So, you've missed the deadline to sign up for a 2017 health insurance plan—don’t panic! We’ll walk you through the steps you need to take to acquire health coverage now that Open Enrollment has ended.
Determine Whether You Qualify for a Special Enrollment Period
A Special Enrollment Period (SEP) is a window of time outside of the annual Open Enrollment Period in which individuals who have had a recent, qualifying life event or circumstance can obtain health insurance coverage.
If you qualify for an SEP, you’ll have up to 60 days after the event has occurred to enroll in a plan.
Some examples of qualifying life events include:
- A loss of health coverage
- A change in household size (marriage, birth or adoption, divorce, death)
- A change in residence
Qualifying life circumstances include:
- Becoming a U.S. citizen, national, or lawfully-present individual
- Being released from incarceration
- Starting or ending your AmeriCorps service
- Being an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
- Being a member in a federally-recognized tribe
- Changes that make you no longer eligible for Medicaid or the Children’s Health Insurance Program (CHIP)
If you do qualify for an SEP, then you can and should purchase a qualifying health plan that meets the ACA's minimum essential requirements.
Determine Whether You Qualify for Medicaid or CHIP
If you don't qualify for a Special Enrollment Period, you may be eligible for Medicaid or the Children’s Health Insurance Program (CHIP) . You can apply to these programs at any time.
If You Need to Appeal a Marketplace Decision
If you feel that you’ve been unfairly rejected for Marketplace coverage, you can appeal a decision by writing a letter to:
Health Insurance Marketplace
465 Industrial Boulevard
London, KY 40750-0061
You can also submit an appeal request form. Download an appeal request form for your state from healthcare.gov.
If You Don't Qualify for a Special Enrollment Period, Medicaid, or CHIP
If you’ve missed the Open Enrollment Period and you do not qualify for any of these special circumstances, you’ll still need to obtain some type of health coverage for yourself and your family for 2017. After all, treating an unexpected—and uncovered—illness or injury can be costly, and going without insurance is taking an avoidable financial risk.
The good news? While you may have missed the deadline to enroll in an ACA-compliant healthcare plan, you may still be eligible for a short-term medical (STM) insurance policy. These types of policies were created for circumstances exactly like this one—in fact, if you don’t qualify for an SEP, then short-term medical insurance is your only coverage option outside of Open Enrollment.
If you purchase a short-term policy, you’ll be covered for eligible costs resulting from unexpected ailments, such as emergency room visits, hospitalizations, outpatient surgery, and lab/X-ray fees. Coverage is available for a period of time less than 3 months.
Please note that STM can be purchased outside the Open Enrollment Period because it exists outside the scope of the Affordable Care Act. This means that STM does not cover pre-existing conditions, it cannot be renewed, it is not guaranteed issue, and it does not count as minimum essential coverage.
These types of policies have these limitations due to their nature as gap-fillers for brief timespans when you would otherwise be uninsured.
- Short Term Medical Insurance
- ACA Options and Temporary Insurance
- ACA Requirements for Employers
- ACA Waiting Period
- Health Care Sharing Groups
- ACA Frequently Asked Questions
- What to Do if You Miss Open Enrollment
- Should You Keep a Non-Compliant Policy?
- ACA Coverage Purchasing Options
- How STM Can Benefit Consumers During ACA Enrollment Gaps
Tokio Marine HCC - MIS Group international insurance products are underwritten by Lloyd's. Tokio Marine HCC - Medical Insurance Services Group (MIS Group) is a service company and a member of the Tokio Marine HCC group of companies. Tokio Marine HCC - MIS Group has authority to enter into contracts of insurance on behalf of the Lloyd's underwriting members of Lloyd's Syndicate 4141, which is managed by HCC Underwriting Agency Ltd.