If you miss open enrollment and need health insurance, you'll need to qualify for "special enrollment" by having a qualifying life event to apply. The following list includes the most common qualifying life events: In addition to qualifying through a life event, there are also alternative health coverage options to consider if you missed open enrollment without a qualifying life event. These options will be explored further below.
Alternative Options for Health Coverage
If you cannot qualify for open enrollment or a Special Enrollment Period via a Qualifying Life Event (QLE), there are several alternative health plan options that may meet your needs:
North American Health Plans with Minimum Essential Coverage (MEC) Options: These plans provide basic coverage compliant with Affordable Care Act (ACA) standards.
Short-Term Health Plans: These temporary plans may not qualify for reimbursements under Qualified Small Employer Health Reimbursement Arrangements (QSEHRA) but can help during gaps.
Sharing Plans: Though not traditional insurance, these can sometimes be paired with MEC plans for ACA compliance and medical expense reimbursements.
Losing existing health coverage (e.g., losing employer-based coverage or eligibility for Medicaid/CHIP)
Turning 26 and transitioning off a parent's health insurance plan
Getting married or legally separating/divorced
Having (or adopting) a baby, or becoming a foster parent
Death in the family that impacts coverage eligibility
Relocating to a different ZIP code or county that offers different insurance plans
Gaining U.S. citizenship or lawful presence in the country
Experiencing other events like leaving incarceration or a change in income that affects eligibility for coverage assistance
Please see our article on What is a Qualified Life Event (QLE) if you are outside of open enrollment, and wish to shop. Additionally, if you missed open enrollment and lack a QLE, it's vital to understand the potential consequences. Without qualifying for a special enrollment period, you may face a coverage gap until the next open enrollment period, which also means forfeiting reimbursements under programs like QSEHRA during the gap.