Whoops! Now that open enrollment has come to an end, you just realized that you missed signing up. If this is you, don’t panic. You are not alone. What happens if you miss open enrollment depends on whether you need traditional health insurance or Medicare. But in either situation, you have options. Here is everything you should know.
Traditional health insurance
Traditional health insurance is the type of coverage that most people have. This encompasses all health coverage that isn’t Medicare, Medicaid, or a special program such as CHIP (children’s health insurance program). Those purchasing individual or family insurance are subject to these rules, whether or not they are utilizing the federal healthcare exchange.
When is the open enrollment period for traditional health insurance?
Open enrollment for traditional health insurance generally runs from November 1 through January 15, although some states have slightly different dates. This is the time that anyone can purchase new health insurance or change to a different plan. If you sign up by December 15 (slightly different deadlines in some states), your insurance will take effect on January 1. Later signups will be effective on February 1.
Note that the open enrollment period may not apply to you. Native Americans are eligible to sign up throughout the year. Some states allow their residents to enroll in specific health insurance programs at any time. And thanks to legislation passed in 2021, those who meet income and other guidelines automatically qualify for a special enrollment period (SEP) that allows them to enroll through the healthcare exchange (Healthcare.gov) anytime during the year. Or you might experience a qualifying event.
What are qualifying events?
If you missed open enrollment and do not automatically qualify to sign up for health insurance at another time, you can still enroll if you have a qualifying life event. These include:
- Involuntary loss of prior coverage
- Renewal date for previous coverage that falls outside of open enrollment
- Gaining or becoming a dependent
- Marriage (and possibly divorce, depending on circumstances)
- Becoming a citizen or lawful resident
- Moving outside your coverage area
- Your employer-sponsored health insurance no longer meets minimum guidelines
- Significant changes in income
- Various technicalities and special circumstances
Note that different rules govern different qualifying events. In some cases, you must have had health insurance for the 60 days prior to the qualifying event in order to enroll in new coverage. You might be limited to the same tier of insurance coverage that you had before. If you think you might have experienced a qualifying event, visit Healthcare.gov to determine what specific regulations apply to you.
Short-term health insurance plans are not required to meet the regulations imposed by the Affordable Care Act (ACA). So you may have to undergo medical underwriting, preexisting conditions, and essential benefits may not be covered, and there may be annual and lifetime caps on coverage. But for many people, they can act as a reasonable stopgap while waiting for the next open enrollment period to roll around. Some states do not permit them, but in states where they are available, you can sign up at any time throughout the year. These plans can last for up to 364 days and can be renewed up to a total of 36 months.
Other options for health insurance coverage vary by state. You may be able to sign up for a concierge medicine plan through a specific provider that covers most basic healthcare for a single monthly charge. The Farm Bureau offers an insurance alternative in a few states. Some faith-based organizations offer healthcare ministry plans that cover some basic needs. None of these alternatives are a substitute for full health insurance, but they might help you get through until you are able to sign up for an ACA-compliant healthcare plan.
When to sign up for Medicare is much more complicated than the single open enrollment period for traditional health insurance. Under Medicare, open enrollment is just one of several enrollment times throughout the year, each of which allows you to do different things. Let’s break it down.
Understanding the different types and timelines of Medicare coverage
It’s important to first understand what types of coverage are available under Medicare, since the open enrollment period only applies to certain parts of the program. Other parts are available on different timelines.
Original Medicare is a government-sponsored health insurance program that includes two parts: A and B. Medicare Part A covers hospitalization along with specialized services such as hospice. It’s free for anyone who worked and paid Medicare taxes, and is available starting at age 65 or when you develop a qualifying disability. Medicare Part B covers routine medical services such as doctor visits and tests. You will become eligible for Part B at the same time as Part A, but it isn’t automatic or free. You will need to opt-in and pay a small monthly premium.
Most people sign up for original Medicare during their initial enrollment period. This window opens three months before the month in which you turn 65 and runs for a total of seven months. If you want to start using your new coverage on your birthday, apply at least three weeks in advance to ensure that your new cards arrive on time.
If you didn’t sign up for Original Medicare during your initial enrollment period, you can sign up during general enrollment. This window is open from January 1 through March 31 every year. However, you will pay a small penalty on your Part B premiums.
Medicare Advantage, or Medicare Part C, is private insurance offered through companies such as Blue Cross and Blue Shield of Kansas. It was designed to plug some of the gaps in original Medicare, and offers everything provided by original Medicare along with some additional benefits. You can sign up for Medicare Advantage during your initial enrollment period. Or you can switch from original Medicare to Medicare Advantage during the annual enrollment period, which runs from October 15 through December 7 every year. This period is also the time when you can change from one Medicare Advantage plan to another or drop Medicare Advantage and return to Original Medicare.
There is also a period known as Medicare Advantage open enrollment, which lasts from January 1 through March 31 each year. During this time, those who already have Medicare Advantage can make one change—either to a different Medicare Advantage plan or to Original Medicare.
Those who are on Original Medicare can also choose from a wide range of Medicare Supplement plans, also known as Medigap. These are individual products that work in tandem with original Medicare to close specific gaps, such as the Part D prescription drug plan. You can sign up for a Medicare Supplement plan during your Medicare Supplement open enrollment period, which opens the first day of the month in which you turn 65 and lasts for six months. You can also sign up for Part D during the October 15 to December 7 annual enrollment period.
You can sign up for other Medicare Supplement plans at any time, but you will have to undergo a medical underwriting. This means that you could be denied due to your health status. Only during your Medicare Supplement open enrollment window are you eligible for any Medicare Supplement product available in your state without medical underwriting.
Special enrollment periods
There are times when you can sign up for different Medicare products outside of the standard enrollment periods. Known as special enrollment periods, these are triggered by specific life events.
- Employer-sponsored health insurance. If you are still working and covered by employer-sponsored health insurance, you can delay your Medicare enrollment beyond your 65th birthday. You can sign up at any time while you still have health insurance, or for up to eight months after you lose your employer-sponsored care.
- Return to the United States. If you have been living abroad, you can enroll in Medicare anytime during the two months following the month in which you return to the U.S.
- Moving. If you have Medicare Advantage and move to an area with different plan options, you have up to two months to choose a different Medicare Advantage plan or return to Original Medicare.
- Other circumstances. If you move into or out of a skilled nursing facility, jail, or other institution, you typically have two months from the date of your move to sign up for Medicare products. Other circumstances may also trigger a special enrollment period, so it’s worth asking whenever you undergo a major life change.
Medicare timelines are not nearly as straightforward as the annual open enrollment period for traditional health insurance. It’s best to work with a licensed insurance agent who can help you understand the various options and ensure that you are getting the right coverage for your unique needs.
Whether you are looking for traditional health insurance or Medicare products, Blue Cross and Blue Shield of Kansas can help you take better care of your health. To learn more, give us a call today at 866-627-6705.