Can I Get Health Insurance Right Now?

Three Ways to Buy Individual Coverage

If your employer doesn't offer a plan, you're not limited to one option. Three distinct paths lead to individual health insurance, and they're built differently under the law.

ACA Marketplace

Bought through HealthCare.gov or your state exchange. The only path that can carry income-based premium tax credits.

Best fit when: your income qualifies for a subsidy, or you have a health condition that needs guaranteed-issue protection.

Off-Exchange ACA-Compliant

Same required benefits and guaranteed-issue protections as Marketplace plans, sold directly by a carrier instead. No subsidies available this way.

Best fit when: your income is too high for a subsidy and you'd rather work directly with a carrier.

Private, Medically Underwritten

Priced and approved based on your health history. Can be less expensive for healthy applicants, but isn't guaranteed-issue and may exclude pre-existing conditions.

Best fit when: you're healthy, don't qualify for a subsidy, and want a lower premium while you're between other coverage.

What Opens a Special Enrollment Period

Outside of Open Enrollment, you generally need a qualifying life event to enroll in a marketplace plan. Most events give you a 60 day window from the date it happens. Miss that window and you usually wait for the next Open Enrollment.

Events that usually qualify

• Losing other coverage. A job ending or hours being cut, COBRA running out, Medicaid or CHIP ending, or aging off a parent’s plan at 26.
• Household changes. Marriage, having a baby, adopting, or placing a child in foster care. Divorce or a death in the family can also count when it causes you to lose coverage.
• Moving. A move to a new ZIP code or county where different plans are available. A move just across town usually does not count.
• Certain income or status changes that change what help you qualify for.

What usually does not qualify

This is where people get caught out, so it is worth being blunt about it. Cancelling your own coverage does not open a window. Neither does losing it because premiums went unpaid. Deciding your current plan is too expensive is not a qualifying event on its own either. Knowing this ahead of time saves you from counting on a window that is not there.

You Still Have Options

Not qualifying for a Special Enrollment Period does not mean you have no path to coverage until November. Depending on your situation and state, these may still be open to you:

• Private, medically underwritten plans. These are often available year round. They ask health questions, and what you are offered can depend on your answers, but they are not tied to an enrollment window.
• Medicaid or CHIP. If your income qualifies, you can apply any time of year. There is no enrollment window for these.
• Short term coverage. Built to bridge a gap rather than replace a full plan. Worth understanding the limits before you rely on it.
• The next Open Enrollment. In most states this runs from November 1 through mid January, though some state marketplaces run longer.

Which of these makes sense depends on your health, your budget, and how long you need the coverage to last. That is the conversation worth having before you commit to anything.