We are now outside of Open Enrollment. Unless you have a “qualifying event”, you cannot get individual health insurance with the protections granted by the Affordable Care Act. You can read about qualifying events and Special Enrollment Periods here. If you don’t qualify for a Special Enrollment Period, your only other option is a short-term health insurance plan.
You may have heard how the current administration has expanded the availability of short-term health insurance plans. You can enroll in these plans at any time and they tend to be less expensive than the ACA plans. You can now also enroll for up to a full year at a time. However, you do need to complete a medical questionnaire and be approved. Pre-existing conditions will not be covered.
We are also very hesitant to recommend these plans unless they are the only option available. These plans have many loopholes. Some that I have seen include:
- No mental health care
- No prescription coverage
- No coverage for injuries sustained while participating in sports
- No coverage if you are admitted to a hospital on a Friday or Saturday for non-emergency care
- No maternity coverage – even if you get pregnant after the policy start date
- Routine physical is not covered
The House has recently opened an investigation into these plans to consider whether they are deceptive in their business practices. Many well-trusted media sources have also questioned whether these plans are worth the cost. Consumer Reports has come out with cautious advice each of the last two years. You can read their 2018 analysis here.
If you missed Open Enrollment and do not have a qualifying event that would allow you to enroll in an ACA plan mid-year, it might be worth looking at short-term plans. Otherwise, we recommend sticking to an ACA-approved plan that guarantees coverage of pre-existing conditions and essential health benefits.