What if I have clients who missed open enrollment?
The annual open enrollment period was established by the Affordable Care Act (ACA) during which your clients can apply for health insurance coverage and be guaranteed the minimum essential coverage. Open enrollment allows you and your clients to find coverage regardless of their medical history, pre-existing health conditions, or financial situations. The deadline to enroll in most health insurance plans for 2019 coverage was November 1 - December 15, 2018.
To help your clients find health coverage without waiting until the next open enrollment period, you can see if they qualify for a special enrollment period (SEP) or short-term health insurance.
What is special enrollment?
Special enrollment periods refer to the 60 day period following a qualifying life event during which your clients can still enroll in a major medical health plan, even if they missed the standard open enrollment period.
The ACA considers the following qualifying events:
- Your client lost their job and/or their COBRA coverage
- Your client recently moved to a new coverage area
- Your client recently changed their marital status
- Your client recently becoming a widow or widower
- Your client recently aging out of their parents’ health care coverage
- Your client has recently had a baby or adopted a child
If your client doesn’t qualify for a special enrollment period…
You may want to help your client find short-term health insurance until they’re eligible for a major medical plan. Short-term health insurance provides fast, flexible coverage for your clients who need to purchase health insurance outside of the allowed open enrollment period. Short-term plans also offer alternative forms of coverage for people who don’t think an ACA-compliant major medical plan is a good fit for their budget and coverage needs.
Who benefits from short-term health insurance?
- Clients who lose coverage due to changing jobs
- Clients who are recent college graduates and are no longer eligible for student health insurance
- Clients who are new hires and aren’t yet eligible for group coverage
- Clients who are eligible for Medicare but are waiting for their Medicare coverage to start
Some short-term plans can be:
- Better suited to people without pre-existing conditions
- Not compliant with the ACA
Costs, coverage, and compliance.
Depending on the client, short-term insurance may be more expensive than an ACA-compliant plan. Many short-term plans won’t cover preventive care or pre-existing conditions, meaning your client could be denied coverage or charged higher copays and premiums. Furthermore, since short-term plans aren’t ACA-compliant, they don’t have to cover the 10 essential benefits established by the ACA:
- Ambulatory patient services (outpatient services)
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
You’ll need to confirm the specifics of your plan with your insurance company to ensure that they cover services like preventative care. Even if you’ve lost or missed your opportunity to enroll in major medical coverage, if your family still needs children’s health insurance, you could consider applying for Medicaid for the children in your family until you and your dependents are eligible for major medical insurance.
What if my client’s options are more limited?
If your client’s family and/or financial situation limits their ability to find coverage that works for them, you may still be able to help them obtain insurance for their dependents. If you have lower-income clients with children, they might qualify for the Children’s Health Insurance Program (CHIP), or they might qualify for Medicaid, both of which are jointly funded by each individual state’s government and the federal government.