Each year, companies with over 50 employees offer employer-sponsored health insurance plans to make medical care affordable. Employees can enroll in this plan during the “open enrollment” window – a period of time when they are allowed to sign up or make changes to their health insurance plans. However, forgetting about or missing out on the open enrollment period is very possible; and missing out leaves you with limited options.

If you were unable to sign up for a plan during the open enrollment period, there is a chance you may not be insured for the year. But there are special exceptions that allow those who missed the open enrollment window to enroll. These exceptions generally revolve around significant life-changing (or qualifying) event.

What is a Life-changing Event for Health Insurance?

Life-changing events that can make you eligible for health insurance after the open enrollment window revolves around two major categories: basic life events or the loss of coverage.

Basic Life Events

Basic life events are situations that determine the eligibility or ineligibility of an individual for a health insurance plan. For instance, a spouse can be added to or deleted from a plan following marriage or divorce. After childbirth, the child can be added to the plan.

Other basic life events that could trigger a special 30-day window to effect a change include the adoption of a child, death of the spouse that provided the plan, death of a dependent, ineligibility of a dependent, or when dependent acquires different insurance.

Loss of Other Coverage

The 30-day special window may be triggered if an employee loses other coverage. If, for instance, the employee divorces his or her spouse, such spouse may be removed from their health insurance plan. Losses that can trigger special enrollment include separation, retirement, change of work status (from part-time to full-time), death of a spouse of a parent providing the coverage.

Options for Those Who Missed Out

  • Special Enrollment Period

If a life-changing (qualifying) event has caused you to miss out on the open enrollment window, a special enrollment period could be triggered. For instance, if your coverage is under your spouse’s plan and you get divorced or they lose their job, a special enrollment period will be triggered to allow you enroll in your company’s health insurance plan.

You could also enroll your dependents via the special enrollment window if you get married, bear a child, or adopt one. The special enrollment period also applies in the individual market; so, even if you lose your employment-based health insurance after the open enrollment window, you can still enroll in a plan directly through a health insurance company or via the exchange.

  • Medicaid or CHIP

Medicaid and CHIP (Children’s Health Insurance Program) are available at any time of the year. So, you can buy coverage for your kids if they are eligible. Income determines eligibility here, and this varies from state to state. But the income limits for eligibility may be higher than you expect, especially for the CHIP. But ensure you check to see if your kids qualify for CHIP or Medicaid if you have missed the open enrollment, so you do not stay uninsured for the year.

Explore Options outside a Minimum Essential Coverage

Consider plans that are not minimum essential coverage. These may include fixed indemnity plans, accident supplements, critical illness plans, short-term plans, etc. These plans are not regulated by the Affordable Care Act, and are available year-round.

If this type of plan is your only health insurance coverage, you wouldn’t be complying with the ACA’s mandate. But the good news is that there is no federal fee for non-compliance on individual mandates; what’s more, having some form of coverage is a lot better than having none at all. However, as of 2019, states like California, New Jersey, and Massachusetts penalize those without minimum essential coverage, and Rhode Island will join this group in 2020.

Short-term plans are a great option for those who missed the deadline, and they are the closest thing to “real” health insurance. It is available in all but ten states in the United States and can provide decent coverage if the only other option is to stay uninsured. However, it is important to note that they do not include the essential health benefits of the ACA, do not help you avoid being penalized for not having coverage, and can still reject applications of those with pre-existing conditions.