What Happens If You Miss the Individual Health Insurance Enrollment Deadline?

Find out what can happen if you don't obtain coverage in time.

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The clock is ticking on the individual health insurance open enrollment period for 2014. You have until March 31, 2014 to obtain individual non-group coverage for yourself and your dependents, either through your state health insurance exchange or directly from a private health insurer. However, if you qualify for Obamacare health insurance tax subsidies for 2014, you must obtain your coverage through your state exchange to receive them.

What happens if you don’t obtain coverage by March 31, 2014? Several things, none of them good. First, you may have to pay a penalty to the IRS equal to the greater of $95 or 1% of your 2014 adjusted gross income. Second, the aforementioned Obamacare health insurance subsidies will be unavailable to you and your family for 2014, potentially costing you hundreds or thousands of dollars you could have had to help pay for your coverage.

What happens if, after March 31, 2014, you decide you made a mistake not obtaining coverage and want to purchase it for the remainder of 2014? You could be well out of luck—that is, you may be unable to purchase individual non-group health insurance coverage for the rest of 2014, either through your state exchange or directly in the open market from a private insurer. This means you’ll have to bear all of your health costs for 2014 out of your own pocket. You’ll have to wait until the next open enrollment period to obtain individual coverage starting in 2015. The open enrollment period for 2015 coverage is scheduled to run from November 15, 2014 through January 15, 2015 (however, this could change).

Qualifying Life Events

After the open enrollment period ends, individual non-group health insurance coverage will be available for purchase only for individuals who have a “qualifying life event” during the year. This includes:

  • losing your existing health insurance coverage—for example, because you quit your job, were laid off, or your work hours were reduced below the level required for you qualify for employer-provided coverage
  • you got married, divorced, or legally separated
  • you gave birth to or adopted a child
  • you lost your coverage because you moved to another state or a part of the same state outside of your health plan service area
  • you lost eligibility for Medicaid—for example, because your income grew
  • you are no longer eligible to receive coverage as someone else’s dependent—for example, you turn 26 and are no longer eligible for coverage through your parents’ plan
  • you timely enrolled in coverage through your state exchange, and your income increases or decreases enough to change your eligibility for subsidies for 2014, or
  • you become a U.S. citizen.

Once a qualifying life event occurs, you have 60 days to obtain individual coverage, either through your state health insurance exchange or private insurers. This period is called your “special enrollment opportunity.”

Note carefully that the following are not qualifying life events:

  • getting sick
  • getting pregnant
  • losing your coverage because you didn’t pay your premiums, or
  • voluntarily quitting your existing health coverage.

Thus, for example, you can’t go without coverage past March 31, 2014 and then decide you want to enroll because you get sick (or pregnant).

You Can Enroll In Medicaid Any Time

You can enroll in Medicaid or the Children’s Health Insurance Program (CHIP) in your state at any time. There is no open enrollment period for these programs, which are designed to help the poor.

Twenty-six states have expanded their Medicaid programs starting in 2014. If you live in one of them, you’ll probably qualify if your annual income is below $16,104 for an individual or $32,913 for a family of four. If your state isn’t expanding Medicaid you may still be eligible, especially if you have children, are pregnant, or have a disability. Every state’s eligibility rules are different. For details, visit the HealthCare.gov website.

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