What to Do When You Miss Open Enrollment

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 Affordable Care Act (ACA) exchanges or directly from health insurance companies (ie, off-exchange).

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During an open enrollment period, eligible individuals 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, or during which an eligible individual can enroll (the exception to this is when the enrollee or eligible individual experiences a qualifying event).

When Is the Open Enrollment Period?

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 and their plan year, so it doesn't have to correspond with the calendar year.

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.

The open enrollment window for ACA-compliant plans in most states now runs from November 1 to December 15, with coverage effective the following January. But there are some state-run exchanges that have extended enrollment windows.

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. California, Colorado, and DC have permanently extended open enrollment.

Most of the other state-run exchanges tend to add at least a little extra time to the enrollment window each year. Twelve states and DC have their own state-run exchange platforms, while the other 38 states use HealthCare.gov. The enrollment window on HealthCare.gov ends December 15 each year, although a few extra days are sometimes added.

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.

This is how health insurance already worked for people with employer-sponsored coverage: Eligible employees could not be rejected or charged higher premiums based on their medical history, but enrollment was limited to their initial enrollment window, the annual open enrollment window, or special enrollment periods triggered by qualifying events.

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.

Missing Job-Based Open Enrollment

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 under 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 get divorced, this would trigger a special enrollment period that would allow you to enroll in your company's health plan right away.

Millions of Americans are experiencing job losses amid the COVID-19 pandemic, and many are losing their employer-sponsored insurance as a result.

There are a variety of options in this situation: COBRA or state continuation may be an option, but the coverage loss will also trigger a special enrollment period during which they can enroll in a spouse's plan if it's available, or buy a plan in the individual market.

Additionally, if you marry, have a child, or adopt a child, you could enroll your dependents right away during a special enrollment period.

These special enrollment periods also apply in the individual market. 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

Medicaid and Children's Health Insurance Program (CHIP) 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.

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 Other Plans

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 federal penalty for non-compliance has been reset to $0, so you won't be penalized for non-compliance unless you live in a state that has imposed its own individual mandate.

As of 2020, there is a penalty for being without minimum essential coverage in New Jersey, DC, Massachusetts, California, and Rhode Island. Having some coverage is generally better than having no coverage at all.

As of 2019, short-term plans can provide coverage for up to 364 days, although more than half of the states have regulations that limit short-term plans to three or six months, or 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, although pre-existing conditions are generally not covered at all under these plans.

Of the plans that aren't minimum essential coverage, short-term plans tend to be the closest thing to "real" insurance. However, short-term plans don't have to include the ACA's essential health benefits, and can still reject applicants with pre-existing conditions (and generally don't cover any pre-existing conditions, even if the application is accepted).

They can also impose caps on the benefits the insurance plan will pay. So read the fine print before you apply for a short-term health plan.

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  1. Norris, Louise. healthinsurance.org. California, Colorado, and DC: Open enrollment has been permanently extended. February 12, 2020.

  2. Medicaid.gov. Medicaid and CHIP eligibility levels.