What Happens if I Missed the Deadline for ObamaCare?

If you miss the annual deadline for ObamaCare Open Enrollment you still have options for obtaining health insurance. Options for getting covered outside of open enrollment include qualifying for a special enrollment period which can extend the time you can use the marketplace.

If you don’t qualify for special enrollment (details below) you can still sign up for Medicaid and CHIP or some types of temporary private health insurance outside of the marketplace through an Agent, broker or provider.

The deadline for ObamaCare open enrollment 2015 is February 15th, 2015.  This is true both inside and Outside The Marketplace.  So no matter how you plan to get private coverage for you or your family you’ll need to sign up before open enrollment ends!

Most health insurance types, like employer-sponsored coverage and Medicare, have unique open enrollment periods, while some forms of health insurance, like short term and Medicaid, can be obtained at anytime.

FACT: The deadline to get a plan that starts on January 1st is December 15th each year. If you have a marketplace plan from last year, make sure to verify your information and plan before December 15th to ensure you get the right plan and cost assistance.

obamacare open enrollment deadline

If you missed the deadline: you won’t be able to get marketplace insurance or an ACA-compliant private plan outside the marketplace until the next annual enrollment period, without qualifying for special enrollment.

Missing the Deadline For Coverage Starting January 1st

From the start of open enrollment to December 15th each year you can enroll, switch plans, and verify cost assistance. If you miss that deadline you won’t have a plan that starts by January 1st. Since a lot of your out-of-pocket costs are based on policy periods, it makes little sense to not have a plan for the full year.

In some state’s you still have until December 23rd to enroll in a plan for the 1st, while plans typically renew by December 19th, so if you are still in that window do yourself a favor and sign into your marketplace account and make sure everything is in order. If you are outside of that window, but it is still open enrollment you can still enroll, switch plans, and verify cost assistance. Coverage obtained before the 15th starts the 1st of the next month after you pay your premium.

FACT: All marketplace plans end on December 31st unless otherwise noted. Remember, out-of-pocket cost sharing limits like deductibles and out-of-pocket maximums are based on policy periods, so make sure to start your plan on time to get the most out of your health plan.

Buying a Plan Outside of Open Enrollment

Unless you qualify for special enrollment in the health insurance marketplace, you’ll end up shopping for private coverage for Individual and Family coverage outside of the marketplace if you miss the ObamaCare deadline for open enrollment.

The selection of Private Health Plans offered to individuals and families will be limited to mostly short term plans post open enrollment, as insurers for the most part won’t offer ACA compliant plans outside of open enrollment.

Short term plans don’t have to follow the rules and regulations of ACA compliant plans and won’t help you avoid the fee for not having health insurance, but they will help cover your healthcare costs and needs. Short term plans, on the plus side, are almost always less expensive then unsubsidized private health plans and tend to have no waiting periods.

FACT: Those who have been ignoring the requirement to obtain and maintain coverage risk finding out about how it affects them for the first time during the 2015 tax season. Since taxes are due April 15th and Open Enrollment ends February 15th, it creates a gap in which some will want coverage, but won’t be able to get a plan that starts before January 1st, 2016. Learn more about why you should get health insurance.

ObamaCare Deadline, Fee and Extensions

If you missed the ObamaCare enrollment deadline on March 31st, 2014 you will incur a fee for each month you go without health coverage (unless you qualify for an exemption) and not be eligible for cost assistance or marketplace insurance (unless you qualify for an extension), but you still have options.

To get coverage for 2015 you’ll need to shop during 2015 open enrollment. The deadline for ObamaCare open enrollment 2015 is February 15th, 2015.  If you miss the annual deadline for ObamaCare you won’t be able to get marketplace coverage outside of open enrollment unless you qualify for a special enrollment period, but like last year you still have options.

You can enroll during each years open enrollment period.  In 2015 open enrollment is from November 15th, 2014 to February 15th, 2015.  Outside of open enrollment you have options, but they are limited.

Let’s take a look at some scenarios and figure out what extensions and exemptions are available and what health insurance options folks who missed the ObamaCare enrollment deadline have while they wait for the next open enrollment period.

To avoid the penalty in 2014 you needed to have coverage that started by May 1st, 2014.  For 2015 you need to enroll by February 15, 2015 to ensure you have coverage that starts by March 1st, 2015. Insurance purchased before the 15th of each month starts on the first of the following month after you have paid your premium.

ObamaCare Deadline Extension

There is an ObamaCare deadline extension (this was a one time exemption, not the ongoing special enrollment period) for folks who have signed up for the health insurance marketplace but were unable to enroll in a plan by the March 31, 2014 deadline. By checking a box upon logging in after April 1st you were able to enroll in a plan until about mid-April. After mid-April you were still able to qualify for an extension under special circumstances.

To enroll in ObamaCare’s marketplace after the open enrollment deadline deadline, you can:

  • Log in to your online Marketplace application on HealthCare.gov and finish the enrollment process – you’ll need to just confirm online that you were still trying to enroll on March 31.
  • Or contact the Marketplace Call Center at 1-800-318-2596. The Call Center can help you complete your enrollment over the phone. TTY users should call 1-855-889-4325. Be sure to tell our customer service representative that you’ve been trying to enroll.

ObamaCare Missed Deadline 2014

If you missed the sign up deadline ObamaCare for February 2014 or earlier you are safe. You could still enroll in a health insurance plan anytime before March 31st, 2014. If you have signed up for the marketplace, but were unable to enroll by March 31, you had until about mid-April to finish the enrollment process due to an extension. If you still haven’t enrolled in a plan you’ll have to either call the call center and see if you can be granted a special enrollment period, purchase health insurance outside of the marketplace, pay the per month fee for not having coverage, or qualify for an exemption from the fee.

Beyond special enrollment and exemptions you may be able to obtain ObamaCare compliant health care plans from private providers to protect you from the per month fee for not having health insurance. Please note most options for private insurance in between open enrollment, like short term insurance, won’t help you avoid the fee.

Remember signing up and enrolling are two different things. You needed to enroll before the ObamaCare deadline to be considered covered.

Can I Still Get Subsidies if I Missed the ObamaCare Deadline?

If you miss the annual deadline to sign up for ObamaCare you’ll have to wait until next years open enrollment to get subsidized health insurance through the marketplace, unless you qualify for a special enrollment period. Please note in 2014 all Americans who signed up for the marketplaces before March 31st, but had trouble enrolling in a plan for any reason, qualified for a special extension that gives them until mid-April to enroll.  This also extended the time they were exempt from the fee.

Open enrollment for 2014 was closed from April 1st, 2014 until November 14th, 2014. Without a special qualifying life event you won’t be able to purchase marketplace coverage during this time.

ObamaCare Special Enrollment Period

A special enrollment period is a time outside of the open enrollment period when you and your family can sign up for health insurance. You may qualify for a special enrollment period of 60 days following certain life events that involve a change in family status (for example, marriage or birth of a child) or loss of other health coverage.

If you don’t have a special enrollment period, you can’t buy insurance inside or outside the Marketplace until the next open enrollment period. Job-based plans generally allow special enrollment periods of 30 days.

The following life events will generally qualify you for a special enrollment period.

  • You signed up for the marketplace, but were unable to complete the enrollment process for any reason (until mid-April 2014).
  •  Getting married.
  •  Having, adopting, or placement of a child.
  •  Permanently moving to a new area that offers different health plan options.
  •  Losing other health coverage (for example due to a job loss, divorce, loss of eligibility for Medicaid or CHIP, expiration of COBRA coverage, or a health plan being decertified). Note: Voluntarily quitting other health coverage or being terminated for not paying your premiums are not considered loss of coverage. Losing coverage that is not minimum essential coverage is also not considered loss of coverage.)
  •  For people already enrolled in Marketplace coverage, having a change in income or household status that affects eligibility for tax credits or cost-sharing reductions.
  •  An individual, who was not previously a citizen, national, or lawfully present individual gains such status.
  •  A qualified individual’s enrollment or non-enrollment in a QHP is unintentional, inadvertent, or erroneous and is the result of the error, misrepresentation, or inaction of an officer, employee, or agent of the Exchange or HHS, or its instrumentalities as evaluated and determined by the Exchange.
  •  An enrollee adequately demonstrates to the Exchange that the QHP in which he or she is enrolled substantially violated a material provision of its contract in relation to the enrollee.
  •  An individual is determined newly eligible or newly ineligible for advance payments of the premium tax credit or has a change in eligibility for cost-sharing reductions, regardless of whether such individual is already enrolled in a QHP. The Exchange must permit individuals whose existing coverage through an eligible employer-sponsored plan will no longer be affordable or provide minimum value for his or her employer’s upcoming plan year to access this special enrollment period prior to the end of his or her coverage through such eligible employer-sponsored plan.
  •  An Indian, as defined by section 4 of the Indian Health Care Improvement Act, may enroll in a QHP or change from one QHP to another one time per month.
  •  A qualified individual or enrollee demonstrates to the Exchange, in accordance with guidelines issued by HHS, that the individual meets other exceptional circumstances as the Exchange may provide.

Above information compiled from healthcare.gov and section 155.420 gpo.gov Federal Register.

See our section special enrollment for more details.

I Don’t Qualify For Special Enrollment, What Other Health Insurance Options Do I Have?

If you don’t qualify for special enrollment you still have health insurance options. If you qualify for Medicaid or CHIP you can sign up at anytime, although you’ll have to use alternative sign up methods for Medicaid and CHIP as you won’t be able to sign up through the marketplace. If you don’t qualify for subsidized insurance or public health options your best course of action will be to simply speak to an agent or provider and purchase private insurance outside of the marketplace. While many insurance options outside of open enrollment aren’t ACA compliant and won’t help you avoid the fee, they can help you cover your medical costs and needs.

NOTE: If you sign up for insurance after open enrollment you will owe 1/12th of the yearly fee for not having insurance for each month you go without coverage. This is true regardless of how or when you obtain insurance.

What If I Don’t Obtain Health Insurance?

The Affordable Care Act doesn’t force you purchase health insurance, but it does mandate that you pay a fee if you choose to go without health insurance. If you don’t obtain health health insurance during open enrollment each year you will owe 1/12 of the yearly fee for each month you go without coverage. Learn more about the individual mandate.

What Happens If I Miss the Deadline to Enroll in ObamaCare?