Seeking Healthcare Solutions Outside of Open Enrollment

by Marc Manor

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Navigating your way through an entire year with nothing to help you pay for medical bills can be a significant risk to your financial and personal wellbeing. Missing the Healthcare Marketplace Open Enrollment may not mean you have to go the rest of the year with no coverage at all. Many states have a variety of coverage options available that can help you fill the void if you are locked out of enrollment into an Affordable Care Act (ACA) compliant plan.

Saying to yourself that you are “healthy” and don’t need healthcare insurance can leave you thousands of dollars in debt so what choices do you have? Since options available in one state may be completely different than another, it's highly advisable to consult an independent healthcare insurance agent to help you get an objective opinion on your options. Here are a few possibilities:


Special Enrollment Period (SEP). You may be able to obtain an ACA compliant healthcare plan outside Open Enrollment if you meet certain criteria. Here are some:

• Lost your health coverage
• Losing existing health coverage, including job based, individual, and student plans
• Losing eligibility for Medicare, Medicaid, or CHIP
• Turning 26 and losing coverage through a parent’s plan
• Changes in household
• Getting married or divorced
• Having a baby or adopting a child
• Death in for family
• Changes in residence
• Moving to a different ZIP code or county 
• A student moving to or from the place they attended school
• A seasonal worker moving to or from the place they both live and work
• Moving to or from a shelter or transitional housing
• Other qualifying events
• Changes in your income that affect the coverage you qualify for
• Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
• Becoming a U.S. Citizen
• Leaving incarceration (jail or prison)
• AmeriCorps members starting or ending their service
Sources: https://www.healthcare.gov/glossary/qualifying-life-event/
https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/

* You will likely have to provide some documentation to prove you qualify for one of these situations.

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Short Term Medical Plans. Short term plans can be a great solution to mitigate your risk and help pay for a variety of things that may come up throughout the year. They don’t always provide the comprehensive coverage that an ACA compliant plan does, but if you are locked out this can be a great fit. Because these plans are not ACA compliant, they may not have Maximum Out-of-Pocket protections. They usually have a maximum coverage. Be sure to know these numbers. Another ACA protection you may not have with these plans relate to pre-existing conditions. You may be denied or rated with a higher premium if you have ongoing conditions. Some may just exempt coverage for claims related to the pre-existing condition for a period of time. Be sure to have your agent explain these and all other “exclusions”.

Supplemental Plans. Supplemental plans can be obtained to cover specific risks to your health. You can find these for Cancer, Critical Illness (such as heart and stroke), Accident, and Hospital Indemnity. These plans are very specific, but they are usually very inexpensive so you may opt to obtain coverage on one or any combination of these depending on where you have the most risk. For example, if you are young and healthy, you may conclude you have more risk from injury from an accident. A combination of Accident and Hospital Indemnity coverage may be an alternative. If you are older, you may decide that Cancer and Critical illness insurance may be more appropriate. These plans generally pay cash benefits directly to the policy holder so be sure you understand the process for filing a claim. You will also want to make sure your emergency contact (spouse or close friend) knows about how to access these in case you are incapacitated.

Short and Long-Term Disability. These plans are not generally used to gap healthcare coverage, but more to protect your income. If you become disabled and cannot work, how will that affect your life? Everyone from doctors to lawyers to truck drivers should consider this. If a surgeon loses their ability to use their hands, what would that do to their lifestyle and the people depending on them? Of all the things we protect with insurance, most people overlook the importance of protecting their income. Pretty important if you think about it!

I would not normally recommend using these alternatives to ACA compliant healthcare plans, but we all know life happens. You could miss open enrollment or just not be able to afford an “Affordable” Care Act plan! I do always recommend to anyone to get some type of protection because of the high cost of healthcare. Also, you may not even seek help if you know you are not insured. We are all just one accident or illness away from bankruptcy if we are not covered. It generally does not cost you anything to look into your options, so I highly recommend at least talking to an agent to find out what is available to you.

Marc Manor is a 30-year military veteran who is now dedicated to teaching his fellow Americans how to make the most of their Medicare and Supplemental Insurance benefits. As an independent agent, Marc has access to a wide variety of carriers with an abundance of resources to find tailored solutions. There is no charge for a consultation so call 904-222-0698 or email: marc@marcmanor.com.