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Can I Sign Up For Health Insurance After Open Enrollment?

When the Affordable Care Act was signed back in 2010, the way that Texans bought individual health insurance changed. Purchasing an "exchange" health insurance policy only occurred during the last two months of the year and became effective on the following January 1st. Barring a couple of exclusions. This Open Enrollment Period was modeled after Medicare annual enrollment and proved to be good for insurers, while sometimes frustrating for insureds. Now several years later, one of the most frequent questions that we are asked is "can I sign up for health insurance after open enrollment".

Yes, You Can Sign Up For Health Insurance Outside Of Open Enrollment

While Open Enrollment still exists for the health insurance exchange policies, there are multiple ways to secure health insurance coverage outside of the open enrollment period. There are three main ways to get that coverage while not paying attention to the open enrollment period.

  1. Qualifying Life Event
  2. Short Term Medical
  3. Catastrophic Health Insurance

What Is A Qualifying Life Event

A Qualifying Life Event is a major change in your situation that qualifies you to enroll in an health insurance exchange policy outside of the time period. These events will be categorized into four main buckets and only apply to policies sold on the exchange.

  • Loss of Health Insurance Coverage - could be due to job change, COBRA loss, eligibility changes in Medicare/Medicaid/CHIP, or turning 26.
  • Changes In Household - Marriage/Divorce, having a child/adoption, or a death in the family.
  • Change in Residence - if you move to a different state, change college, or other changes such as migrant workers or moving from a shelter.
  • Other Events - becoming a citizen, income changes, leaving jail just to name a few.

The other two options listed above are coverage that doesn't have an open enrollment period at all. That is the good news. But with everything insurance related, there is always a BUT it seems. Let's look at each of the other two options.

What Is A Short Term Medical Plan

Short Term Medical plans were originally put in place when the exchange health insurance plans were rolled out. They were designed to cover gaps between health insurance coverage ending and open enrollment starting when a Qualifying Life Event didn't occur. The primary issue here was COBRA benefits running out from a previous employer. These plans have morphed over time, and can now be a longer term solution with the following conditions and benefits.

  • These plans are underwritten and can therefore exclude pre-existing conditions.
  • These health insurance policies can last no more than 364 days and then must be re-written.
    • The initial policy and subsequent re-writes can total three years.
  • These health insurance policies do not meet Affordable Care Act guidelines for covering the Minimum Essential Components.
    • This means you may not receive maternity benefits, covered wellness visits, or other preventive measures like vaccines.
    • Prescription Benefits will vary greatly by company.
  • These plans have VERY flexible deductibles and maximum out of pocket costs. This makes them appealing to a wide variety of people.
    • Some can include traditional co-pays for Primary Care visits.
  • These health insurance policies are in fact insurance, unlike healthcare sharing plans. That makes your ability to manage costs via a PPO network easier.

Does Catastrophic Health Insurance Exist In Texas

The other option available to you is a Catastrophic Health Insurance plan. These health insurance policies are a throw back to times gone by where you pay for your primary care out of your own pocket. The policy is truly designed to take care of the big items rather than involving insurance in the day to day of care.

  • These plans are underwritten and can therefore exclude pre-existing conditions.
  • These health insurance policies do not have time restrictions like the Short Term Medical policies.
  • These health insurance policies do not meet Affordable Care Act guidelines for covering the Minimum Essential Components.
    • This means you may not receive maternity benefits.
    • Since Primary Care is not covered by the policy, covered wellness visits or other preventive measures like vaccines will not be included.
    • Prescription Benefits will vary greatly by company.
  • These plans have VERY flexible deductibles and maximum out of pocket costs. This makes them appealing to a wide variety of people.
  • Since your Primary Care visits are not covered by the plan, it pairs well with a scenario like Direct Primary Care.
  • These health insurance policies are in fact insurance, unlike healthcare sharing plans. That makes your ability to manage costs easier.

If you find yourself seeking individual health insurance on the open market, it's important to understand what all of your options are for you and your family. Insurance For Texans works with many carriers to make sure you get the coverage you need in the most effective way for you. Schedule a time to talk with one of our agents today!

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