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How to Get Affordable Special Enrollment Period Insurance in Texas

health insurance
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Navigating the health insurance market can be an overwhelming task. It becomes even more unnerving when you find yourself with an immediate need for coverage, and you begin hearing terms like open enrollment, eligibility, and Special Enrollment Periods (SEP), that is, of course, once you get past the rumors of astronomical costs! We are here to tell you that getting adequate and affordable health insurance in Texas any time of the year regardless of open enrollment is, in fact, possible and with the newly mandated 2021 special enrollment period of February 15th – May 15th healthcare has been made even more accessible than ever.

If you find yourself in the market for medical insurance, here are several options for you to consider.

ObamaCare Special Enrollment Period

President Joe Biden has directed the federally managed insurance marketplace that administers the ObamaCare medical plans to re-open enrollment for a designated period of time. This presents a unique opportunity for Americans seeking coverage to take advantage of the plans offered in the program. There are some Important factors to consider if you are planning on obtaining coverage during this period.

  • The SEP runs from February 15th – May 15th this can vary slightly from state to state.
  • Enrollment is simplified through a network of certified agents. You can now access the SEP through a health insurance broker like us who can help you select the best plan for you. There are also no fees for this service.
  • Current enrollees can switch plans. If you currently have coverage but would like to switch plans, you can also take advantage of the SEP.

A Qualifying Event Outside of the Mandated SEP

Life events happen for better or worse, and specific changes can create opportunities to re-evaluate your healthcare plan or obtain coverage if you need it. When this occurs, you are provided with a SEP, allotting you a specific time range to choose your healthcare plan. Although the time range may vary, in some cases, the SEP will begin up to 60 days before your qualifying event and last up to 60 days after.

  • Change in household: If you are newly married, recently had a child, adopted a child, just finalized a divorce, or if there was a death of a member on your current plan you may qualify for the change in household SEP.
  • Change in Residence: This qualifying event includes moving to a new location within the U.S., moving to the U.S. from a foreign country, if you are a student moving into school, or moving to or from a traditional home or shelter.
  • Loss of current Health Insurance: The unexpected happens, so if you have a loss of your recent job-based coverage, loss of eligibility from Medicaid or Medicare, loss of coverage through a family member who lost eligibility to their plan, you may qualify for a SEP.

Short-Term Health Insurance

If you are fairly-healthy and missed the ACA Open Enrollment, you may want to consider purchasing a short-term health plan. While these plans were initially designed to provide up to 3 months of coverage, there are now options for 12 months and beyond, making them a good choice for long term coverage as well despite their name. There are some critical things to consider when selecting short-term health insurance in Texas.

  • By design, these plans do not meet ACA requirements for minimum coverage and therefore may not provide the scope of coverage you most likely previously had.
  • Pre-existing conditions and any related doctor appointments are typically not covered. They may also require you to self-insure specific illnesses such as mental health and maternity care although there are some exceptions.
  • They are not available in every state, so it is important to verify if your state offers short-term health insurance.
  • While they are usually more affordable than major medical plans, premiums are based on medical history and can sometimes be expensive depending on several factors and conditions.

Overall, these plans are an excellent solution for coverage for unexpected health emergencies or if you are in a transitional period of your life or looking to get coverage for the waiting period until you become Medicare eligible.

Medicaid & CHIP

With costs and coverage options differing from state to state, a viable option available all year round for qualifying individuals is Medicaid. As a provider of health insure to millions of Americans, it is administered on a state level but structured in accordance with Federal Requirements. In addition, CHIP was created to cover children of families who do not meet Medicaid requirements.

  • To qualify, you must meet the plan criteria for one of the following categories: low income, disabilities, elderly, pregnant women, children, or individuals receiving supplemental security income.
  • You must be a resident in the same state in which you are receiving Medicaid and either a U.S. citizen or a permitted resident.
  • Coverage is effective as of the date of application or on the first day of the same month once approval is obtained.

Ready to shop and need help finding the best individual health insurance in Texas?

Whether you are looking for guidance on the SEP, a qualifying event, or short term health insurance, let Custom Health Plans help you find a happy medium between coverage and value so that you can rest assured knowing that you and your family are insured for the unexpected times when you will need it most. Our licensed team will guide you through all the options available to you and most importantly, at no cost to you.

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