What Happens if You Miss Open Enrollment for Health Insurance?


Open enrollment is a crucial time for individuals and families to apply, select, switch, or renew their health insurance plans. It affords them the opportunity to review their options and make any changes necessary to best suit their needs, however, it is a limited window of time, typically once a year. 

Missing this important period does come with its set of consequences, but it’s not the end of the road for securing health coverage. That said, let us talk about the implications, alternative coverage options, and how you can avoid missing Open Enrollment.

Understanding Open Enrollment 

Open Enrollment is a period designated by health insurance marketplaces and most employers when individuals can make unrestricted changes to their healthcare coverage without the requirement of qualifying life events. The primary goal is to ensure everyone has the opportunity to find a plan that best fits their health needs and financial situation. 

This time frame typically falls in the final few months of the year, with exact dates varying by location. Though, open enrollment may occur as early as October or November and end by January.  Individuals who miss this window may have to wait until the next open enrollment period to make changes to their coverage and/or enroll without a “qualifying life event”. 

For more information about dates, please visit www.healthcare.gov. 

Consequences of Missing Open Enrollment 

If you miss the open enrollment period, you will likely face some consequences, depending on your circumstances.  

Consequences of Missing Open Enrollment 

  1. Loss of Coverage Options: Typically, when Open Enrollment is closed, your options for health insurance become extremely limited. You may be restricted to catastrophic health plans, which tend to have high deductibles and are designed for emergency coverage. 
  1. Limited Access to Health Insurance: Without a “qualifying life event,” such as the loss of coverage, moving to a new state, or changes in family size, you might have to wait until the next Open Enrollment period to sign up for a health insurance plan. 
  1. Potential Penalties: Going without health coverage can result in tax penalties at the end of the year. The penalty amount varies and can be quite substantial. In addition, some states have their own individual mandate requirements that may result in penalties for not having health insurance. 

Alternatives to Open Enrollment

Although missing Open Enrollment can be a stressful situation, there are still options available for obtaining coverage. 

These alternatives include: 

  • Special enrollment periods: Qualifying life events such as marriage, birth or adoption of a child, loss of coverage, or moving to a new coverage area may make you eligible for a Special Enrollment Period. You typically have thirty days from the qualifying event to enroll and/or make changes to a plan. 
  • Medicaid and CHIP: These government-funded programs provide health insurance coverage to low-income individuals and families. Eligibility requirements vary by state, but if you meet the criteria, you can enroll at any time. 
  • Short-term health insurance plans: These plans offer temporary coverage for a specified period, usually up to 12 months. Southern Guaranty Insurance Company (SGIC)’s Short Term Medical Insurance is a flexible, affordable option that lets you choose your level of coverage and term, starting from as short as 30 days, making it a perfect solution for short gaps in coverage, such as missed Open Enrollment.*

*Coverage, terms and conditions may vary from plans purchased during open enrollment.  

How to Avoid Missing Open Enrollment 

Missing Open Enrollment can be a costly mistake, but it’s avoidable with proper planning and awareness. Here are a few tips to help you stay on top of your health insurance coverage: 

  • Mark Your Calendar: Make sure to have the open enrollment dates marked on your calendar so you do not forget. 
  • Set Reminders: Set reminders on your phone or email to notify you of upcoming open enrollment deadlines. 
  • Review Your Coverage Annually: Use the open enrollment period as an opportunity to review your current coverage and make sure it still meets your needs. If not, consider making changes during this time. 
  • Seek Assistance: If you are unsure about what coverage options are available or need help navigating the enrollment process, seek assistance from a licensed medical insurance company. They can guide you through the process and help you make informed decisions. 

Navigating Healthcare: Staying Insured Year-Round 

Missing Open Enrollment for health insurance may result in limited coverage options, potential penalties, and restricted access to healthcare. However, there are alternatives available such as special enrollment periods, Medicaid and CHIP, and short-term health insurance plans. Make sure to also check out our frequently asked questions about short term medical insurance.  

To avoid this situation altogether, it is essential to stay on top of your coverage and utilize resources such as reminders and assistance from licensed insurance companies. 

With proper planning, you can ensure you and your family have adequate health insurance coverage throughout the year.  So do not wait, start preparing now for next year’s Open Enrollment period! 

Let us help you find the best healthcare coverage for your needs today at Southern Guaranty Insurance Company (SGIC). 

Reach out to us at the contact form below.