The Affordable Care Act brought the idea of purchasing individual plans to the forefront for many healthcare consumers instead of solely relying on group plans provided by employers. This change has led to common questions encountered by licensed insurance brokers. Some of these inquiries include: ‘When is it possible to buy individual and family insurance plans?’ and ‘Does the purchasing process continue throughout the year, or does it have specific timeframes?’
To address the question of whether health insurance can be bought at any time, it’s important to understand the mechanics of both open and special enrollment periods.
What is Private Health Insurance?
Private health insurance is a personal coverage option that differs from group plans. The best private health insurance policies are available for individuals to purchase outside the insurance marketplace. These policies cater to individuals or families and can fill gaps left by group policies and Medicare/Medicaid. Moreover, private health insurance policies often provide a broader range of benefits.
When is Private Health Insurance Needed?
Several situations may require obtaining private health insurance coverage. The loss of COBRA coverage due to benefits depletion or the employer ending premium contributions can necessitate individual health insurance. Life events like marriage or adding dependents can also trigger the need for a private policy. Individuals over the age of 26, and thus ineligible for their parents’ group policy, may find private health insurance necessary. Self-employment or unemployment also mandates obtaining personal coverage. During transitional periods such as job changes, a short-term health insurance policy might suffice.
Can I Purchase Health Insurance Anytime?
Getting private health insurance coverage follows open enrollment protocols, similar to other health insurance types. If a qualifying event occurs, individuals have a 60-day window to apply for a qualified health insurance policy. While you might find a desirable policy outside the open enrollment period, purchasing it without a qualifying event is not possible. Some agencies might allow policy selection and partial payment of the private health insurance cost to secure the premium rate. However, the coverage won’t activate until the open enrollment period ends.
For those looking to buy Obamacare-compliant health insurance for themselves or their family, established opportunities exist. The Open Enrollment Period (OEP) provides everyone the chance to purchase or modify health insurance plans acquired from the exchange. Typically spanning from November 1 to December 15, the annual OEP is a consistent event. State regulations might lead to variations in this period, so it’s advisable to confirm the specific OEP dates for your state.
The annual OEP is the designated time to acquire ACA-compliant Qualified Health Plans (QHPs) without complications. Evaluating options and applying for coverage before the OEP concludes is crucial. Special scenarios, however, allow for obtaining these plans outside the open enrollment phase, particularly if eligibility for special enrollment arises due to a qualifying life event.
What if I Want to Buy Health Insurance Outside the Open Enrollment Period?
After the Open Enrollment period ends, circumstances change for individuals seeking individual or family health insurance. To obtain ACA-compliant insurance plans through the exchange, one must meet the prerequisites for special enrollment. The Special Enrollment Period, defined by Healthcare.gov (the federal marketplace or exchange), refers to the period after open enrollment for private health insurance when individuals with unique situations can purchase individual and family policies.
Eligibility for special enrollment is granted if a qualifying life event occurs. Several qualifying events include:
Recent marriage
Recent divorce
Birth of a new baby
Death of a current policyholder
Change in residence, including:
Moving to a different zip code or county
Arriving in the U.S.
Shifting residence for students
Transitioning from shelter living to an apartment
Loss of current insurance coverage due to reasons like:
Job-based coverage termination
Discontinuation of the existing individual or family plan through no fault of your own (e.g., insurance provider discontinuation or loss of access to a student plan)
Note: Not paying premiums or voluntarily terminating insurance doesn’t grant special enrollment. Such cases require waiting until the subsequent open enrollment period to secure insurance.
Loss of Medicaid, Medicare, or CHP coverage
Loss of coverage provided by a family member (e.g., turning 27 and losing coverage under a parent’s plan)
In most cases, there’s a 60-day window after the qualifying life event during which you can apply for a new qualified health insurance plan.
If uncertainty remains about your eligibility for special enrollment, an eHealth licensed insurance broker can help clarify eligibility and assist in selecting an ACA-compliant plan if criteria are met.
What if I’m Not Eligible for Special Enrollment?
If you don’t meet the requirements for special enrollment, there are still several options available to ensure coverage until the next open enrollment phase. We provide alternative options designed to cover the interim period, including short-term health insurance and discount prescription drug plans. While these alternatives don’t adhere to Obamacare regulations, they can serve as viable substitutes for individuals seeking some form of medical coverage.
It’s important to note that these alternatives might include products that go beyond health insurance, essentially acting as supplementary offerings. However, it’s crucial to understand that non-Obamacare products won’t protect you from potential fines associated with lacking insurance.
Additionally, non-Obamacare insurance plans have limitations: they aren’t required to provide the minimum essential benefits mandated by Obamacare, they might exclude coverage for pre-existing conditions, and they don’t qualify for government subsidies or tax credits.
Need help? Call Health Plans in Oregon: 503-928-6918. Our assistance is at no cost to you.
