What to Do if I Miss Open Enrollment?

If you miss the open enrollment period for your health benefits, your existing coverage may simply be renewed. This is the case whether you’re insured through an individual plan or your employer. However, without an existing plan, you’ll have to wait until the next open enrollment. Only specific cases allow for enrollment outside of this schedule. This guide breaks down what you can do in different situations.

About Open Enrollment Periods

Open enrollment is the period when you can enroll, drop, or update the coverage of your health benefits. This is the standard for employer-sponsored and individual or family health plans, thanks to the Affordable Care Act (ACA). During this time, you may notice changes in the insurance rates as they are reassessed. That said, health benefits not regulated under the ACA do not have an open enrollment period.

If You Missed Open Enrollment for Employer-Sponsored Plans

Companies usually schedule open enrollment during the fall for new plans to start on January 1 the following year. If you think you’ve missed open enrollment, confirm the details with your employer. Although open enrollment usually lasts for a week up to a month, this rule is not set in stone. Employers usually have wiggle room, depending on the terms of the health insurance agreement.

You may need to wait until next year if you completely miss your company’s schedule. You can also ask your human resources department for other available options. Companies typically offer voluntary benefits as supplemental insurance.

If You Missed Open Enrollment for Individual or Family Plans

Maybe you purchased your own health insurance plan. Open enrollment varies per state, but typically lasts from November 1 to January 15, with coverage starting in January or February. If you missed the healthcare enrollment period for your desired plan, you’ll have to wait for the next open enrollment schedule unless you qualify for special enrollment. Other states may have longer enrollment periods, as states with their own exchange platforms can set their own deadlines. As of 2025, 20 states fully run their health insurance marketplaces.

Keep in mind that with individual plans, you can drop your coverage at any time. There’s also no penalty for not having health coverage, as it was removed in 2018, thanks to the Tax Cuts and Jobs Act. However, you’ll have to wait for the next open enrollment to get a new plan.

If You Missed Open Enrollment for Medicare

Medicare offers varying enrollment periods depending on whether you’re enrolling for the first time, dropping a plan, or switching to Medicare Advantage. An existing plan will just renew the following year if you miss the open enrollment period. However, if you’re completely new, you may be susceptible to late enrollment penalties. The penalty will be added to your monthly premium and is not a one-time late fee — the longer the delay, the larger the penalty.

Here are the dates to remember:

• Initial enrollment period if you’re completely new: Three months before you get Medicare and up until three months after.
• Initial enrollment period if you’re new to Part B: Three months before the month you’re first eligible for Parts A and B, up until two months after you get both parts for the first time.
• Open enrollment period: From October 15 to December 7. If you’re switching between Medicare Advantage plans or dropping one to switch to Original Medicare, the period is from January 1 to March 31 or within the first three months of your enrollment.

About Special Enrollment Periods

A special enrollment period (SEP) is available if you experience a qualifying life event (QLE). If you missed open enrollment and don’t have any backups for your health benefits, the SEP might help. You can usually apply within 30-60 days of the QLE, depending on your situation.

Qualifying Life Events for Special Enrollment

The following scenarios make you eligible for special enrollment:

• Changes in your residence: You may have gotten a new home or moved from the place where you attended school or work. You may have also moved to the United States from another country. You need proof that you had qualifying health coverage during the 60 days before you moved.
• Changes in the household: You may have gotten married, had a baby, or gotten divorced. A change in household also counts as a QLE if someone on your Marketplace plan passes away.
• If you lost or expect to lose your health coverage: You may be losing your health coverage from your employer or because you had a discontinued individual plan. You may also have been denied Medicaid or the Children’s Health Insurance Program (CHIP), or lose your premium-free Medicare Part A coverage. You may also have lost your coverage through your spouse, parent, or other family member. You may be eligible for an SEP if this happened in the past or within the next 60 days.
• If you were offered an individual HRA or QSEHRA: Your employer may offer you an individual coverage Health Reimbursement Arrangement (HRA) or a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA). You may qualify for an SEP if your employer offered one of these arrangements in the past 60 days or you expect it within the next 60.

These situations can also qualify you for an SEP:

• Becoming a U.S. Citizen
• Leaving incarceration
• Getting affected by an uncontrollable natural disaster
• Gaining membership in a federally recognized tribe
• Becoming an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
• Starting or ending your service in the AmeriCorps State and National, the National Civilian Community Corps (NCCC), or the Volunteers in Service to America (VISTA)

150% Special Enrollment Period

Thanks to the American Rescue Plan (ARP) Act of 2021 and the Inflation Reduction Act (IRA) of 2022, the Centers for Medicare and Medicaid Services (CMS) offers a monthly SEP for eligible consumers with a projected household income at or below 150% of the federal poverty level (FPL). That means you don’t need to worry about late healthcare insurance enrollment. However, this is only offered for a limited time through the year 2025. There is no deadline for reporting changes in the Marketplace, unlike with other qualifying life events.

How to Apply for Special Enrollment

You can apply for coverage by creating a Marketplace account or logging in to an existing one. Here are the steps once you log in:

1. Choose which application you’ll be updating.
2. Select “Report a Life Change” and the kind of change specific to your situation.
3. Wait for eligibility results to understand your options.

You may have limited options for eligible health plan categories. In some cases, you’re limited to the category of your previous or current plan. You may be able to switch categories if:

• You’re eligible for cost-sharing reductions
• If you lose extra savings
• If you have new household members due to marriage, birth, adoption, or court order
• If your current plan doesn’t allow new members
• If you get access to an individual coverage HRA or QSEHRA from your employer

You’ll need to send documents that prove your life event within 30 days of choosing a plan, unless it’s not stated in your eligibility notice. You can upload the documents online or by mail. Some qualifying life events don’t accept online applications.

Your coverage starts after you pick a plan. However, you cannot use it until after you’ve been confirmed eligible. You also need to make your first premium payment.

Alternatives for Missing Open Enrollment and Special Enrollment Periods

If you missed the health insurance enrollment period and any applicable SEP, there are a few more solutions you can try.

Medicaid and CHIP

Medicaid and CHIP are great alternatives, as you can apply at any time for free or low-cost coverage. Eligibility varies per state. However, there are mandatory eligibility groups, like qualified pregnant women and children, low-income families, and individuals receiving Supplemental Security Income (SSI).

Eligibility requirements include financial requirements, like being in a specific income bracket, and non-financial requirements, like age or parenting status. Once you become ineligible, such as due to an increase in income, you may qualify for a special enrollment period for other healthcare benefits.

Basic Health Programs

Through the ACA, states can create a Basic Health Program (BHP) that provides more affordable coverage for low-income households. These plans are for individuals:

• Who don’t qualify for Medicaid, CHIP, and other minimum essential coverage
• Within the income bracket of 133% to 200% of the FPL
• Whose income does not exceed 133% of the FPL but are unqualified for Medicaid due to non-citizenship

The BHP can provide a great backup plan if you missed the healthcare insurance enrollment period. Enrollment schedules for a BHP vary per state, and some states allow for year-long enrollment. States currently with a BHP include Minnesota, Oregon, and New York, although New York has their BHP suspended until December 31, 2028.

Plans Not Regulated by the Affordable Care Act

Plans that are not considered minimum essential coverage, and therefore are not regulated by the ACA, typically allow enrollment year-round. These include:

• Health plans with short-term coverage
• Dental or vision plans
• Medical discount plans
• Accident supplements
• Critical illness plans
• Fixed indemnity plans
• Healthcare sharing ministry plans

These plans are typically used as supplemental coverage. If you qualify, you may use one while you wait for the next open enrollment period of your desired coverage.

Why There Is an Open Enrollment Period

Understanding how health insurance works can help explain the need for open enrollment periods. With health insurance, every member regularly pays an amount placed in a “risk pool,” regardless of their health condition. This pooled amount covers the healthcare costs of any member who needs it. Healthy people contributing to this pool stabilize the system, as they are less likely to need the funding. Without an open enrollment period, healthy people can choose to opt for insurance only when they get sick or injured.

Before the ACA was established, there were no open enrollment periods for healthcare insurance. However, insurers typically charged higher premiums or rejected applications of people with preexisting conditions. Today, coverage is guaranteed regardless of your health condition.

How to Avoid Missing Open Enrollment Next Time

To avoid worrying about what to do if you missed open enrollment, keep track of the deadlines. Talk to your HR department regarding your employer’s open enrollment schedule. If you have an individual healthcare plan, take note of the Marketplace schedule. Plotting the relevant SEP in your calendar will also help you remember.

Consider regularly planning at the end of the year for any changes you want to make to your coverage. This helps you stay on top of your deadlines and evaluate whether your current plan is still relevant to your needs. You can also take this time to research other plans to explore your options.

Risks of Staying Uninsured

If you’ve missed open enrollment or special enrollment periods, it can be tempting to stay uninsured. However, there are many risks to not having health insurance or not trying for the other available benefits:

• Increase in medical debt: Health insurance helps you reduce the amount you pay out of pocket. Without one, you can get tempted to take out a loan, which increases your medical debt. Considering the interest rates, this can end up more expensive in the long run. This can also affect the overall state of your finances if medical bills pile up.
• Postponed healthcare treatment: If getting treatment hurts your budget, you may also get tempted to postpone getting medication or treatment. This can worsen your condition and may lead to more expensive medical bills in the future. If you’re a healthy individual, you may also avoid getting preventive care, which could have been beneficial in detecting early symptoms.
• Penalties: There may be no tax penalties on a federal level, but some states may impose their own health insurance penalties. Medicare is another place where penalties can pile up.
• Decreased mental well-being: Thinking that you might not have the funds when you need to care for your health can contribute to your stress and anxiety levels. This, in turn, can develop or contribute to any illness you might have.

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Your employer may work with us to provide a variety of healthcare benefits. They may offer you the Difference Card Medical Expense Reimbursement Plan (MERP), a Health Savings Account (HSA), a Flexible Spending Account (FSA), a Dependent Care Account (DCA), or other account types depending on your needs. Learn more about what you can get today as a member. Employers and insurance brokers can also request a proposal.