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Protecting What Matters


What Will I Do if I Miss Open Enrollment?

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Here is some good news: with ACA health insurance, you can’t be rejected or charged a higher premium if you have a pre-existing condition. However, ACA health coverage must be purchased during a limited timeframe. That period is ending very soon. You should know that if you miss open enrollment, the remaining health insurance options may leave you ill!

Because of unusual circumstances, some physicians may miss the open enrollment deadline. If this happens to you, does it mean that you won’t be able to have health coverage until next year? Not necessarily – there are a few options that may work for you.

Health Coverage Options After January 31

If you miss the deadline, short-term (interim) health insurance plans can provide some protection in the event you have an unexpected serious illness or accident. However, there are serious drawbacks to short-term health insurance plans.

These plans should be thought of as catastrophic coverage, since they generally do not cover preventive care or prescription medicine. Unlike ACA health insurance, short-term plans do not cover pre-existing conditions, so you may be turned down for coverage. Finally, since they are not ACA compliant, you will likely face a 2.5% income tax penalty if you rely on short-term health insurance.

Other types of health insurance that you can purchase at any time include accident insurance, critical illness plans, and supplemental hospital plans. These are all less expensive than a comprehensive major medical insurance plan, but there are several limitations and they only cover qualifying injuries or illnesses. Since each plan varies, be particularly sure to read the fine print.

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Special Enrollment Periods May Allow ACA Coverage

There is a special ACA enrollment period for those with extenuating circumstances. If any of the following events take place during the year, you can take advantage of a special enrollment period to add family members to your plan:

  • Get married
  • Have a child
  • Adopt a child
  • Become a foster parent
  • Become responsible for child support

Additionally, if you lose your current health coverage during the year due to the following, you can obtain coverage during a special enrollment period:

  • Divorce
  • Loss of dependent status
  • Moving out of state
  • Loss of employer coverage

For those who qualify due to these circumstances, there is a 60-day period for special enrollment from the date of the qualifying event.

A 15-Minute Call for Healthier Health Insurance

In short, there are few options if you miss the January 31 deadline and will not qualify for special enrollment. Remember though; you can avoid the headache and hassle of other options if you obtain solid health coverage now. With our experienced health insurance advisors ready to assist you, you can have the comprehensive, ACA-compliant health insurance that you deserve before the deadline runs out. Contact us today.

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For over 60 years, TMA Insurance Trust advisors have been serving Texas physicians, their families and staff. TMA Insurance Trust prides itself on offering unbiased information and strategies to members, along with exclusive group rates on a range of the highest-rated plans in the industry.

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