Missed Open Enrollment? Here’s How to Get Covered Anyway

Open Enrollment and Non-ACA Plans for All Needs

Open Enrollment for health insurance

Open enrollment for health insurance is a designated period each year when individuals and families can sign up for or make changes to their health insurance plans. Here’s a closer look at what it involves:

Timing: Open enrollment typically occurs once a year, often toward the end of the calendar year. For most health insurance plans in the U.S., it usually runs from November to mid-December, with coverage starting January 1 of the following year.
Who It’s For: Open enrollment is an opportunity for people who don’t have health insurance through their employer or another qualifying provider (like Medicare or Medicaid) to obtain coverage. It’s also a chance for current policyholders to renew, change, or update their plans to fit their needs better.
What Can You Do During Open Enrollment:
- Sign Up: If you’re currently uninsured, this is the time to enroll in a plan.
- Switch Plans: If you’re already insured but want a different coverage option or provider, you can switch to a new plan during this period.
- Add or Drop Dependents: If your family situation has changed, you can add or remove dependents.
- Adjust Coverage Levels: If you need more (or less) coverage, you can explore different levels of plans that might suit your needs or budget better.
Financial Assistance: Many people qualify for financial assistance through government subsidies if they buy health insurance through the Health Insurance Marketplace (often called the Exchange). During open enrollment, you can see if you qualify for subsidies that can help reduce premium costs.
Missed Enrollment: If you miss the open enrollment period, you usually can’t get insurance until the next period unless you qualify for a Special Enrollment Period due to life events like marriage, childbirth, or losing other health coverage. I wll tell you more about how to enroll in health insurance later in this episode.

Open enrollment is an essential time to review and ensure you have the health coverage you need for the upcoming year, whether through the Health Insurance Marketplace, an employer, or other providers.

When did Open Enrollment begin?

Open enrollment periods for health insurance, particularly in the U.S., were established as a way to manage the enrollment process and ensure that coverage options remain accessible. Here’s a look at the history behind it:

1. Origins of Health Insurance in the U.S.

Health insurance in the U.S. dates back to the early 20th century, with early forms covering specific medical costs. By the mid-20th century, employer-sponsored health insurance became the norm, largely due to tax incentives and labor laws.

2. Affordable Care Act (ACA) and Open Enrollment

The idea of a specific open enrollment period took shape with the Affordable Care Act (ACA), enacted in 2010. The ACA aimed to reduce the number of uninsured individuals.
One key aspect of the ACA was establishing an open enrollment period. By restricting enrollment to a specific time each year, it helped insurers manage risk, reducing the possibility of people only signing up when they needed immediate healthcare.
The first ACA open enrollment period began in October 2013 for coverage starting in January 2014. This period allowed individuals and families to sign up through the Health Insurance Marketplace, with the option of financial assistance based on income.

3. Benefit of Open Enrollment

Encourage Preventive Care: When people commit to a full year of coverage, it encourages continuous preventive care and maintenance of their health, which can reduce overall healthcare costs and improve outcomes.

5. Open Enrollment Structure

Today, open enrollment typically starts in early November and runs through mid-December, with specific dates announced annually.

In essence, open enrollment periods under the ACA represent a structured approach to making health insurance accessible. This annual window encourages more individuals to maintain continuous coverage.

Can You Enroll in Health Insurance Outside of the ACA?

Yes, people can enroll in health insurance outside of the Affordable Care Act (ACA) Marketplace. Here are several ways individuals can obtain health insurance outside of ACA open enrollment:

1. Employer-Sponsored Health Insurance

Many people receive health insurance through their employers. Employers usually have their own open enrollment periods each year, during which employees can enroll in or make changes to their coverage.
If someone starts a new job or has a qualifying life event (like marriage or the birth of a child), they may be eligible to enroll in their employer’s health plan outside of the standard enrollment period.

2. Medicaid and the Children’s Health Insurance Program (CHIP)

Medicaid and CHIP are government programs that provide health coverage to low-income individuals and families, including children, pregnant women, the elderly, and people with disabilities.
There is no restricted enrollment period for Medicaid or CHIP; people can apply for these programs at any time of the year if they meet the eligibility requirements. Eligibility is based on income, family size, and other factors, which vary by state.

3. Medicare

Medicare, the federal health insurance program for people 65 and older and some younger people with disabilities, has its own enrollment periods, including:
- Initial Enrollment Period: When someone first becomes eligible for Medicare.
- Medicare General Enrollment Period: January 1 to March 31 each year for people who missed their initial enrollment.
- Medicare Open Enrollment Period: October 15 to December 7 each year, during which people can join or switch Medicare Advantage and prescription drug plans.
Medicare also allows for special enrollment periods based on certain life events or changes in eligibility.

4. Special Enrollment Periods (SEP)

For individuals buying insurance through the ACA Marketplace or directly from insurers, a Special Enrollment Period (SEP) allows enrollment outside of the open enrollment period if certain life events occur. Common qualifying events include:
- Marriage or divorce
- Having a baby or adopting a child
- Losing other health coverage (e.g., losing a job with insurance benefits)
- Moving to a new coverage area
SEPs typically allow people 60 days from the qualifying event to enroll in a plan.

5. Short-Term Health Insurance

Short-term health insurance plans provide temporary coverage, typically for up to 12 months and sometimes renewable for up to 36 months, depending on state regulations.
These plans are usually less expensive than ACA plans but do not cover the essential health benefits required under the ACA, such as maternity care or mental health services. They can, however, serve as a temporary solution for people who missed the open enrollment period or need coverage for a short time (e.g., between jobs).

6. Private Insurance Plans Outside the Marketplace

Individuals can purchase health insurance directly from private insurance companies instead of going through the ACA Marketplace. Some insurers offer plans that meet ACA requirements (like covering pre-existing conditions and essential benefits), while others may offer limited-coverage plans that do not meet ACA standards.
These plans can often be bought year-round, although certain plans might have enrollment restrictions.

7. Healthcare Sharing Ministries

Some individuals choose to join healthcare sharing ministries, which are nonprofit organizations where members contribute funds to cover each other’s medical expenses. These are not technically insurance and are not required to meet ACA standards but can provide a level of support for health costs.
These plans may have membership requirements, such as adherence to certain beliefs, and typically exclude coverage for pre-existing conditions or certain types of care.

While the ACA Marketplace has a specific open enrollment period, there are numerous other ways to obtain health insurance year-round, depending on an individual’s circumstances and needs.

Private health insurance for Solopreneurs

Open enrollment is the annual period when people can sign up for health insurance or make changes to their current plan. It’s the main time of the year when Americans can get coverage through ACA (Affordable Care Act) marketplaces, but it’s also a great time for solopreneurs and independent professionals to explore private health insurance options that could better fit their unique needs.

For solopreneurs, open enrollment can feel overwhelming because the ACA plans are often built with broader requirements that may include coverage you don’t need, resulting in higher premiums. If you’re a one-person business owner, you might be looking for flexibility—plans that only cover what’s essential for you without paying for services you don’t need.

At Health Solutions Today, we specializes in private health insurance plans specifically tailored for solopreneurs. These plans provide:

Customizable Coverage: Choose only the benefits that matter to you and avoid paying for mandatory coverages like maternity or certain preventive services that may be required by ACA plans.
More Affordable Options: Many solopreneurs find private plans to be a more budget-friendly alternative to ACA plans, especially if they’re not qualifying for subsidies.
Year-Round Support: Unlike the ACA, which is only accessible during open enrollment, our team is here to help year-round, ensuring you’re always supported, whether you need to adjust your coverage or have questions about your plan.

So, while open enrollment highlights ACA options, it’s also the ideal time for solopreneurs to consider flexible, private plans that provide essential health benefits tailored to your life and business needs.
Open enrollment is an essential time to make sure you have the right health coverage for the upcoming year. However, as a solopreneur, you might be looking for more flexible, cost-effective options outside of ACA plans. At Health Solutions Today, we specialize in private health insurance plans tailored just for solopreneurs. Get in touch with us to discover plans that cover only what you need, without unnecessary extras, and offer year-round support. Don’t miss out on securing the best coverage for your unique needs—contact us today to explore your options!