Lost Your Health Insurance? Not Obamacare Open Enrollment? What Now?

Don't stress over losing your health insurance when it's not open enrollment. You may be able to sign up for an Obamacare plan anyway.. Image © Douga-Waters/Getty Images

If you’ve lost your health insurance and you’re looking for a replacement health plan, you may be alarmed to learn that your state's health insurance exchange (and off-exchange market in every state except Nevada) only allows you to sign up for a health plan during the annual open enrollment period. But, what happens if you’re losing your health insurance and have months to go before the next open enrollment period?

How do you get health insurance and avoid being uninsured?

Special Enrollment Period

Depending on when and why you lost your health insurance, you may be eligible for a special enrollment period on your state’s Affordable Care Act health insurance exchange (in most cases, special enrollment periods apply outside the exchange too). A special enrollment period allows you to sign up for health insurance even though it’s not open enrollment.

Special enrollment periods are time-limited, usually 60 days, and are triggered by specific types of events. If you dawdle and don’t enroll in a new plan before the end of your special enrollment period, you’ll have to wait until the next open enrollment period to sign up. Meanwhile, you may find yourself uninsured.

Are You Eligible for Special Enrollment?

Certain qualifying events trigger a special enrollment period that will let you sign up for a plan on your state’s health insurance exchange, or directly through a health insurance carrier in the off-exchange market.

These are usually things like loss of other health insurance and changes in family size. Here are some specific examples of triggering events that make you eligible for a special enrollment period:

  • You get laid off and lose your job-based health insurance.
  • You get divorced and lose the health insurance your former spouse’s job provided.

In two cases, the special enrollment periods don't apply outside the exchanges. In other words, you can get coverage in the exchange with these special enrollment periods, but if you go directly to a health insurance carrier, they're not required to accept your enrollment:

  • Being a Native American (special enrollment periods continue throughout the year)
  • Gaining U.S. citizenship or lawfully present residency status in the U.S.

One thing that doesn’t usually trigger a special enrollment period is losing your health insurance because you didn’t pay the monthly premiums.

This isn’t included as a triggering event because it would allow people to game the system and switch to a new health plan whenever they wanted. All they’d have to do is stop paying their premiums. For example, you could buy a health plan with lousy coverage inexpensively and then change to a plan with better coverage when you get sick. This would defeat the purpose of an open enrollment period.

Loss of a job and/or a drop in income is also not a qualifying event, unless you're already enrolled in a plan through the exchange, in which case you might have the opportunity to switch to a different plan. But if you're enrolled in a plan outside the exchange — because you weren't eligible for subsidies when you enrolled, for example — and you lose your job mid-year, you wouldn't have an opportunity to switch to a plan in the exchange at that point.

How Does Special Enrollment Work?

Here’s an example.

You have health insurance through your job, but your company isn’t doing very well financially. A couple of months after the Obamacare open enrollment period closes, you get laid off and lose your job-based health insurance.

You may be eligible to continue your current health plan using COBRA continuation coverage, but instead, you decide you’d rather get a new health plan on your state’s health insurance exchange. You’re eligible for a special enrollment period because you just lost your job-based health insurance due to being laid off.

You go to your health insurance exchange’s website or call your exchange a couple of weeks later and enroll in a new health plan. If your employer’s plan was covering your spouse and kids, they’re eligible for a special enrollment period, also. You can each sign up for individual health insurance or you can get a family plan on the exchange. 

Since your income has taken a hit by being laid off, you may also qualify for a subsidy to help you pay the monthly health insurance premiums. Subsidy eligibility is based on your income and can be paid directly to your new insurance company to lower the amount you have to pay each month for coverage. There are also subsidies to help lower your cost-sharing obligations like deductibles, copayments, and coinsurance. And, there’s a subsidy to lower your out-of-pocket maximum.

You apply for these subsidies through your health insurance exchange as you’re going through the health insurance enrollment process. Subsidies can only be used with health insurance purchased on your state’s Affordable Care Act health insurance exchange. So although your special enrollment period will give you the option of enrolling outside the exchange if you prefer, you can’t get a subsidy to help pay for health insurance not purchased through your exchange (that includes COBRA; if you opt to keep your coverage via COBRA, you'll have to pay the full premium yourself).

Updated by Louise Norris


Cornell Univerity Law School, Legal Information Institute, 45-CFR-155.420, Special Enrollment Periods

Department of Health and Human Services, PPACA; Amendments to Special Enrollment Periods and the Consumer Operated and Oriented Plan Program.

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