If you’re new to health insurance or this is the first time you’ve had to buy coverage that isn’t from your job, then there are some important things to know about when to sign up. Contrary to what you might think, you can’t buy health insurance whenever you want – at least not major medical. There’s a set time each year when you can get healthcare coverage, whether you buy it from an Obamacare marketplace, directly through an insurance company or via an independent website like this one. This period is known as open enrollment, and it’s important to understand how it works if you’re in the market for a health plan that isn’t sponsored by your employer.
Why the limit?
Knowing about open enrollment is critical because, for most people, this is the only time period during which you can purchase a private health insurance plan for the upcoming year. Once this period ends, you may not be able to sign up for a major medical plan until enrollment re-opens the following fall. This applies whether you plan to purchase insurance through the healthcare marketplace or outside the exchange.
This restriction is designed to keep people from waiting to purchase major medical insurance until they have a health need. Before the ACA, insurers could deny applicants based on their health history, so waiting until a health crisis to apply for insurance was a risky gamble. The ACA now mandates that insurers accept all applicants regardless of pre-existing conditions or health status, so open enrollment is a way to encourage people to buy insurance before a medical crisis comes up.
Your health insurance premiums go towards paying for the cost of your medical care, along with the premiums of everyone else enrolled in your health plan. Just as having auto coverage protects you from shelling out thousands in repair bills during a fender-bender, having health insurance gives you a safety net during medical problems. And just as you can’t buy auto insurance right after a wreck, you can’t buy health insurance right after you get sick if it’s outside of open enrollment. The limit exists to keep everyone’s premiums down (including yours).
What to Do During Open Enrollment
Even if you like your current health plan, open enrollment gives you the perfect chance to shop around and see if there’s something better out there. Plans change from year to year, and you might find more options in 2019 than you did last year. If you’re shopping through the marketplace, start by filling out an application and learning whether you’re eligible for a premium tax credit. This subsidy reduces your costs for monthly premium payments. You can get this tax credit off the exchange if you work with an independent broker, but the plan must still come from an exchange. Not sure what that means? We can help you.
Next, survey the insurance options that are available to you. Most plans fall into the gold, silver and bronze tiers. You may also have access to platinum or catastrophic options. When comparing plans, consider both their premium amounts and their out-of-pocket costs to help you determine which one is right for you.
Once you figure out which plan best suits your needs, commit to buying it. This might seem like something that doesn’t need to be said, but we need to say it: Make sure you pay your premium. Because open enrollment falls during the holiday season, you might not put it high on your priority list. It’s easy to forget that final step of making the first premium payment. But if you don’t make your payments, your coverage can be canceled. It’s one of the few reasons that insurers can drop your coverage under the Affordable Care Act, and you don’t want to start the new year without a plan in place.
Open Enrollment 2019 Dates
Open enrollment for an Obamacare 2019 plan will take place at the end of 2018. The federal open enrollment period will begin on November 1, 2018, and will close on December 15, 2018. Residents of most states will have only those six weeks to browse the selection of plans on and off the marketplace and sign up for one.
Some states set their own open enrollment dates, so residents of those states may have longer to select a plan. If you live in California, Colorado, Connecticut, the District of Columbia, Idaho, Maryland, Massachusetts, Minnesota, New York, Rhode Island, Vermont or Washington, you may be able to begin shopping for plans sooner or wait until the end of December or January to finalize your selection. That’s because these states run their own exchange sites and regulate them differently. Check with your state’s exchange site to confirm the exact dates of open enrollment in your area.
Plans purchased during the federal open enrollment period all go into effect on January 1, 2019. If you live in a state that allows later signups, your first effective date might be after January 1.
Missing Open Enrollment
It’s critical that you commit to an Obamacare plan before the end of open enrollment because you might not have another option for when to buy health insurance. But if you do miss open enrollment, there may be another way to get coverage. Look into whether one of the following exceptions might help you get health insurance in 2019:
- Special enrollment period: Experiencing a major life change might grant you the opportunity to buy health coverage outside of open enrollment. Major life changes include getting married, having or adopting a baby, moving, or losing your job.
- Medicaid and/or CHIP eligibility: These government-sponsored healthcare programs aren’t subject to the rules of open enrollment. If you qualify, you can enroll any time throughout the year.
- Native American enrollment: Members of federally recognized Native American groups can sign up for insurance during the first half of any month.
- Job-based insurance: If a member of your family is hired by an employer that offers group health insurance, you’ll have at least 30 days to join that plan.
Medicaid and CHIP
Although most major medical coverage requires that you sign up during open enrollment, government-sponsored programs for low-income individuals and families are not bound by this restriction. You can sign up for Medicaid or the Children’s Health Insurance Program (CHIP) throughout the year. These programs provide free or low-cost medical insurance to enrollees.
Each state sets its own rules for who qualifies for its Medicaid program. In some states, anyone with a household income under 133 percent of the federal poverty level can enroll. Other states set stricter regulations. Sometimes, these programs are open only to children, pregnant women, parents or those with disabilities.
If you qualify for Medicaid or CHIP, you don’t have to wait for open enrollment to apply. You can sign up at any time. How soon your coverage can begin depends on the policies in your state. Filling out a health insurance application on the healthcare marketplace is one way to find out if you’re eligible for one of these year-round programs. You can also check with your state’s Medicaid department or talk to an insurance broker.
Different Rules for Medicare
Older adults who are eligible for Medicare must abide by an annual enrollment period, but it’s not the same as the open enrollment period for the healthcare marketplace. If you’re 65 or older, your Medicare enrollment period for 2019 runs from October 15 to December 7. There’s a separate enrollment session for changes to Medicare Advantage. This period starts on January 1 and ends March 31.
Special Enrollment Periods
Significant life changes can happen throughout the year, and the ACA makes provisions to allow people to obtain healthcare coverage at those times. When you experience a qualifying life event, you typically have up to 60 days from that date to purchase a new major medical insurance plan or switch your insurance plan. As we mentioned above, qualifying life events including moving, having a baby or changing your marital status, among other things. Losing your major medical coverage can also qualify you for a special enrollment period, but losing a short term health plan does not.
The federal government sets specific rules about who qualifies for special enrollment periods and when the new coverage can begin. Visit the federal healthcare website or consult an insurance broker to learn more about whether this provision can help you obtain health insurance in 2019. You can be connected with a licensed insurance broker by calling our phone number.
[callus side=”left|right” copy=”What is Obamacare?” phone=””]
If you miss the ACA 2019 signups and aren’t eligible to obtain major medical insurance by other means, consider purchasing a short term health plan instead. This type of insurance is not as comprehensive as major medical coverage, but you can sign up all year long. In 2019, you’ll have the option to keep a temporary health plan for nearly a full year, and you may be eligible to renew it for a total coverage period of up to 36 months.