What Happens if I Missed the Deadline for ObamaCare?
If you miss the annual deadline for ObamaCare Open Enrollment, you might miss your opportunity for cost assisted coverage. However, you may still have options for obtaining health insurance.
In general open enrollment for private individual and family health plans is limited each year. For example, in 2019 open enrollment runs from November 1st, 2018 to December 15th, 2019 (extended in some states).
Unless there are extensions granted by federal and/or state government, individuals and families can’t purchase major medical coverage outside of the marketplace or get a marketplace plan with or without cost assistance outside of the open enrollment period each year.
However, in many cases there are options for getting covered outside of open enrollment. These options include requesting a short extension right after open enrollment ends, qualifying for a special enrollment period due to life circumstances (which can extend the time you can use the marketplace), qualifying for Medicaid, CHIP, Medicare, or employer coverage, or purchasing short-term health insurance.
In short, if you miss the deadline for open enrollment you still have options, but your options become limited.
That is the main deadline under the Affordable Care Act (ACA), but there are others. Below we will discuss different deadlines under the ACA and what to do if you miss this year’s open enrollment period for the individual and family private market.
TIP: For 2019 forward the individual mandate is repealed on a federal level (some states have their own mandates). For those in states without mandates, although your options for coverage are limited outside of open enrollment, you won’t be penalized for not having coverage.
What To Do If You Miss the Deadline For Open Enrollment 2019
Here is a list of things you can do if you miss the Dec. 15 2019 open enrollment deadline.
In some cases missing the deadline, but meeting specific criteria, will qualify you for a short special enrollment window (a sort of extension of the open enrollment deadline). In other cases, extensions are offered to everyone.
- The federal marketplace sometimes extends the deadline for HealthCare.Gov.
- Some states extend their deadline or allow customers to file for extensions.
- If you sign up for the Marketplace but don’t complete the enrollment process, you might get a few extra days to complete enrollment in some states. See state extensions from 2015 as an example.
- If you have trouble signing up or have a plan from last year but couldn’t complete the process, you can attest that your trouble signing-up was due to a website or call center problem. If you do this you may be granted a short special enrollment period in this case.
- If you applied for Medicaid or CHIP during open enrollment, but got rejected from Medicaid or CHIP after open enrollment, the denial may qualify you for a special enrollment period.
- You may qualify for Special Enrollment due to qualifying life events even if we didn’t expressly state your situation above. Contact an insurance agent outside the Marketplace, or go to HealthCare.Gov or your state’s marketplace now.
- You or a family member may qualify for another coverage type like Medicaid or CHIP (which are offered year round) or may qualify for open enrollment in Medicare or your employer’s coverage (employers and Medicare have unique enrollment dates).
- To the last point, there is a chance that the requirement to get covered will end this year and that short term health insurance will be expanded, if this is the case people may have options for coverage and avoiding the fee in 2018 even if they missed open enrollment (the fee is reduced to zero for 2019 forward).
EXAMPLE OF AN EXTENSION: According to the HealthCare.Gov Twitter in 2018: If you call 1-800-318-2596 and leave your name and number it seems you will be granted an exemption to the Dec. 15 deadline. This doesn’t apply for 2019 necessarily, but generally one can expect short exemptions like this each year.
It’s busy at our call center today! If you call and are asked to leave your name and phone number, please do so. A call center rep will call you back after Dec 15 to make sure you have Marketplace coverage that starts Jan 1. You may also visit https://t.co/eTfU7hBbyh to enroll.
— HealthCare.gov (@HealthCareGov) December 15, 2017
TIP: If you miss the deadline and don’t create an account, you likely won’t be able to get cost assistance on marketplace insurance (or an ACA-compliant private plan) until the next open enrollment period starts again in most cases (there are very few exceptions to this outside of obtaining employer coverage or another coverage type like Medicare or Medicaid).
State Specific Deadlines for Open Enrollment 2019
Some states have state specific deadlines for 2019.
- California: January 15, 2019
- Massachusetts: January 23, 2019
- Minnesota: January 13th, 2019
- Rhode Island: December 31st, 2018
- Washington DC: January 15th, 2019
Other states are subject to extension as well. Look for extensions for Colorado, Connecticut, Flordia, Maryland, and New York.
TIP: If you enroll in coverage before the 15th of a given month of open enrollment, coverage starts by the 1st of the next month. If you enroll after coverage starts, your coverage will begin on the 1st of the month after. Thus, those who enroll at the last minute in January will have coverage that starts March 1st. Luckily we all get a “short coverage gap” exemption. “Missing the December 15th deadline” means “your coverage won’t start until February 1st.” Need to do this quick? We suggest an HSA eligible silver plan as a rule of thumb (get more tips for health plans here). Remember to sign up and enroll; just signing up isn’t enough.
A Few More Things to Know About Missing the Deadline
If you missed the annual ObamaCare deadline, you’ll no longer be able to get Minimum Essential Coverage in the individual and family market for the upcoming year. This is true both inside and outside the Marketplace.
Still, you should keep in mind:
- You won’t be able to get a major medical plan that counts as Minimum Essential Coverage or cost assistance for 2019 without qualifying for another coverage type like Medicaid or employer coverage unless you qualify for a short special enrollment period.
- Short Term Health Insurance can be obtained outside of the marketplace through an insurance agent or broker outside of open enrollment. However, short term coverage doesn’t offer all of the ACA’s protections and doesn’t qualify for cost assistance.
- Insurance types like Medicare and employer coverage have unique enrollment periods.
- If you wanted coverage but missed the deadline, you should check if you qualify for special enrollment, there are over 40 different qualifying life events and exemptions to look into (so some will find they have options).
TIP: If you missed the deadline and have no options, consider Short Term to protect your health in the meantime. Consider special enrollment and exemptions to protect you from the fee and to help expand your coverage options.
When Is the ObamaCare Deadline?
- The deadline for ObamaCare open enrollment 2014 was March 15th, 2014.
- The deadline for ObamaCare open enrollment 2015 was February 15th, 2015.
- The deadline for ObamaCare open enrollment 2016 was January 31, 2016.
- The deadline for ObamaCare open enrollment 2017 was January 31, 2017.
- The deadline for ObamaCare open enrollment 2018 was December 15, 2017.
- The deadline for ObamaCare open enrollment 2019 is December 15, 2018.
- Some states will extend the deadline each year, and the federal deadline is itself sometimes extended.
- Moving forward the deadline for ObamaCare open enrollment may change. However, the “normal” deadline will be December 15th of each year.
- Remember deadlines apply to all private coverage in the individual and family market, both inside and outside the marketplace.
No matter how you plan to get private coverage for you or your family, you 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 any time of the year.
Missing the Deadline For Coverage Starting January 1st
As a general rule of thumb, the deadline to get a plan that starts on January 1st is December 15th each year. If you have a marketplace plan from the year before, make sure to verify your information and plan before December 15th to ensure you get the right plan and cost assistance. If you miss that deadline, make sure to verify your info before open enrollment ends.
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 states, you can enroll after December 15th, in these states you have to check with the state marketplace if enrolling after will result in your plan starting on Jan. 1 or Feb. 1.
TIP: In other words, as a rule of thumb, coverage obtained before the 15th starts the 1st of the next month after you pay your premium (but there are sometimes exceptions when enrollment is extended for a few days).
FACT: Remember that 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, if you miss the ObamaCare deadline for open enrollment, you’ll end up shopping for private Individual and Family coverage outside of the Marketplace.
The selection of private health plans offered to individuals and families will be limited to mostly short-term plans post open enrollment since 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; however, they will help cover your healthcare costs and needs. Short-term plans, on the plus side, are almost always less expensive than 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 how they’re affected 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 will not 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
NOTE: The fee doesn’t apply in 2019 forward, but for past years this information may still be helpful.
If you missed the ObamaCare enrollment deadline, you would incur a fee for each month you go without health coverage (or exemption), and you will not be eligible for cost assistance or marketplace insurance (unless you qualify for an extension). 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.
ObamaCare Deadline Extension
Each year the deadline may be extended, you’ll need to check the federal marketplace or your state marketplace for extension information.
To enroll in ObamaCare’s marketplace after the open enrollment deadline, you can:
- Log in to your online Marketplace application on HealthCare.gov and finish the enrollment process – you’ll just need to confirm online that you were still trying to enroll on March 31st.
- 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 the customer service representative that you’ve been trying to enroll.
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 year’s open enrollment to get subsidized health insurance through the marketplace unless you qualify for a special enrollment period. Please note: Americans who sign up for the marketplaces before the deadline but, for any reason, have trouble enrolling in a plan will qualify for a special extension that gives them a little extra time to enroll and can extend the time they were exempt from the fee.
You can’t get cost assistance unless you have a Marketplace plan, and you can’t get Marketplace plans outside of open enrollment.
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 allow for special enrollment periods of 30 days.
Some special enrollment periods are longer or shorter, so check the enrollment period’s length when you qualify.
The following life events will generally qualify you for a special enrollment period.
- You signed up for the marketplace but, for any reason, were unable to complete the enrollment process (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 the decertification of your health plan). Note: Voluntarily quitting other health coverage or being terminated for not paying your premiums do not qualify as loss of coverage. Losing coverage that is not minimum essential coverage is also not considered a 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.
See our special enrollment section 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 any time although you’ll have to use alternative sign up methods for Medicaid and CHIP as you will not 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 to purchase health insurance, but it does mandate that you pay a fee if you choose to go without health coverage. If you don’t obtain health insurance during open enrollment each year, you will owe 1/12th 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?