What to Do When You Miss Benefits Open Enrollment

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Each year, employers with more than 50 employees that offer health benefits must offer an "open enrollment" period (most small employers also offer an open enrollment period).

Open enrollment is also available for individuals or families who buy their own health insurance through the ACA exchanges or directly from health insurance companies (ie, off-exchange).

During an open enrollment period, health care recipients can opt in or out of plans, or make changes to the plan they currently have. Rates are reassessed during this period, and health plan prices are often altered for the coming benefit year (this usually corresponds to the calendar year, but in the case of employer-sponsored plans, it doesn't have to).

Typically, this open enrollment period is the only period of time throughout the year during which changes can be made to an enrollee's coverage (the exception to this is when the enrollee experiences a qualifying event).

When Does Open Enrollment Take Place?

If you get your health benefits through your job, your annual open enrollment period may last a few weeks or often a month. The open enrollment period typically occurs sometime in the fall, but employers have flexibility in terms of scheduling open enrollment. Your company should notify you about your open enrollment period. Contact your Human Resources department if you are unsure or seek further information about your company’s health care plans and policies.

If you buy your own health insurance and have an ACA-compliant plan—as opposed to something like a short-term health insurance policy or a limited benefit plan—you are also subject to open enrollment, as coverage is only available for purchase during that time (or during a special enrollment period if you have a qualifying event later in the year).

If that's the case, your open enrollment period is determined by the U.S. Department of Health and Human Services, under regulations pertaining to the Affordable Care Act (prior to 2014, there was no such thing as open enrollment for individual health insurance, but insurers in most states could reject applications from people with pre-existing conditions, or charge them higher premiums; coverage is now guaranteed issue, regardless of medical history, but enrollment is limited to open enrollment or special enrollment periods). 

For 2016 and 2017 coverage, open enrollment for individual market plans (on and off-exchange) ran from November 1 through January 31. Starting with 2018 coverage, however, the open enrollment window became much shorter. It now runs from November 1 to December 15, with coverage effective the following January. This is the schedule that was already slated to take effect beginning in the fall of 2018, but HHS moved it up by a year, implementing it in the fall of 2017.

States that run their own exchanges have the option to extend open enrollment by adding a special enrollment period, available to all residents, before or after the regularly scheduled enrollment period. For 2019 coverage, California and DC have announced that they'll continue to have open enrollment periods that last three months (in California, the three-month window has been made permanent, via legislation).

If you're on top of life's little details, you may be well aware of open enrollment. You may even re-assess your plan during that time each year. However, it is more than possible for an individual to forget about, or miss their open enrollment period. If you miss out, you have limited options.

I Missed My Job-Based Benefits Open Enrollment Period. What Can I Do?

If you miss your company's open enrollment period for health insurance benefits, you may be out of luck. If you have not already signed up for health insurance, there's a good chance you won't be able to do so this year. If you have automatic renewal, you will automatically re-up with the same plan you had last year.

Some organizations are more lenient than others about open enrollment, but very few will make special exceptions for someone who just forgot to show up, as exceptions are generally prohibited by the terms of the health insurance agreement.

Special Enrollment Period

If you miss open enrollment and weren't already enrolled in a plan that was automatically renewed, you may very well be without health insurance, unless you have recently experienced a significant, life-changing event that would trigger a special enrollment period.

A special enrollment period could be triggered if you are covered on someone else's plan and lose that coverage. For example, if you are covered under your spouse's plan and your spouse loses her job or you become divorced, this would trigger a special enrollment period that would allow you to enroll in your company's health plan right away.

Additionally, if you marry, have a child, or adopt a child, you could enroll your dependents right away in a special enrollment period. These special enrollment periods also apply in the individual market, so if you lose your job-based health insurance in the middle of the year, you're eligible to enroll in a plan through the exchange or directly through a health insurance company, despite the fact that open enrollment for the year has already ended.

If nothing has happened to trigger a special enrollment period, you will most likely have to wait until the next open enrollment period to sign up for health benefits or make a change to your existing benefits.

Enroll in Medicaid or CHIP If You're Eligible

Medicaid and CHIP (Children's Health Insurance Program) enrollment are available year-round. So if you or your kids are eligible, you can sign up anytime. Eligibility is based on income, and it varies considerably from one state to another. But you might find that the income limits for eligibility, especially for CHIP, are higher than you had expected. So if you're uninsured and have missed open enrollment, be sure to check to see if you or your kids might qualify for Medicaid or CHIP before you resign yourself to being uninsured for the rest of the year.

Consider a Plan That Isn't Minimum Essential Coverage

Plans that aren't minimum essential coverage, including short-term coverage, fixed indemnity plans, critical illness plans, accident supplements, etc. are not regulated by the Affordable Care Act, and allow year-round enrollment. If you rely on this type of plan as your only coverage, you're not in compliance with the ACA's individual mandate. But the penalty for non-compliance will be $0 starting in 2019. And having some coverage is generally better than having no coverage at all.

Of the plans that aren't minimum essential coverage, short-term plans tend to be the closest thing to "real" insurance. It's important to keep in mind, however, that short-term plans don't have to include the ACA's essential health benefits, can still reject applicants with pre-existing conditions (and generally don't cover any pre-existing conditions, even if the application is accepted), and can impose caps on the benefits the insurance plan will pay. So read the fine print before you apply for a short-term plan. And know that if you rely on a short-term plan in 2018, you'll owe the individual mandate penalty unless you qualify for an exemption.

In 2018, short-term plans are limited to three-month durations. But that is expected to be extended to 364 days under rules proposed by the Trump Administration. If the rules are finalized, longer short-term plans will become available in many states, although some states have regulations that will limit short-term plans to three or six months, or continue to prohibit them altogether. When and where short-term plans are available, however, they allow for next-day effective dates for applicants who are eligible for coverage.

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