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 individual/family health insurance through the Affordable Care Act (ACA) exchanges or directly from health insurance companies (ie, off-exchange).

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).

For employer-sponsored plans, open enrollment is also the only time that coverage can be dropped without a qualifying event. But coverage purchased in the individual/family market (on-exchange or off-exchange) can be dropped at any time, without the need for 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 for only a few weeks. 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 healthcare 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).

As of 2023, DC and 17 states run their own exchanges. States that run their own exchanges have the option set their own open enrollment deadlines, and several have opted to extend open enrollment to the end of January or even later.

Prior to the 2022 plan year, state-run exchanges could have open enrollment periods that were longer than the window established by the federal government, but not shorter. But when the federal government issued regulations in the summer of 2021 to extend open enrollment through January 15 (it had previously ended December 15), they noted that state-run exchanges would be allowed to have a shorter window as long as their deadline wasn't earlier than December 15.

Idaho's state-run exchange has opted for a December 15 deadline, although the other 17 state-run exchanges all chose to either align with the federal government's deadline (January 15) or use a later deadline.

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 until the next annual enrollment window. But if you were already enrolled last year, your plan likely automatically renewed for this year if you didn't make any changes during your employer's open enrollment period.

Some organizations are more lenient than others about open enrollment (for example, offering a longer enrollment period), 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.

If your employer offers a flexible spending account (FSA), you normally have to make your FSA decisions during open enrollment as well (whether to participate, and how much to contribute).

These elections are normally irrevocable during the plan year unless you have a qualifying event. But as a result of the COVID pandemic, these rules were relaxed a bit for 2020, 2021, and 2022. Employers were allowed (but not required) to permit employees to make changes to their FSA contributions any time during the plan year in those years, without a qualifying event.

For 2023, however, the normal rules are again applicable. This means that your decision (during open enrollment) about whether to participate in your employer's FSA, and if so, how much you'll contribute, will be irrevocable for the whole plan year unless you experience a qualifying life event.

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 have experienced job losses amid the COVID-19 pandemic, and many have lost 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.

However, Native Americans can enroll in a health plan through the exchange at any time, without needing a qualifying event.

Through at least 2025, there's an ongoing special enrollment period for people with household income that doesn't exceed 150% of the federal poverty level.

And if you're in New York or Minnesota and your income doesn't exceed 200% of the poverty level, Basic Health Program coverage is available year-round.

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 (this chart shows income limits for eligibility in each state as a percentage of the poverty level). 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, health care sharing ministry 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 (requirement that people maintain health insurance). But the federal penalty for non-compliance has been set at $0 since 2019, so you won't be penalized for non-compliance unless you live in a state that has imposed its own individual mandate.

(Note that when the individual mandate was federally enforced, there was an exemption for people enrolled in health care sharing ministry plans; the plans are not considered health insurance, but members were not subject to a penalty).

As of 2023, there is a penalty for being without minimum essential coverage in New Jersey, DC, Massachusetts, California, and Rhode Island. Short-term health insurance is not available in any of those states, but other types of non-ACA-compliant coverage may be available, and having some coverage is generally better than having no coverage at all, even if you'll still be subject to a penalty.

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 although a short-term plan might work in a pinch to get you through until the next open enrollment period, you'll want to carefully read the fine print before you apply for a plan.

Summary

Open enrollment is an annual window when you can enroll in health coverage, switch to a different plan, or drop your coverage (that last point is only applicable if you have an employer-sponsored plan; self-purchased individual/family plans can be dropped at any time).

If you miss open enrollment, you may find that you cannot enroll or make changes to your coverage until the following year. But qualifying life events can trigger a special enrollment period that will allow for mid-year enrollments and plan changes. And some people, including Native Americans and those who are eligible for Medicaid or CHIP, can enroll in coverage anytime.

There are also various health plans (most of which are not sufficient to serve as stand-alone coverage) that can be purchased year-round, although these plans tend to provide fairly limited benefits and generally do not provide coverage for pre-existing conditions.

A Word From Verywell

If you've missed open enrollment and still need health insurance, don't give up. You may find that you're eligible for Medicaid, CHIP, or Basic Health Program coverage, depending on where you live and your income. You may also be able to enroll in coverage if you experience certain qualifying life events.

And as a last resort, you may find that you can enroll in a non-ACA-compliant plan (like short-term coverage, a fixed indemnity plan, or a health care sharing ministry plan) to get you through until the next open enrollment period. These plans are not adequate to serve as your only coverage for a long period of time, but they're better than nothing and can provide some coverage in a pinch.