What Should I Do if I Miss Open Enrollment for Health Care?
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If you neglect to sign up for health insurance during open enrollment, you may still be able to get coverage by qualifying for a special enrollment period, shopping for short-term health insurance, joining someone else’s plan or enrolling yourself or your dependents in Medicaid or the Children’s Health Insurance Program (CHIP).
Read below to learn the most important open enrollment dates you should try to commit to memory and to find out what happens if you miss open enrollment.
When Is Open Enrollment?
Open enrollment is a limited window of time when you can sign up for a new health insurance plan or change your existing coverage, which runs from November 1 to January 15 on the federal Health Insurance Marketplace. Your coverage will take effect at the beginning of the new year if you enroll by December 15, while it will start on February 1 if you enroll afterward. You should note that some states that operate their own health insurance exchanges have slightly different open enrollment dates.
If you receive coverage through your employer, your open enrollment period may also occur in the fall but won’t necessarily correspond with the Marketplace open enrollment period. As a result, you should contact your company’s human resources (HR) department for clarification regarding when you can enroll in employer-sponsored coverage. Keep in mind that your job-based health plan may have a shorter open enrollment period than the Marketplace, with most employers opting for a two-to-four-week open enrollment period.
Finally, there are also open enrollment dates to be aware of if you are eligible for Medicare. Original Medicare open enrollment lasts from October 15 to December 7, while Medicare Advantage open enrollment lasts from January 1 to March 31.
What Happens if You Miss Open Enrollment?
There isn’t explicitly a penalty for missing open enrollment but some states will charge you a fine if you fail to maintain coverage that complies with the requirements of the Affordable Care Act (ACA). See the below table for information about the states that impose penalties for not having health insurance.
$800 per adult and $400 per child or 2.5% of the amount of your gross income that exceeds your tax filing threshold based on your tax filing status and number of dependents, whichever is higher
District of Columbia
$695 per adult and $347.50 per child or 2.5% of your household income, whichever is higher
$24 to $183 per month depending on your income relative to the federal poverty level
$695 to $19,800 depending on your household income and number of dependents
$695 per adult and $347.50 per child or 2.5% of the amount of your household income that exceeds your tax filing threshold based on your tax filing status and number of dependents, whichever is higher
If you already have Marketplace health insurance and don’t take action during open enrollment, you will automatically be reenrolled in the same plan or a similar plan for next year. For this reason, missing open enrollment should only be a problem if you don’t already have a health plan or need to update your coverage.
How Do I Get Coverage if I Miss Open Enrollment?
You can change your health coverage at any point during the year if you qualify for a special enrollment period (SEP). SEPs are triggered by qualifying life events that significantly alter your health insurance needs. Examples of common qualifying life events include getting married, having children, moving to a new home and losing coverage due to the death of a family member.
You may also be able to buy coverage from a private insurance company outside of open enrollment. However, these off-Marketplace plans may not meet the ACA’s requirements for qualifying health coverage and you won’t be able to lower your premium through income-based tax credits like you might for a Marketplace plan.
What Happens if You Miss Open Enrollment at Work?
Missing open enrollment for your employer-sponsored group health insurance will generally leave you unable to add coverage or adjust your existing plan and you may even be stuck with your current coverage. Unlike Marketplace plans, which you can cancel at any time, employer-sponsored plans only allow you to drop coverage outside of open enrollment if you pay your premiums on a post-tax basis.
Employer-paid health plans may automatically renew like Marketplace plans, although you may want to check with your HR department so you can know for sure whether you risk losing coverage if you don’t take action during open enrollment.
In addition, you should keep in mind that starting a new job and becoming eligible for employer-provided coverage triggers an SEP. As a result, missing your job-based health plan’s open enrollment window may only be an issue if you declined to enroll when you first started the job.
How Do I Get Coverage if I Miss Open Enrollment at Work?
Even if you miss open enrollment at work, your employer should offer you an SEP lasting at least 30 days after you experience a qualifying life event. Alternatively, you could see if you are eligible for coverage through your spouse’s employer if their open enrollment period is still ongoing.
You could also get a Marketplace health insurance plan if open enrollment is ongoing or you are eligible for an SEP. However, your employer won’t contribute to the premium payments for an individual Marketplace plan like it would your job-based group plan, so you could end up paying more for coverage if you take this route.
Finally, if your employer doesn’t automatically renew your insurance and you end up losing coverage due to missing open enrollment, you should be able to get back on your parents’ health insurance if you are under the age of 26.
What Options Are Available if I Missed Open Enrollment?
If you have missed open enrollment, you may want to check to see if you or your dependents are eligible for Medicaid or CHIP. These government-funded programs provide subsidized coverage for low-income families and eligible people can enroll in them year round.
Another option is purchasing short-term health insurance to secure coverage that can tide you over until the next open enrollment period. However, you should be aware that short-term health plans may not provide the same level of coverage as ACA-compliant health plans and they are not available at all in some states with individual mandates such as California and New Jersey.
Finally, you may be able to enroll in one or more supplemental health insurance plans at any time. These types of plans cannot adequately replace major medical insurance but can at least provide limited coverage for specific situations. Examples of supplemental plans include critical illness insurance and hospital indemnity insurance.