From qualifying for coverage to the enroll-by deadlines, here’s how to navigate your coverage options year-round.
If you’ve ever shopped for health insurance, you may have heard of the term “open enrollment.” This refers to the period of time each year — from November 1 through January 31 — when you can buy health insurance or change your health plan.
In most circ*mstances, you have to wait until open enrollment to buy a new health plan or change an existing one — and for good reason. Restrictive timing keeps the cost of health insurance under control for everyone by preventing individuals from enrolling only when they are sick or injured. You can’t wait and get homeowners insurance after your basem*nt floods; the same rules apply for health insurance.
If you miss the enroll-by date, you might have to wait until the next open enrollment period — but there are some exceptions. If you go through a major life change, you may still be able to apply for health insurance with Covered California under special enrollment. A special enrollment window is triggered when you experience a qualifying life event — like losing your current health insurance, getting married, or having a baby — and for most qualifying life events, you have 60 days from the date of that event to enroll.
Common Ways to Qualify for Special Enrollment
Below are some common ways you may qualify for special enrollment, everything from moving to having a child.
Lost Coverage
Losing your employer-sponsored coverage, becoming ineligible for Medi-Cal or student health coverage, exhausting your COBRA or even aging out of your parent’s health plan can all qualify you for special enrollment.
Moved
You will qualify for special enrollment if you have relocated to California from out of state. Some health plans available through Covered California are regionally specific, so if you have moved within the state and now have access to new plans, you also qualify.
Just Married
If you’ve gotten married or entered into a domestic partnership, one or both members can enroll.
New Child
The birth or adoption of a child, or receiving a child through foster care, can trigger special enrollment for the entire family.
Low-Income Families
Those with an annual household income at or below 150 percent of the federal poverty level, who are not eligible for Medi-Cal, can enroll in coverage through Covered California any time of year. This new form of special enrollment doesn’t have a deadline. You can check if you qualify here by matching your household size and your income.
A more comprehensive list of qualifying life events also includes returning from active duty military service or gaining citizenship or permanent legal residency. While a serious chronic condition, terminal illness, or pregnancy itself is not considered a qualifying life event, your provider leaving your health plan network during your care for one of these conditions can trigger a special enrollment. Other unique options are also available for pregnant women who find themselves without insurance, including Medi-Cal, which enrolls qualified members year-round.
Special Enrollment Deadlines Still Apply
Remember: If you qualify for special enrollment, it’s important to take action and enroll for coverage as soon as possible. For most qualifying life events, you have 60 days from the date of your event to enroll in a Covered California health insurance plan or change your existing plan. Stay covered to protect your health, safeguard your finances, and avoid the California penalty that comes from going uninsured.
Use our Shop and Compare tool to understand your options or apply for health insurance today. If you have questions or need assistance, free expert help is available.
FAQs
Often, health insurance has an initial waiting period of 30 – 90 days, with 90 days being the government-mandated limit. However, certain conditions and procedures may have waiting periods with longer time requirements before coverage kicks in.
How long can you go without health insurance in Massachusetts? ›
Gaps in Coverage
Individuals can have up to three consecutive months without penalty. Thus, taxpayers who lose but then resume their coverage within three or fewer consecutive calendar months will not be subject to penalties for lack of health insurance coverage.
What is the best time to take health insurance? ›
Even though there is no such health insurance age limit in India, younger people are generally healthier and considered lower risk, which leads to lower premiums. This can lead to big savings throughout your time with the policy, making it cost-effective to start your coverage early.
What should you do first when shopping for health insurance? ›
Below are four things you should think about when choosing coverage - Costs, provider network, benefits, and quality.
- Costs. ...
- Which doctors and other providers can I go to? ...
- What benefits does the plan offer? ...
- What quality of care will I get with this coverage?
What is the 90-day waiting period exactly? First things first, the 90-day waiting period is the maximum amount of time an eligible employee has to wait before enrolling in a company-sponsored health insurance plan. Once the time period ends, by law, employees must be given the opportunity to get health coverage.
How soon after getting insurance can you use it? ›
So, you do not get any coverage within 30 to 90 days of purchase of your health insurance plan in case of any type of hospitalization. This is called the initial waiting period and it may vary from insurer to insurer. Usually, this waiting period is a minimum of 30 days.
What happens in America if you can't afford healthcare? ›
By federal law, nonprofit hospitals must offer financial assistance to those who cannot pay their bills. Some states also have other laws about uncompensated care, such as Washington, where all hospitals must tell patients about financial assistance programs when they receive care.
What is the penalty for not having health insurance in Massachusetts in 2024? ›
Anyone deemed unable to afford health insurance will not face a penalty. No penalty will exceed 50% of the minimum monthly premium an individual would have paid for insurance through the Health Connector.
Does the IRS penalize you for not having health insurance? ›
Health coverage exemptions: Forms & how to apply
The fee for not having health insurance (sometimes called the "Shared Responsibility Payment" or "mandate”) ended in 2018. This means you no longer pay a tax penalty for not having health coverage.
What is the best time to buy insurance? ›
When's the best time to buy car insurance? The cheapest time to get quotes is 20 to 27 days ahead of your renewal date – cover becomes more expensive the closer you get. It's the same if you are buying car insurance for the first time.
12-months Condition Specific Waiting Period – this is a period during which a member is not entitled to claim benefits in respect of a condition for which medical ad- vice, diagnosis, care or treatment was recommended or received within the 12 month period ending on the date on which an application for membership was ...
At what age should I get insurance? ›
You'll typically pay less for life insurance at age 25 than at age 40. Waiting until age 60 may mean an even bigger rate increase and limited policy options.
What health insurance is the best? ›
Summary: The Best Health Insurance Companies
| COMPANY | FORBES ADVISOR RATING | OUR EXPERT TAKE |
|---|
| Blue Cross Blue Shield | 5.0 | Best Provider Network |
| Kaiser Permanente | 5.0 | Best Quality |
| UnitedHealthcare | 4.6 | Best for Low Out-of-Pocket Costs |
Sep 1, 2024
HMO plans are generally less expensive than PPO plans, with lower monthly payments, making them ideal if your favorite doctors are already in the network, or if you receive most of your care close to home.
Is health insurance worth it? ›
Health insurance provides important financial protection in case you have a serious accident or sickness. People without health coverage are exposed to these costs. This can sometimes lead people without coverage into deep debt or even into bankruptcy.
What time period is covered by this insurance policy? ›
Your insurance policy period will be listed as a date range, showing both the effective date and the expiration date. The time between those two dates, inclusive, represents your policy period.
What is an insurance policy grace period? ›
Before your insurance company can end your coverage, you have a short period of time to pay called a. grace period. A short period after your monthly health insurance payment is due to pay all owed premiums to avoid losing coverage.
How long does medical take to approve? ›
Verify your Eligibility
The process for verifying your Medi-Cal eligibility, from the time your completed application is received to when you receive your Benefits Identification Card (BIC), normally takes 45 days.
How long can I use my health insurance after I quit? ›
COBRA lets you keep your existing health insurance for up to 18 months for most people after you leave your job. You can qualify for COBRA regardless of whether you quit, were laid off or fired.
