Understanding Your Coverage Options After Open Enrollment

Missing the open enrollment period can be stressful, but there are still ways to secure health coverage. Between extended and temporary options, there are a few opportunities available to ensure you don’t go without coverage. We’ll go over what these options are, and when they may be available to you.

Special Enrollment Period (SEP)

A Special Enrollment Period (SEP) allows individuals to sign up for health insurance outside of the open enrollment window if they experience a qualifying life event. These events include:

• Losing employer-sponsored coverage
• Marriage or divorce
• Birth or adoption of a child
• Moving to a new coverage area
• Loss of Medicaid or CHIP eligibility

Typically, you have 60 days from the event to enroll in a new plan. If you qualify, you can explore options on the Health Insurance Marketplace or through your employer. If you fail to enroll during your SEP, you may have a gap in coverage until the next Open Enrollment. There are other situations that qualify you, such as a low-income or domestic abuse SEP. If you qualify for an SEP, you can apply for it through healthcare.gov or your state exchange.

Medicaid and CHIP Enrollment

Medicaid and the Children’s Health Insurance Program (CHIP) provide coverage for low-income individuals and families. Unlike private insurance, these programs offer year-round enrollment.

Medicaid covers many essential health services, including doctor visits, hospital stays, prescriptions, & preventative care. CHIP provides similar benefits to children in need, including medically needy children. Some states even offer CHIP to pregnant women, covering prenatal, delivery, and postpartum care.

If you meet eligibility requirements, you can apply at any time through your state’s Medicaid office or healthcare.gov. The application process typically involves verifying income, residency, and household size.

If you do not qualify for Medicaid, your state may offer alternate low-cost health programs. Check with your states Medicaid office to explore all available options.

Short-Term Health Plans

Short-term health insurance is designed as a temporary solution for those who experience a gap in coverage. Short-term health plans can provide necessary coverage while between health plans or while outside of open enrollment. These plans may offer lower premiums as well. Length of coverage varies by state. Most states, coverage can last up to 4 months. In Colorado, plans are allowed to be up to 6 months long. California does not allow short term health plans at all.

However, they often provide limited coverage, excluding essential benefits like maternity care and preexisting conditions. Other costs, such as deductibles and copays, commonly run higher as well. Short-term health plans are best used as coverage in case of an emergency, not a plan to rely frequently on. Consider these carefully before enrolling.

COBRA Coverage

The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows individuals who lose job-based coverage to continue their employer’s plan for a limited time. COBRA can be expensive since you pay the full premium, but it ensures continuity of coverage while exploring other options.

COBRA coverage can last for up to 18 months in most cases, and sometimes up to 36 months under specific circumstances. Although costly, it provides the same comprehensive benefits as your previous employer-sponsored plan, including access to the same doctors and hospitals. This can be particularly valuable for individuals with ongoing medical needs or those undergoing treatment who wish to avoid disruptions in care.

Employers are required to inform you of your COBRA eligibility after losing job-based insurance. You generally have 60 days to decide whether to enroll. While COBRA premiums can be high, some states offer subsidies or alternative continuation coverage options that may be more affordable.

If COBRA is not financially viable, it’s worth exploring alternatives like Special Enrollment Period plans through the Health Insurance Marketplace, Medicaid, or short-term insurance. Comparing all available options will help you find the best solution to maintain coverage without unnecessary financial strain.

What to Do Next

If you missed open enrollment, don’t panic. Review your options and determine which path best fits your needs. Whether you qualify for a SEP, Medicaid, or need short-term coverage, taking action quickly will help you stay protected.

If you would like help navigating this complex landscape, get in touch. We’re here to help you get the best options for you.