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Can I Get Health Insurance Outside Of The Enrollment Window

    You may need to provide documentation that proves your eligibility for enrollment, based on a life event that you have experienced. The amount of time it takes for the insurer to verify your eligibility to enroll can vary from one insurer to another. Except for applying for Medicaid or CHIP, you cannot make changes to your insurance plan outside of open enrollment unless you have experienced a qualifying life event.

    People who are eligible for Medicaid or CHIP also may sign up anytime. If you are eligible for either of those lower-income programs, you also might be able to extend eligibility to some parts of Medicare, beyond the normal enrollment periods described above. If you do not have low income (you are eligible for programs such as Medicaid, the Medicare Savings Program, or Extra Help with Part D), enrolling later in any part of Medicare B can lead to higher premiums, according to medicare.gov.

    While your Special Enrollment Period would provide you with an opportunity to enroll outside of an exchange, if you choose, you cannot receive a subsidy to help you pay for health insurance that is not purchased through your exchange (but, again, there is another subsidy, provided through the American Rescue Plan, that would cover the cost of COBRA coverage or continuation coverage from your state until September 2021). If your income qualifies you for an ACA premium subsidy, it is critical to enroll through your states marketplace during open enrollment (or the special enrollment period caused by a qualifying event, such as losing access to employer-sponsored health insurance); otherwise, you lose access to comprehensive health coverage and a tax credit).

    Certain qualifying events trigger a Special Enrollment Period (SEP) that allows you to sign up for a plan either through your states health insurance exchange, or directly with a health insurer on the non-exchange market (no financial help is available beyond the exchange). You can get health insurance, or change a federal Health Insurance Marketplace plan, beyond the open enrollment period only if you have experienced at least one life event that qualifies for the Special Enrollment Period.

    Although losing existing minimum essential coverage is a qualified event that triggers the special open enrollment period for ACA-compliant individual-market plans, short-term policies are not considered minimum essential coverage, so losing your short-term plan is not a qualified event. However, losing a short-term plan is a qualified event for employer-sponsored coverage, so you will be eligible to enroll in an employer-sponsored plan at the end of your short-term plan. Although loss of existing minimum essential coverage is a qualifying event that triggers a special open enrollment period for ACA-compliant individual market plans, short-term policies are not considered minimum essential coverage, so the loss of short-term coverage is not a qualifying event (loss of a short-term plan is a qualifying event for employer-sponsored coverage, however, so you would be able to enroll in your employers plan when you short-term plan ends ). Note that Idaho has a waiver that applies to individuals with a minimum of 11 months of continuous coverage on an Enhancing Short-Term Plan. Because leaving your parents health insurance plan is a qualifying life event, Max may sign up for Maxs employers plan on or before the day after your parents coverage ends (either on your 26th birthday or the last day of a calendar month).

    If you do not meet SEP eligibility and choose not to apply for the short-term health plan, you will need to wait until open enrollment in 2022, which begins in the fall of 2021. For individuals who did not sign up for coverage in open enrollment or a COVID-related enrollment window, are not eligible for employer-sponsored insurance or Medicaid/CHIP, and are not expecting to experience a qualifying event in the later part of the year, 2021 coverage options are limited to policies that are unregulated under the ACA and therefore are not considered a minimum-essential-coverage-level coverage under the ACA.

    If you applied for Medicaid during open enrollment and were denied, you have 60 days following your denial to enroll in another health insurance plan; if this happens, your new coverage may go into effect on the first day of the month following your enrollment in a new plan. During this six-week period, customers are offered an opportunity to enroll in a new health plan, change their current health plan to a new plan, and/or apply for cost assistance. If you lost health coverage and are looking for a replacement plan, you might be alarmed to hear that your state health insurance exchange (and off-exchange marketplace, in which you purchase insurance directly from an insurance company rather than through the exchange) limits plans purchased during an annual open enrollment period.

    Because enrollees can buy into faith-based health care any time of the year, faith-based plans provide an alternative coverage source for those who miss their open enrollment deadline. Although not required to cover essential health benefits required under the Affordable Care Act, faith-based plans are grandfathered into the ACA, so members of a faith-based plan are exempt from paying the individual mandate penalty if imposed. While these plans do not cover essential health benefits, and therefore are not ACA-compliant, they cover a broad array of services, and they offer some level of financial security should an unexpected emergency room visit become necessary.

    A short-term health plan typically has a shorter acceptance periodA Some plans have a next-day acceptance periodA and may give you a certain amount of coverage while youare waiting for your major medical plan to become approved. Your employer might have several options on when youare eligible to begin individual coverage under an HRA or QSEHRA, so that you can get more time to sign up. For most commonly occurring special enrollment events, like losing your insurance, you may also be able to enroll up to 60 days before your special enrollment event.

    You may be eligible for the Special Enrollment Period if you or someone in your household has recently gained access to a single-coverage HRA or qualified small employer health reimbursement arrangement (QSEHRA) within the last 60 days, or you anticipate doing so within the next 60 days. Loss of employment-based coverage You may qualify for a Special Enrollment Period if you lost health insurance coverage through your employer or through the employer of a family member, including if you lost health insurance coverage through your parent or guardian due to the fact that you are no longer a dependent. Members may qualify to change plans outside of Open Enrollment, but will have to contact HPR (866-608-9422) to find out if they are eligible.

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