When an injury or illness occurs, health insurance may protect you and your loved ones from unexpected medical costs. For example, a broken leg may cost up to $7,500 or more without health insurance. To avoid paying all of the medical bills out-of-pocket, health insurance may cover some of them.
In the case that you lose health insurance due to a change of residency or loss of employment, you may qualify for a special enrollment period. A special enrollment period allows you to enroll in health insurance outside of the annual open enrollment period.
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Can I Get Immediate Health Insurance Coverage?
You may only get immediate coverage if your health insurance is not ACA compliant, such as short-term health insurance.
For health insurance found on the health insurance marketplace or during an open enrollment period, your health coverage may not start until later. For some health plans, there may be an effective date that the plan may start. Moreover, some insurers may need time to do a medical background check to see if you would be eligible for their health coverage.
When looking for health insurance, you may use the health insurance marketplace to find coverage options.
Health Insurance Waiting Periods
A waiting period is a window of time that you may have to wait before your health insurance takes effect. During this period, the insured may not file claims or receive benefits from their health plan.
The standard waiting period may take up to 90 days and may not go over 90 days, as that violates the Affordable Care Act (ACA). If you’re waiting more than 90 days to receive effective health insurance from your employer, it is recommended to contact the US Department of Labor.
Open Enrollment Period
Open enrollment is a period of time during which you may choose to sign up, end, or change your health insurance plan.
This period is important because you may change your health plan without answering any health questions. This allows you to be eligible for a health plan that you may not be eligible for outside of the open enrollment period.
There are different open enrollment periods for those who are looking for individual and Medicare plans. Marketplace and individual plans open from November 1 to January 15. For Medicare applicants, open enrollment is between October 15 to December 7.
Note that in most states, enrollments that occur on or by December 15 will take effect on January 1. If enrollment occurs between December 16 and January 15, the plan will take effect on February 1. There are some exceptions to this when it comes to state-run exchanges that allow enrollment as late as January 31. These will most often have March 1 effective dates.
Open Enrollment Exceptions
You may be eligible to enroll in health insurance outside of the annual open enrollment period. To be eligible, you must have a Qualified Life Event (QLE) that triggers a special enrollment period.
A Qualified Life Event consists of:
- Changes in your household
- Changes in your employment and finances
- Changes in location
- Changes in Age
- Changes in your current health insurance
As of 2022 for states that use the Health Insurance Marketplace, enrollments completed due to a QLE will have coverage on the first day of the following month, regardless of the date completed. This means that if you complete enrollment on April 29, you will receive coverage on May 1.
Health Insurance Costs
The Kaiser Family Foundation announced that in 2021, the average annual premiums for single coverage were $7,739 and $22,221 for family coverage.
Even for an employer-health plan, those who were on a single coverage health plan averaged $7,016 and $20,802 for family coverage.
Factors such as age, where you live, and what kind of health plan you choose may contribute to your health insurance costs. For example, a 50-year-old adult living in New York may have higher premiums compared to a 30-year-old living in Minnesota.
Short-term Health Insurance
Short-term health insurance may be beneficial for those who are in between jobs, are waiting for the annual enrollment period, and for early retirees who have lost their health coverage.
With short-term health insurance, you may get up to a year of temporary health coverage. After a year, you may choose to renew the plan for the following year. Bear in mind that premiums may be more expensive due to the change in your age.
You may find a short-term health plan through private insurance companies. When enrolling, you may be asked to choose your deductible amount and how long you’d like to be covered for. Plans vary from 1 to 12 months of short-term health coverage.
Short-term Health Insurance Costs
The average cost of short-term health insurance ranges from $100 to $130 per month and may be less costly than other ACA-compliant health plans.
Although short-term health plans are less costly than other plans found on the healthcare marketplace, it does not offer ACA-compliant essential health benefits such as prescription drugs, mental healthcare, or substance abuse treatment. For those with preexisting conditions, you may be denied coverage for short-term health insurance as well.
Catastrophic Health Insurance
Catastrophic health insurance provides coverage for medical emergencies or preventative care such as:
- Hospitalization
- Surgery
- Major illness or injury
A catastrophic health plan provides essential benefits such as hospitalization, emergency services, and prescription drugs. However, the plan comes with a high deductible that you must meet before it can provide coverage.
This health plan may be beneficial for young adults under 30 years old or for those 30 years old and over who qualify for a hardship exemption, as the plan has low premiums to cover essential health benefits and emergency services.
Because catastrophic health insurance is part of the ACA, the same coverage timelines apply for both open enrollment and special enrollment periods.
Catastrophic Health Insurance Eligibility
To qualify for Catastrophic Health Insurance, you must be under 30 years old or qualify for a hardship exemption if you’re over 30 years old.
A hardship exemption is an exemption for individuals who can’t afford health insurance due to personal or financial circumstances. Circumstances may consist of homelessness, bankruptcy, or being a victim of domestic abuse.