I Missed Obamacare Open Enrollment. What Now?

Miss open enrollment for Obamacare? You still have options. Image © Hans Neleman/Taxi/Getty Images

If you missed open enrollment on your state’s Affordable Care Act health insurance exchange, you have a few things to deal with.

First, you need to get health insurance some other way or prepare to be uninsured until the next enrollment opportunity. Next, you may face a tax penalty for the months you didn't have health insurance. You can either budget for this or try to get an exemption so you won’t owe the penalty.

How to Get Health Insurance If You Missed Obamacare Open Enrollment

If you missed open enrollment on your state’s Affordable Care Act health insurance exchange, you don’t have a lot of other options, but you do have a few. Here are some of your alternatives for getting health insurance.

Special enrollment period: If you have a qualifying event, you may be eligible for a special enrollment period on your health insurance exchange. Special enrollment periods are usually triggered by life-events that change the size of your family or your location, or cause you to lose other health insurance.

For example, you may have a qualifying triggering event if you get married or have a baby. If you or your spouse lose the job that provided your health insurance, your loss of coverage will be a qualifying event. If you no longer qualify for Medicaid coverage because your income went up, losing your Medicaid coverage will be a qualifying event.

Here's a full list of all the qualifying events in the individual health insurance market. Most of them apply both on and off-exchange, although a few only apply in the exchanges. 

HealthCare.gov and many of the state-run exchanges have stepped-up eligibility verification for special enrollment periods, so be prepared to provide proof of your qualifying event.

And although a permanent move to a new area (where different health plans are available) is a qualifying event, it only triggers a special enrollment period if you already had coverage prior to the move. This rule change went into effect in 2016, and prevents uninsured people from moving to a new location in order to gain access to health insurance.

Medicaid: If you’re eligible, you can enroll in Medicaid or enroll your kids in the Children’s Health Insurance Program at any time. You don’t have to wait for open enrollment on your health insurance exchange. To be eligible for Medicaid you must meet low-income guidelines in your state. Some states require you to meet other eligibility criteria in addition to having a low income. Your kids might be eligible for CHIP even if you’re not eligible for Medicaid.

If you're in Minnesota or New York and your income doesn't exceed 200 percent of the federal poverty level, you can enroll in the state's Basic Health Program; enrollment in those plans continues year-round. If you're in Massachusetts, your income doesn't exceed 300 percent of the federal poverty level, you're eligible for ConnectorCare coverage. Enrollment is available year-round, if you're either newly-eligible for ConnectorCare or you haven't enrolled in the past.

You can apply for Medicaid, learn about the eligibility criteria, and learn about low-income guidelines in your state by contacting your state’s health insurance exchange. Or, if you prefer to contact your state’s Medicaid program directly, you can look up contact information by clicking on your state at the website of the National Association of Medicaid Directors.

In Minnesota, the Basic Health Program is called MinnesotaCare.

In New York, the Basic Health Program is called The Essential Plan.

In Massachusetts, ConnectorCare is available to people with income up to 300 percent of the poverty level.

Job-based health insurance: If you missed Obamacare open enrollment, you’ll still be eligible for job-based health insurance when you get a job with insurance benefits. Although there’s usually a short waiting period before new hires are eligible for health insurance, the ACA limits it to no more than three months.

Short-Term Health Insurance: If short-term health insurance plans are available in your area, you can enroll at any time. However, short-term policies don't provide all of the consumer protections that more comprehensive policies provide. For example, your pre-existing conditions will most likely be excluded from coverage and the policy will almost certainly have a maximum benefit limit (these aren't allowed anymore under the ACA, but short-term health insurance isn't regulated by the ACA). Because of these limitations, a short-term policy won't satisfy the ACA's mandate to have health insurance. You'll still have to pay the penalty for being uninsured.

The Advantages of Short-Term Health Insurance
The Shortcomings of Short-Term Health Insurance

HHS implemented new rules starting in 2017 that limit short-term plans to no more than three months in duration. Although that rule took effect January 1, 2017, it isn't being enforced until April 1, 2017. That means people can enroll in short-term plans with durations of more than three months, as long as they enroll by the end of March. After that, short-term plans in every state will be limited to three months in duration.

I’m Going to Be Uninsured. What Now?

If none of the above options work for you and you’re going to be uninsured until next year’s Obamacare open enrollment, get to know your local free clinic or Community Health Center. The Affordable Care Act increased funding to Community Health Centers to help them care for folks without health insurance.

Better prepare for being uninsured using this toolkit for going without health insurance.

Will I Have to Pay a Tax Penalty for Being Uninsured?

The Affordable Care Act’s individual mandate says all legal residents of the United States have to have health insurance or pay a tax penalty called the individual shared responsibility payment. This tax penalty is a percentage of your income or a flat rate - whichever is greater - and is paid when you file your taxes for the year you were uninsured. The penalty is pro-rated if you were only uninsured for part of the year.

Learn more about the health insurance penalty with these resources:

9 Things to Know About the Health Insurance Penalty

How Much Is the Health Insurance Penalty for an Individual?

How Much Is the Family Health Insurance Penalty?

Can I Avoid the Health Insurance Penalty?

The individual shared responsibility payment comes with some loopholes. For example, if your income is so low that you aren’t obligated to file federal income taxes, you’re automatically exempt from the penalty. Even financial problems like being evicted from your apartment or getting a utilities cancellation notice can qualify you for a hardship exemption.

Learn about other ways to get a health insurance exemption and avoid the penalty:

How To Get a Hardship Exemption From Health Insurance

Can You Get a Health Insurance Exemption?

When Is My Next Chance to Enroll in Obamacare?

Open enrollment for 2018 coverage will begin on November 1, 2017. The earliest possible effective date during open enrollment will be January 1, 2018.

Open enrollment for 2018 had been scheduled to run through January 31, 2018, but HHS proposed in February 2017 to shorten open enrollment for 2018 so that it ends December 15, 2017. 

The November 1 to December 15 schedule is already slated to take effect in the fall of 2018, for coverage effective in 2019 and subsequent years. If HHS finalizes their proposal, the shorter open enrollment window will take effect a year earlier, in the fall of 2017.

Sources:

Department of Health and Human Services, Patient Protection and Affordable Care Act, Market Stabilization. February 15, 2017.

Department of Health and Human Services, PPACA Notice of Benefit and Payment Parameters for 2017.

Federal Register, Excepted Benefits; Lifetime and Annual Limits; and Short-Term, Limited-Duration Insurance, October 31, 2016.

United States Department of Labor, Obama Administration Announces Final Rule Regarding Affordable Care Act 90-Day Waiting Period Limitation, February 24, 2014.

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