Health insuranceis expensive, so why not just wait and buy coverage when you need it?
Why pay months ofpremiumswhen you might not need to use it?
If you get sick in the meantime, youll probably be out of luck.
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They usually occur in the fall, for coverage starting January 1.
Special enrollment periods are time-limited.
Health Insurance Waiting Periods
Health insurance coverage doesnt take effect the day you buy it.
For example:
Short-term health insurance can take effect as soon as the day after you purchase it.
But as we’ll discuss in a moment, short-term health insurance generally will not cover any pre-existing conditions.
So it won’t work as a coverage solution once you need medical care.
Even if youre young and healthy, bad things can still happen.
What if you sliced your hand when a wine glass broke as you were washing it?
Stitches in an emergency room can be very expensive.
What if you tripped over the cat while walking downstairs?
A broken ankle cant wait for treatment and might even require surgery.
It’s doubtful that you’d want to wait around for weeks to go to the emergency room.
Note that children and people who are pregnant can qualify for Medicaid with significantly higher income levels.
To qualify for subsidies, you must buy your health insurance through the exchange (Marketplace).
Either way, you’ll use Form 8962 when you file your federal tax return.
Before 2023, those family members were ineligible for subsidies in the exchange/Marketplace.
Catastrophic plans cannot be purchased by people over 30 unless they have a hardship exemption.
What About Short-Term Health Insurance?
Short-term health insurance can also be purchased with an effective date as soon as the day after you apply.
But nearly all short-term health plans have blanket exclusions on pre-existing conditions.
The insurer canreject your tool altogether based on your medical history.
And post-claims underwriting is common on short-term plans.
If it is, they can deny the claim.
(This doesn’t happen with ACA-compliant plans, because they cover pre-existing conditions.)
So people cannot wait until they’re sick and then purchase coverage.
This is why it’s so important to maintain health insurance even when you’re perfectly healthy.
It’s not just yourself you’re protecting, it’s the whole pool.
HealthInsurance.org.How can American Indians and Alaska Natives get coverage under the ACA?
Are there specific plan options for them?Mar.
HealthInsurance.org.An SEP if your income doesnt exceed 150% of the federal poverty level.
Dec. 20, 2024[/efn_note]
Norris, Louise.
healthinsurance.org.What are the deadlines for the ACAs open enrollment period?
Medicare.gov.When does Medicare coverage start?
Code of Federal Regulations.Title 45 155.420 Special enrollment periods.
Norris, Louise, healthinsurance.org.Exceptional circumstances for special enrollment.
CMS.gov.Health Coverage Options for American Indians and Alaska Natives.
Healthinsurance.org.An SEP if your income doesnt exceed 150% of the federal poverty level.
U.S. Department of Labor.FAQs on HIPAA Portability and Nondiscrimination Requirements for Workers.
CMS.gov.Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2024.
Cornell Law School, Legal Information Institute.29 CFR 2590.701-6 - Special enrollment periods.
Feb. 18, 2025.
HHS.gov.2025 Poverty Guidelines: 48 Contiguous States (all states except Alaska and Hawaii).
See 138% of FPL, which is the eligibility cap for adult Medicaid in most states.
KFF.Status of State Action on the Medicaid Expansion Decision.
Medicaid.gov.Medicaid, Children’s Health Insurance Program, & Basic Health Insurance Program Eligibility Levels.
healthinsurance.org.2025 Obamacare subsidy calculator.
Internal Revenue Service.About Form 8962 Premium Tax Credit.
U.S. Department of the Treasury.Affordability of Employer Coverage for Family Members of Employees.
healthinsurance.org.Finalized federal rule reduces total duration of short-term health plans to 4 months.
