How to Get Health Insurance Outside Open Enrollment

by | Jan 15, 2025 | Colorado Health Insurance, Health Insurance | 0 comments

How to Get Health Insurance Outside Open Enrollment

If you need health insurance outside Open Enrollment, you still have options to stay protected.

How to Get Health Insurance Outside Open Enrollment

Whether you’ve missed the deadline or need coverage sooner than the next enrollment window, there are several ways to secure health coverage. Here, we’ll explore how to get health insurance outside Open Enrollment, including special enrollment periods, health sharing plans, short-term insurance, COBRA, and joining a group plan.

Understanding these options can help you make an informed decision and avoid going without the coverage you need.

Understanding the Problem

The Colorado Open Enrollment Period for ACA-compliant health insurance runs from November 1st to January 15th each year.

If you miss this window, you can’t enroll in or switch to a new plan unless you qualify for a special exception, called a special enrollment period.

Without protection, from either a traditional health insurance plan or a health sharing plan (see below), you could face high out-of-pocket costs if an unexpected medical event occurs. A heart attack or a cancer diagnosis, or even a bad slip-and-fall or car accident could be bankrupting!

So, it’s important to get something in place to protect you against the unexpected.

If you’re a Colorado resident and you’ve missed the Open Enrollment window for health insurance, this article is for you.

We’ll walk you through all your options, including:

  • Special enrollment periods
  • Health sharing plans
  • COBRA
  • Joining a group plan

Free QuotesFREE QUOTE

COLORADO HEALTH INSURANCE

Option 1: Enroll Using a Special Enrollment Period (SEP)

A Special Enrollment Period allows you to enroll in an ACA-compliant plan outside of Open Enrollment if you’ve experienced certain qualifying life events. These qualifying events are designed to ensure individuals with significant life changes can access health insurance when they need it most.

Common Qualifying Events

  • Loss of Coverage: Losing employer-sponsored insurance, aging out of a parent’s plan, or losing Medicaid eligibility. These scenarios often trigger SEPs for individuals facing sudden gaps in coverage.
  • Change in Household: Marriage, divorce, having a baby, or adopting a child can significantly impact your healthcare needs, making SEPs essential.
  • Change in Residence: Moving to a new zip code or county, or returning from living abroad, can also qualify you for a SEP.
  • Other Exceptions: Gaining citizenship, leaving incarceration, or experiencing significant income changes that affect subsidy eligibility.

How SEPs Work

  • Timeframe: After a qualifying event, you typically have 60 days to enroll in a new plan.
  • Proof Required: You may need to provide documentation of the qualifying event, such as a marriage certificate or termination letter.
  • Coverage Options: Plans available during SEP are the same as those offered during OEP, including Bronze, Silver, Gold, and Platinum tiers.

Advantages:

  • Guaranteed access to ACA-compliant plans with no medical underwriting. Acceptance is guaranteed, regardless of your medical history. 
  • Financial assistance (premium tax credit subsidies) may be available based on income.
  • Coverage begins quickly, even for pre-existing conditions.

Disadvantages:

  • Limited to those who experience qualifying events.
  • Strict documentation requirements can slow the enrollment process.
  • Subsidy eligibility may vary depending on income changes.

The Low-Income Special Enrollment Period

You may qualify for a special enrollment period that allows you to enroll in a health insurance plan, with a subsidy, based on your income alone.

For 2025, the low-income Special Enrollment Period (SEP) income eligibility thresholds in Colorado are based on 150% of the Federal Poverty Level (FPL).

Here are the specific income limits for singles and a family of three:

Low-Income SEP Income Eligibility Limits in Colorado for 2025:

  1. Single Individual:
    • Annual Income: $21,870
    • Monthly Income: $1,822.50
  2. Family of Three:
    • Annual Income: $37,830
    • Monthly Income: $3,152.50

Explanation:

  • Individuals and families with household incomes below these limits qualify for the low-income SEP. This allows year-round enrollment in ACA Marketplace plans.
  • Subsidies: Those within these income ranges typically qualify for both premium tax credits and cost-sharing reductions (CSRs). CSRs reduce your out-of-pocket deductibles and coinsurance costs in the event you need care.

    To qualify for CSRs, you must enroll in a Silver-tier plan. Exception: Native American and Native Alaskan members of federally-recognized tribes may be eligible for CSRs with any “metal” tier plan.

These income limits are adjusted yearly to reflect changes in the Federal Poverty Level.For more details, or to enroll, contact a ColoHealth Personal Benefits Manager for a free consultation.

Option 2: Join a Health Sharing Plan

Health sharing plans are an alternative to traditional insurance, where members share healthcare costs within their community.

They are not insurance. They’re non-profit, voluntary associations of people with shared values who agree to help share the unexpected healthcare costs of their fellow members.

Often but not always faith-based, these plans are increasingly popular among Colorado residents seeking flexibility and affordability.

How Health Sharing Plans Work

Members contribute a monthly share amount into a pool used to pay eligible medical expenses for others in the group. While these plans are not insurance, they often cover major medical expenses like surgeries, hospitalizations, and emergency care. Some health sharing plans also provide support for preventive care or routine doctor visits, depending on the program.

Advantages:

  • Flexibility: No narrow provider networks—use any doctor or hospital.
  • Affordability: Monthly costs are typically lower than traditional insurance.
  • Community Focus: Plans often align with shared values or faith-based principles, fostering a sense of support and connection.

Disadvantages:

  • Pre-Existing Conditions: Costs from pre-existing conditions may not be shareable immediately, with waiting periods often lasting six to 12 months.
  • No Guarantees: Health sharing plans are not bound by ACA regulations, so coverage is not guaranteed.
  • Limited Routine Care: These plans often focus on major medical needs, not preventive or routine care.
  • Varying Rules: Each health sharing plan has its own guidelines, which may exclude certain types of care or treatments.

Key Point: You can join a health sharing plan anytime, making it a convenient option outside Open Enrollment. However, understanding the plan’s limitations is essential before committing.

LEARN MORE: Health Sharing in Colorado

Option 3: Take COBRA Continuation Coverage

If you’ve recently left a job that provided employer-sponsored health insurance, COBRA allows you to continue your workplace coverage for up to 18 months.

There’s no worry about pre-existing conditions since you keep the same plan.

Advantages:

  • Same Coverage: You keep the same doctors, benefits, and provider network.
  • Immediate Continuity: No gaps in coverage when transitioning between jobs.
  • Familiarity: You don’t need to switch plans or learn new coverage rules.

Disadvantages:

  • High Costs: You must pay the full premium, including the portion previously covered by your employer, plus a 2% administrative fee.
  • Not eligible for premium tax credits. COBRA plans don’t get the “Obamacare subsidy.” 
  • Time-Limited: COBRA coverage is temporary and can be expensive over time.
  • Limited Eligibility: Only available to individuals who had access to employer-sponsored coverage.

NOTE: If you qualify for a premium tax credit subsidy based on your income, it’s almost never a good idea to take COBRA coverage rather than use your special enrollment period after you lose your job to enroll in a traditional health insurance plan that does qualify for a subsidy.

FREE QUOTE 

COLORADO COST-SHARING

Option 4: Join a Group Plan by Getting a New Job

If you’re starting a new job, your employer may offer health insurance as part of your benefits package. Group plans often provide comprehensive coverage with lower premiums compared to individual plans.

Advantages:

  • Comprehensive Coverage: Includes routine care, preventive services, and major medical.
  • Employer Contribution: Employers often subsidize a portion of the premium.
  • Dependents Included: Family members may also be eligible for coverage.

Disadvantages:

  • Job Dependency: Coverage is tied to employment, which can be lost if you change jobs or are terminated.
  • Waiting Periods: Some employers impose a waiting period before benefits begin.
  • Limited Choices: Plans are typically preselected by the employer, leaving fewer options for customization.

Conclusion: Explore Your Options

Missing Open Enrollment doesn’t mean you have to go without health coverage.

From Special Enrollment Periods and health sharing plans to short-term insurance, COBRA, and group plans, there are plenty of alternatives to consider. Each option has its own benefits and limitations, so it’s important to choose the one that best fits your needs and budget.

Staying informed about these choices can help you avoid gaps in coverage and unexpected medical expenses.

Don’t Delay! Sign Up Now

Not sure which option is right for you? Contact a ColoHealth Personal Benefits Manager today for free, personalized advice.

We keep it simple, easy, and stress-free.

We’ll help you navigate your choices, find the best plan for your situation, and get the coverage you need. Don’t wait—take control of your healthcare today!

For Further Reading: