If you missed this year’s open enrollment period (November 1–January 15), you may be worried about your family not having health insurance until next year. Fortunately, there are several insurance options and alternatives for you to look into until open enrollment rolls back around.
You can get insurance outside of open enrollment if you experience a qualifying life event that triggers a 60-day special enrollment period. If you don’t have a qualifying life event, another option is fixed indemnity health insurance, which allows you to pay a fixed amount on a per-period and per-incident basis. An alternative to insurance is a medical cost-sharing plan, in which you pay a fixed amount for medical expenses and if you receive a medical expense that exceeds that amount, the remaining cost is covered by the shared pool of money split between all the members of the organization.
1) Get insurance outside of open enrollment by qualifying for a special enrollment period
If you already had an insurance plan and experienced a life event that caused you to lose it, you may qualify for a 60-day special enrollment period in which you are able to obtain new insurance, no matter what time of year it is. There are a variety of events one may experience that may count as a qualifying life event, but you will need to provide proof of such an event before you are able to enroll in a new plan. Qualifying life events include losing your insurance because you are no longer a student, getting married or divorced, experiencing the death of a family member, turning 26 and no longer being able to stay on your parents’ insurance plan, moving to a different state, becoming a US citizen, changes made to your coverage that make it so that you no longer qualify, etc. A more complete list of qualifying life events can be found at HealthCare.gov. If you lose your insurance due to a qualifying life event but do not enroll in a new insurance plan during your allotted 60-day special enrollment period, you will have to wait until the next open enrollment period before you can enroll in a new plan, so don’t delay!
2) Fixed indemnity health insurance
With fixed indemnity insurance, the patient pays a predetermined amount that covers medical expenses on a per-incident or per-period basis. These types of plans can offer fixed rates for services such as hospital admission, daily hospital coverage, daily ICU coverage, surgery, visits to the Emergency Room, X-rays and other forms of imaging, as well as ambulance rides. Fixed indemnity plans do not cover the essential health benefits mandated by the Affordable Care Act, meaning they do not technically count as true health insurance plans. These types of plans are typically used to supplement the health insurance plan one may already have in order to help cut down on out-of-pocket expenses, but if you missed open enrollment and do not qualify for a special enrollment period, it is certainly better than having no coverage at all. If you are a generally healthy individual and do not anticipate needing much healthcare in the period of time between now and the next open enrollment period, it is an option very much worth considering.
3) Medical cost-sharing plans
Medical cost-sharing plans are plans in which medical costs are shared among the members of an organization. When you join one of these plans, you will contribute a monthly payment to the pool of money shared by members for medical expenses. You can essentially think of this monthly payment as your premium. Annually, you pay an unshared amount, which is essentially a deductible that you pay to cover a certain amount of the medical expenses yourself before the shared amount kicks in to cover the rest. If you are only paying for yourself, your monthly payment can be as low as under $100, and your annual unshared payment is likely to be within the range of $300 to $500. The prices will naturally increase if you are paying for a full family, but will still likely remain lower than the cost of your typical insurance premiums and deductibles. Outside of the lower prices, another benefit to medical cost-sharing plans is that you do not have to stay within a network. If a healthcare provider makes you pay out-of-pocket, the cost-sharing plan will cover the expense.
Something to take into consideration with medical cost-sharing plans is that they are not required to cover pre-existing conditions, which could potentially make them an unsuitable option for you and your family. However, if that is not an issue, these types of plans are good affordable options to have in case of an emergency.
You still have options
If the open enrollment period snuck past you this year, you may have more options than you realize. Contact Lighthouse Group today to learn what alternatives you qualify for so that you aren’t going uncovered until the next open enrollment period.
Does choosing to drop my health insurance plan count as a qualifying life event?
No, if you voluntarily dropped your health insurance plan, you will not qualify for a special enrollment period. You would only qualify if you lost your plan due to something outside of your control.
