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), Medicaid, CHIP, short-term health insurance, and other insurance types.

What “missing the ObamaCare deadline” means is subject to change depending on the year, the time of year, and other contexts.

We’ll be discussing what to do if you missed this year’s open enrollment period for the individual and family private market, but other information about other deadlines will be posted as well. So read carefully.

What To Do If You Missed the Deadline For Open Enrollment 2018

Here is a list of things you can do if you missed the Dec. 15 2018 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.

  • Some states extended their deadline or allow customers to file for extensions. See a list of those states below.
  • If you signed up for the Marketplace but didn’t complete the enrollment process, you might get a few extra days to complete enrollment in some states. See state extensions from 2015 for example.
  • If you had trouble signing up or had a plan from last year, you’ll need to attest that your trouble signing-up was due to a website or call center problem. 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.
  • Enrollment has ended, but the federal marketplace sometimes extends the deadline after the fact, so you can wait for news on that (this happened every year so far, but with Trump in office, this could change this year).
  • 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.

Generally we learn more after open enrollment ends. It is unclear if Trump’s administration will be offering extensions beyond the state-based ones listed below, if they do they, we will be the first to update you.

IMPORTANT: According to the HealthCare.Gov Twitter: 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. Do this ASAP (on December 16th) if you want coverage!

TIPIf you miss the deadline and don’t create an account, you 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 2018

State Specific deadlines for open enrollment 2018:[1][2]

  • Connecticut (Nov 1, 2017 – Dec. 22, 2017)
  • Colorado (Nov 1, 2017 – Jan. 12, 2018)
  • Maryland (Nov 1, 2017 – Dec. 22, 2017)
  • New York (Nov 1, 2017 – Jan. 31, 2018)
  • Massachusetts (Nov 1, 2017 – Jan. 23, 2018)
  • Washington (Nov. 1, 2017 – Jan 15, 2018)
  • California (Nov 1, 2017 – Jan. 12, 2018)
  • Minnesota (Nov 1, 2017 – Jan. 14, 2018)
  • Connecticut (Nov 1, 2017 – Jan. 31, 2018)
  • District of Columbia (Nov.1, 2017 – Jan. 31, 2018)
  • Rhode Island (Nov 1, 2017 – Dec. 31, 2017)
  • *Flordia, Georgia, Louisiana, Texas, and those effected by Hurricane Harvey are eligible for an extension until Dec. 31, 2017.

Idaho and Vermont were legally permitted to extend open enrollment. However, we did not hear any updates on those states.

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.

What Happens If You Missed 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. Luckily there are some ways around this.

Here is what you need to know if you miss this year’s deadline:

  • You won’t be able to get Minimum essential coverage for 2018 without qualify for another coverage type like Medicaid or employer coverage unless you qualify for a short special enrollment period.
  • You will owe the fee for each month you go without coverage or an exemption in 2016. The only way around this is to qualify for a special enrollment period due to qualifying life events, Medicaid, or CHIP.
  • Short Term Health Insurance can be obtained outside of the marketplace through an Insurance Agent, broker, or provider outside of open enrollment. However, short term won’t protect you from the fee.
  • Insurance types like Medicare and employer coverage have unique enrollment periods.
  • If you missed the deadline for the year, you should look into all of your health insurance options and possible exemptions.
  • There are over 40 different qualifying life events and exemptions to look into (so some will find they have options).
If you’ve already tried HealthCare.Gov and would like help from outside the Marketplace, try using the form below to get quotes and assistance from the first available qualified broker or provider.

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 is December 15, 2017.
  • 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 proposed “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.

ObamaCare’s 2018 Open Enrollment period will start November 1, 2017 and end December 15, 2017.

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

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.

You can enroll during each year’s open enrollment period.  In 2015 open enrollment was 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 needed to enroll by February 15, 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 was an ObamaCare deadline extension (this was a one-time exemption – not the ongoing special enrollment period) for folks who 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.

There was a similar extension in 2015 allowing folks who signed up until February 22nd to complete enrollment.

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.

ObamaCare Missed Deadline 2014

If you missed the ObamaCare sign up deadline of February 15, 2014, it’s OK. You could still enroll in a health insurance plan anytime before March 31st, 2014 due to a special enrollment period that applied to everyone.

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 didn’t enroll in a plan by that deadline, your options included qualifying for a special enrollment period, purchasing short term health insurance outside of the marketplace, qualifying for another insurance type, paying the per month fee for not having coverage, or qualifying for an exemption from the fee.

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

ObamaCare Missed Deadline 2015 – 2017

There were a few special rules that were in place for 2015 – 2017, they were:

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.

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

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?
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Citations

  1. States That Have Extended Health Insurance Open Enrollment for 2018 (and States That Still Can)
  2. Andy Slavitt Twitter