If you’re reading this story, we’re going to assume that you missed the Affordable Care Act (ACA) Open Enrollment deadline. If you’re keeping track, the 2022 Open Enrollment Period ended for most people on January 15, 2022, in most states.
Or, maybe you’re in a state whose deadline was January 31 and that deadline slipped your mind.
If you missed it, you’re not alone. People miss the ACA deadline for many reasons, says David Anderson, research associate at the Duke-Margolis Center for Health Policy in Durham, North Carolina.
Maybe you didn’t know the ACA has a marketplace where you can purchase health insurance, or you weren’t able to figure out what type of plan you needed in time. Or possibly you were just overwhelmed by trying to pick a plan.
“As people face more and more challenges to a decision, a common decision is not to decide,” says Anderson.
You might also just be a procrastinator who ran out of time.
Don’t worry. Take a deep breath. Even if you missed the deadline, all may not be lost. Here’s what to do now.
You may still be able to purchase ACA benefits after the deadline.
If you missed the January 2022 deadline, you can still apply for ACA benefits in a few cases:
- You make 150% of the poverty level or less. In other words: $19,320 or less per year for a single person, $32,940 or less for a family of three. This is new for 2022—simply file an application on the federal marketplace’s website at any time and list your income when prompted. Heads-up: You may be asked to provide documents, such as a recent pay stub, if your income is a lot lower than what’s shown on your most recent tax return.
- You’re a Native American. The ACA has different rules for Native Americans and Alaska Natives, says Anderson. One such rule is that they can enroll in a health plan year-round. If that’s you, enroll by the 15th of the month, and your coverage will start on the first of the following month.
- You qualify for a Special Enrollment Period (SEP). That is, you’ve had a qualifying life event (see below) that changes your insurance status or the marketplace plans that are available to you, says Anderson.
But how do you know if you’re eligible for an SEP?
The most common life changes that may qualify you include:
- Getting married, divorced, or legally separated
- Having a baby or adopting a child
- Moving to a new home in an area where different health plans are available (as long as you had coverage prior to the move)
- Loss of insurance (for example, you lost your job, you’re no longer eligible for Medicaid, or you turned 26 and are no longer covered by your parents’ health insurance)
Other less common circumstances that might trigger a qualifying event? Being affected by a hurricane or dealing with a technical error on the federal marketplace’s website while you’re trying to apply for ACA benefits.
Yet another important qualifying event: You applied for Medicaid or the Children’s Health Insurance Program (CHIP) during Open Enrollment and were denied access to it after the Open Enrollment Period ended.
You should know that SEPs have limitations.
If you believe you qualify for an SEP, you should apply for a plan as soon as you can.
“You’ll be able to certify that a major life event happened, pick the plan you want, and then you’ll have a window of time to get that approved,” says Anderson.
In most cases, that window is 60 days from the date when the qualifying event occurred, not from the time you applied, says Anderson. So you’ll want to act quickly.
“If there’s good faith but time’s just running out, the deadline can be extended,” says Anderson. But if you miss the deadline, he adds, you’re out of luck and will need to wait for another qualifying event. You can’t file twice for the same one.
You should be aware that, per current SEP rules, you can change plans, but you may not be able to go from being uninsured to insured.
For example, if you move to a new area with different health plans, you have to have had coverage prior to the move to trigger an SEP. If you lost your job but did not have insurance through that job, that wouldn’t count either.
“It’s the loss of insurance, not the loss of a job, that triggers an SEP,” says Anderson.
And don’t expect to change plans to whatever you want. Chances are you’ll have to choose a plan at the same cost level you already had.
Depending on cost, ACA plans have metal names like bronze, silver, gold, and platinum. So, if you’re already enrolled in a bronze plan, you’ll be able to choose a new plan only from the bronze category.
Be sure you can provide proof of your qualifying event, Anderson says. If you got married, you may need to have your marriage license. For a new baby, you may need to show the birth certificate, dated after the Open Enrollment Period ended.
“The insurer will look at it and give a thumbs-up or thumbs-down as to whether it’s sufficient,” Anderson says. If it’s not sufficient, “they’ll tell you what documentation you need to submit.”
If you qualify for Medicaid or CHIP, you don’t have to enroll in ACA benefits.
Do you qualify for Medicaid, a state-run health program offered to individuals with limited incomes? Or for the Children’s Health Insurance Program (CHIP), a federal program that provides low-cost coverage to children whose families earn too much to qualify for Medicaid?
You can apply for these programs at any time during the year—although how you qualify for the benefits may depend on which state you live in.
Just fill out an application through the federal marketplace or your state-run exchange, and if it looks like you qualify for Medicaid or CHIP, the government will send your information to your state agency. Then it will reach out to you to let you know whether you qualify.
Your state’s agency usually has 45 days to process your application, and if your application is easy to process, it could happen even quicker, Anderson says.
In most states, you can qualify for Medicaid if your annual income is below 138% of the federal poverty level. (It’s worth noting that the federal poverty level is higher in Alaska and Hawaii.)
In other words, a single person can usually qualify for Medicaid if they make $17,774. For a family of three, that total goes up to $30,305.
But even if that’s not you—for example, your income is more than 400% of the federal poverty level—you may qualify for premium tax credits that lower the monthly cost of a marketplace plan. Or, in some states, CHIP covers you if you’re pregnant.
Make sure you don’t miss the ACA deadline again.
This year’s Open Enrollment Period came and went. But next year’s, which will begin on November 1, 2022, should now be front and center—and we urge you to put it on your calendar today.
Signing up for health insurance can be frustrating; the more difficult it is to do, the less likely it is that you’ll follow through with it.
Anderson has found that people who sign up for zero-premium plans—i.e., ones that have no monthly cost to you—are far more likely to activate their coverage on January 1 than those who have to pay.
Why? Because they don’t have to make an initial payment, which saves them money and time and is more convenient.
The takeaway: Make the process as easy as possible for yourself, and you’ll be more likely to finish it.
How you can apply for ACA benefits quickly and easily
Signing up for insurance doesn’t have to take a long time, says Anderson: “I helped a friend sign up a couple of weeks ago. It took us one and a half cups of coffee.”
The trick is to come prepared, he says. If you’re a procrastinator, preparation might not be your thing. But you’ll save yourself a ton of time if you simply gather this information before you start:
- Social Security numbers for everyone on your application
- Your banking and credit card statements (you may be asked to confirm a recent purchase to verify your identity, Anderson says)
- Your best household income estimate
Why should you be organized? The average user on the federal marketplace will have 83 plans to choose from in 2022, according to the Kaiser Family Foundation.
Be ready to quickly narrow down your choices by answering these four questions ahead of time:
- What prescription medications do I want covered?
- What doctors or providers do I want to use? (Hint: Add your closest hospital too.)
- How much can I afford to spend on health insurance every month?
- How much can I afford to spend if something bad happens?
You can use this information to narrow down your options.
Having second thoughts? Trust us: Health insurance is worthwhile.
If you missed the deadline for ACA Open Enrollment because you’re not worried about being insured, you should know there are plenty of reasons to enroll in health coverage, even if you’re healthy.
For example, health insurance helps cover you if you need care for an accident or an unexpected illness in the future.
Plus, lots of preventive services—like tests for blood pressure, cholesterol, and depression—are covered under ACA marketplace plans.