Is It Possible To Buy Health Insurance Outside of Open Enrollment?

In most cases, purchasing health insurance is only possible during the annual open enrollment period for the Affordable Care Act. For individuals in California, that means an insurance agent will be able to sell a client new policies for life insurance and other kinds of coverage year-round, but will only be able to change health care coverage for clients during a single annual window. Of course, there are always people whose needs do not fit that window, which is why the ACA makes provisions for some individuals to change coverage during the rest of the year. To buy insurance outside of the open enrollment period, you need to have experienced a qualifying life event.

Life Events That Qualify Individuals for Special Enrollment

There are a few common events that always qualify people for a chance to change coverage:

• Changing employment
• Losing coverage through a parent
• COBRA coverage ending
• Changes in eligibility for Medicaid and other public programs
• Getting married or divorced
• Leaving incarceration
• Gaining citizenship



There are also a few life events that can sometimes count as qualifying events:

• Moving to an area where your current insurance is not offered
• A death in the family if it results in the loss of coverage
• Income changes if they change subsidies substantially

Limitations

​

When an individual needs to change health insurance mid-year and has experienced a qualifying life event, they are given a window in which to make changes. This window is limited just like the open enrollment period, though, so individuals need to act promptly to get new coverage. One can begin shopping for new insurance 60 days before the qualifying event, and the enrollment period ends 60 days after the qualifying event.
 
This limitation is designed to keep people from having lapses in coverage during which a health emergency could strike. If possible, shopping during the 60-day window before the event can help with this goal. Of course, some events like a death in the family are unpredictable, and that is why there is a 60-day window afterward. This should be enough time for most individuals to make an informed decision with an insurance agent.

Proving Qualifications for Special Enrollment

​

To take advantage of the enrollment period for those with qualifying life changes, individuals need to be able to demonstrate why a change of insurance is necessary. Most of the time this is easy, as proof of a change in employment or the death of a policyholder is readily available through documentation. Agents need to include that documentation in applications for health insurance outside the open enrollment period, so it is important to provide copies when making a purchase. If there is any question about whether an event is a qualifying one, talking to an insurance agent can help clear up confusion about the right way to proceed.
 
Sackett & Associates Insurance can help individuals who qualify for new health care coverage outside of the open enrollment window. For more information on changing insurance, contact us at 707-823-3689, like us on Facebook, check out our LinkedIn, and don’t forget to follow the blog for more important information on insurance benefits and related topics.