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Getting Coverage Outside of Open Enrollment

Getting Coverage Outside of Open Enrollment

Getting Coverage Outside of Open Enrollment

Now that the Affordable Care Act (ACA), otherwise known as "Obama Care" is in full force, many people are finding themselves unable to get health insurance when they want it. Does that mean you have to go without any coverage until January 1st? Not necessarily.

The ACA limits enrollment in a qualified health plan to the Open Enrollment period which extends from Novermber 1st to January 31st for the 2016 coverage year. Outside of that window individuals must experience what is known as a qualifying event in order to enroll in a plan. 

A qualifying event may include losing group coverage, having your existing coverage canceled by the company, getting married or turning 27 and when you are no longer eligable for coverage under your parents' plan. Anyone who experiences this type of life-event qualifies for a special enrollemnt period which lasts for two months after the event occurs. 

What if I need coverage and I don't have a qualifying event?

There are still options available to you. Several companies have short-term plans available that can protect you until the next open enrollment. Similar to major medical in some ways, short-term plans have a few key differences that you should be aware of. 

1. Unlike ACA plans, short-term plans have a maximum life-time benefit. This is a lifetime limit on the amount a plan will pay in the case of extreme healthcare costs. 

2. Short-term plans do not have guaranteed eiligability. The new ACA law which does away with limitations on prexisting conditions only applies to major medical plans. Short-term plans are not subject to the same rules; therefore, you can be declined coverage for conditions such as diabetes, cancer, etc. 

3. Short-term plans generally do not pay for preventative care such as annual physicals. This type of coverage is not meant for regular maintance, but rather to protect individuals and families against catastrophic loss in the case of an accident or sickness. 

So while coverage options are available to you outside of annual enrollment, this coverage should not be treated or viewed as a permanent solution.