How to Get Health Insurance After Annual Open Enrollment Ends

Question: Is it true that I can only enroll in health insurance once a year, during the Annual Open Enrollment Period?

Answer: This is a very common question that we hear, and for the vast majority of people, it is true. You can only enroll in health insurance once a year, during a specific time-frame specified by the government.

Question: But what if I don’t want (or don’t qualify for) subsidies through the Marketplace? Can I buy private health insurance from a provider like Blue Cross Blue Shield of North Carolina®, instead of buying through Healthcare.gov?

Answer: Yes you can, but only once a year, during the same Annual Open Enrollment Period established for those who are purchasing health insurance through the Marketplace.

With very limited exception, the requirement to be allowed to enroll in health insurance only during the Annual Open Enrollment Period applies to everyone, regardless of whether you are shopping for health insurance on the Marketplace (Healthcare.gov), or outside of it.

In addition, you may only make changes to existing health insurance plans during the same established Annual Open Enrollment Period, again with limited exception.

Question: So what if I didn’t enroll in health insurance during the Annual Open Enrollment Period, but I find myself needing health insurance now? Or what if I want to change my existing health insurance plan now?

Answer: Some individuals can acquire coverage outside of the established enrollment period. These individuals must apply for and be granted a Special Enrollment Period. If you are granted a Special Enrollment Period, that will open up the opportunity for you to purchase health insurance outside of the Annual Enrollment Period that was established by the government for that coverage year. Unfortunately, the sudden need to get insurance to help cover immediate health care expenses is not, in itself, reason enough to be granted a Special Enrollment Period. Nor is a sudden desire to switch health insurance providers. You must experience what the government considers a Qualifying Life Event to be granted a Special Enrollment Period and enroll or make changes to your health insurance plan outside of the established Annual Enrollment Period.

Question: What kind of life events are “Qualifying Live Events”? How do I get a Special Enrollment Period?

Answer: A Special Enrollment Period is “triggered” or “opened” by a Qualifying Life Event. You may be granted a Special Enrollment Period today if you experienced one of the following events within the last 60 days:

  • Change in coverage
    • recent involuntary loss of health insurance
    • impending involuntary loss of health insurance
  • Change in household size
    • caused by death
    • caused by marriage
    • caused by birth, adoption, or foster care
  • Change in circumstance
    • caused by move to new state or coverage region
    • caused by loss or gain of significant income
  • Change in status
    • caused by gain of citizenship or lawful presence in the U.S.
    • caused by release from incarceration
  • Membership in a federally-recognized tribe or Alaska Native corporation shareholder

The above life events are each considered a Qualifying Life Event. If one of these occurs and you are granted a Special Enrollment Period, you may enroll or make changes to your existing health insurance (including adding dependents and changing coverage plans) for just 60 days from the date you experienced your Qualifying Life Event. The agents at WNC Health Insurance know precisely how to apply for a Special Enrollment Period.  If you suspect that you may have experienced a Qualifying Life Event, contact us in a timely fashion.  The 60 day clock starts to tick as soon as your Qualifying Life Event occurs.