanges also have the option to issue extensions.

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Article Sources

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