When Can You Purchase Health Insurance?

By

Brett Bakshis

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You may know you need health insurance under the Affordable Care Act. But do you know when you can get it? Most health insurance plans are available for enrollment only at certain times. If you miss the window, however, there may be other ways you can get coverage.

Marketplace Open Enrollment

Most people who buy health insurance through the Marketplace will get it during open enrollment. During this timeframe, you can buy a new policy or make changes to an existing plan. You can cancel your policy at any time during the year. But if you do, you may not be able to buy a new plan until the next open enrollment period.

Special Enrollment Periods

In some cases, you may be able to buy a new insurance plan or make changes to your policy outside of open enrollment. There are several life events that may trigger one of these special enrollment periods. You could:

  • Get married

  • Get a divorce or separation

  • Give birth to or adopt a child

  • Have a change in income

  • Lose existing health insurance

  • Turn 26 and lose your parents’ coverage

  • Move to a new residence

  • Be released from incarceration

In order to be eligible for a special enrollment period, these qualifying life events must have happened within the last 60 days. If you qualify for special enrollment, you can apply online or over the phone. Be prepared to answer questions about your qualifying life event.

Exceptional Circumstances

There are very rare situations in which you may simply be unable to purchase health insurance during the open enrollment period. The Marketplace allows for this possibility. There are some circumstances under which you may be able to get a health plan outside the open enrollment period, even if you don’t meet any of the usual qualifying criteria listed above. They include:

  • Natural disaster

  • Temporary cognitive disability

  • Unexpected hospitalization

Sometimes an exceptional circumstance isn't an act of God, but an act of computer. Technical errors, display errors, data source errors, miscommunication between computers—they are all acceptable reasons you may not have been able to purchase insurance during open enrollment.
Victims of domestic abuse who may have been prevented from getting insurance can also usually qualify for a special enrollment period.

Medicare Enrollment, Parts A and B

Like plans purchased through the Marketplace, Medicare is available only at certain times. If you become eligible for Medicare when you turn 65, there’s an initial seven-month window for you to apply for Parts A (hospital insurance) and B (medical insurance). It includes:

  • The three months before the month you turn 65

  • The month you turn 65

  • The three months after the month you turn 65

For example, if you turn 65 in April, you can sign up for Medicare from January to July of that same year.
After that, you can sign up or change your policy during Medicare open enrollment, which runs from January 1 through March 31 every year. Life events, like losing existing health insurance or losing your job, can qualify you for a special enrollment period.

Medicare Enrollment, Parts C and D

The initial sign-up period for Medicare Parts C and D—also known as Medicare Advantage (Part C) and the prescription drug plan (Part D)—covers the same seven months surrounding your birthday as regular Medicare.

The open enrollment period for Parts C and D is different from Parts A and B, however. Enrollment for Parts C and D runs from October 15 through December 7. You also have a special "disenrollment" period from January 1 through February 14. During that time, you can switch from Medicare Advantage to traditional Medicare coverage.

Medicaid and Children’s Health Insurance Program (CHIP) Coverage

Health insurance programs for low-income Americans are available year-round, with no special enrollment periods. Coverage is based on your income, family size, age, and whether you're disabled. If you qualify for Medicare or CHIP, your coverage will start immediately.

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Medical References

  1. What is Medicare? Centers for Medicare & Medicaid Services. http://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/whats-medicare/what-is-medic...
  2. When can I sign up for Part A & Part B? Centers for Medicare & Medicaid Services. http://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/when-sign-up-parts-a-and-b/when-sign-...
  3. Getting health coverage outside Open Enrollment. Healthcare.gov. https://www.healthcare.gov/coverage-outside-open-enrollment/
  4. Changing, updating, or cancelling your Marketplace plan. Healthcare.gov. https://www.healthcare.gov/keep-or-change-plan/
  5. Important Health Insurance Marketplace dates. Healthcare.gov. https://www.healthcare.gov/marketplace-deadlines/
  6. Medicaid & CHIP coverage. Healthcare.gov. https://www.healthcare.gov/medicaid-chip/
  7. See if you qualify for a Special Enrollment Period. Healthcare.gov. https://www.healthcare.gov/screener/marketplace.html
  8. Special Enrollment Periods for complex issues. Healthcare.gov. https://www.healthcare.gov/sep-list/
  9. Understanding Medicare Part C & D enrollment periods–tip sheet. Centers for Medicare & Medicaid Services. https://www.medicare.gov/Pubs/pdf/11219-Understanding-Medicare-Part-C-D.pdf