The Affordable Care Act brought the concept of buying independent plans, rather than relying solely on employer-provided group plans, to the forefront for many healthcare consumers. This shift in approach has led to several recurring inquiries that licensed insurance brokers encounter. Common questions include, ‘When can one purchase individual and family insurance plans?‘ and ‘Is the purchasing process ongoing throughout the year, or does it have specific timeframes?’
To address the query, ‘Is it possible to purchase health insurance at any time?’ it is essential to grasp the mechanics of both open and special enrollment periods.
What is Private Health Insurance?
Private health insurance is an individual-based coverage option distinct from group plans. The most optimal private health insurance policies are accessible outside the insurance marketplace for individuals to purchase. These policies cater to individuals or families and have the capacity to bridge the gaps left by group policies and Medicare/Medicaid. Additionally, private health insurance policies often encompass a more extensive array of benefits.
When do you need Private Health Insurance?
Several circumstances may need the acquisition of private health insurance coverage. The loss of COBRA coverage, whether due to benefits depletion or employer premium cessation, can prompt the need for individual health insurance. Life events such as marriage or the acquisition of dependents can also trigger the requirement for a private policy. Individuals beyond the age of 26, thus ineligible for their parents’ group policy, may find private health insurance essential. Self-employment or unemployment likewise mandates the procurement of personal coverage. In transitional periods, such as between jobs, a short-term health insurance policy might be sufficient.
Can I Buy Health Insurance At Any Time?
Getting private health insurance coverage follows open enrollment protocols, akin to other health insurance types. In the case of a qualifying event, individuals have a 60-day window to apply for a qualified health insurance policy. While you might come across a desirable policy outside the open enrollment period, without a qualifying event, purchase is not feasible. Certain agencies might enable policy selection and partial payment of the private health insurance cost to secure the premium rate. However, the coverage’s activation awaits the conclusion of the open enrollment period.
For those seeking to purchase Obamacare-compliant health insurance for themselves or their family, established windows of opportunity exist. The Open Enrollment Period (OEP) offers everyone the chance to purchase or modify health insurance plans obtained from the exchange. Typically spanning 24/7 from November 1 to December 15, the annual OEP serves as a consistent event. Variations in this period can exist based on state regulations, so verifying the OEP dates specific to your state is recommended.
The annual OEP is the designated timeframe to acquire ACA-compliant Qualified Health Plans (QHPs) without complexity. It’s crucial to evaluate your options and apply for coverage before the OEP concludes. Special scenarios, however, permit the acquisition of these plans outside the open enrollment phase, particularly if eligibility for special enrollment arises due to a qualifying life event.
What if I wish to purchase health insurance outside of the open enrollment timeframe?
Following the closure of the Open Enrollment period, there is a shift in circumstances for individuals seeking individual or family health insurance. To procure ACA-compliant insurance plans through the exchange, one must meet the prerequisites for special enrollment. The Special Enrollment Period, as outlined by Healthcare.gov (the federal marketplace or exchange), pertains to the period beyond the open enrollment for private health insurance, during which individuals with unique situations can purchase individual and family policies.
Special enrollment eligibility is granted if a qualifying life event takes place. Several qualifying events encompass:
- Recent marriage
- Recent divorce
- Birth of a new baby
- Death of a current policyholder
- A change in residence, including:
- Relocation to a different zip code or county
- Arrival to the U.S.
- Shifting of residence for students
- Situations like transitioning from shelter living to an apartment
- Loss of current insurance coverage due to reasons like:
- Termination of job-based coverage
- Discontinuation of the existing individual or family plan through no fault of your own (e.g., insurance provider discontinuation or loss of access to a student plan)
- Note: Failing to pay premiums or voluntary insurance termination does not grant special enrollment. Such cases require waiting until the subsequent open enrollment period to secure insurance.
- Loss of Medicaid, Medicare, or CHP coverage
- Loss of coverage provided by a family member (e.g., turning 27 and losing coverage under a parent’s plan)
In most cases, there’s a 60-day window post the qualifying life event during which you can apply for a new qualified health insurance plan.
Should uncertainty persist regarding your qualification for special enrollment, an eHealth licensed insurance broker can provide assistance in clarifying eligibility and aiding in the selection of an ACA-compliant plan if eligibility criteria are met.
What if I’m ineligible for special enrollment?
In the event that you do not meet the requirements for special enrollment, there are still several avenues available to ensure coverage until the subsequent open enrollment phase. We offer alternative options designed to alleviate the interim period, including short-term health insurance and discount prescription drug plans. While these alternatives do not adhere to Obamacare regulations, they can serve as viable substitutes for individuals seeking some form of medical coverage.
It’s important to note that these alternatives might encompass products that extend beyond health insurance, essentially serving as supplementary offerings. However, it’s essential to recognize that non-Obamacare products won’t shield you from potential fines associated with lacking insurance. Furthermore, non-Obamacare insurance plans bear certain limitations: they are not obligated to furnish the minimum essential benefits mandated by Obamacare, they might exclude coverage for pre-existing conditions, and they do not qualify for government subsidies or tax credits.
Ready to start a plan? Call us (971) 233-3637. Our assistance is at no cost to you.