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  • Writer's pictureSara Yuen

Can I Only Buy Health Insurance During Open Enrollment?

Updated: Mar 7, 2022

Many times, for the average struggling family trying to make ends meet, health insurance seems like a luxury you can’t afford. Even though, for some, it is a necessary evil in today’s day and age. Without basic health insurance, you could end up breaking the bank after a minor injury or a recently discovered health condition.

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Unfortunately, it seems like the health insurance companies love to make the process of purchasing health insurance coverage more confusing for the regular American consumer year after year. Today, we are going to try to shine some light on the process of purchasing healthcare coverage.

What is Open Enrollment?

Open Enrollment is the yearly window of time when people can enroll, or sign up for a health insurance plan. The time frame for open enrollment may be different for various groups of people depending on their state or employment type. Just make sure you find out when open enrollment is for you so that you don’t miss out on your opportunity to be covered. If you do miss the open enrollment window, there are still ways to be able to get health insurance, but under normal circumstances, you have to qualify for “special enrollment”.

Private Plans Outside the Marketplace – Outside Open Enrollment

In some limited cases, insurance companies sell private health plans outside Open Enrollment that count as qualifying health coverage. These plans meet all the requirements of the health care law, including covering pre-existing conditions, providing free preventive care, and not capping annual benefits. The health insurance marketplace doesn’t list or offer these plans. The only way you can enroll in a health plan through the Marketplace outside Open Enrollment is if you qualify for a Special Enrollment Period. You can find these plans through some insurance companies, agents, brokers, and online health insurance sellers. If you buy a plan outside the Marketplace any time, during Open Enrollment or not, you can’t get premium tax credits or other savings based on your income. Insurance companies can tell you if a particular plan counts as minimum essential coverage. However, be cautious while shopping for coverage, because most health insurance plans sold outside of the open enrollment period do not count as qualifying health coverage.

What is Considered a Qualified Health Plan?

In order to protect the American citizen, the United States government has set regulations on what the minimum amount of health care coverage must include, to ensure that you won’t be put in financial ruin after a life or death situation. According to, a health insurance plan that is certified by the Health Insurance Marketplace provides essential health care benefits, meets the 10 essential benefits requirements laid out by the ACA (Affordable Care Act), and follows established limits on cost-sharing (deductibles, co-payments, and max out of pocket amounts.)

What are the 10 Essential Health Benefits?

Here is the list and breakdown of the 10 essential health benefits mandated by the Affordable Care Act (ACA).

  1. Prescription Drugs

  2. The Federal Government of the United States has categorized FDA approved prescription drugs – at least one from each category must be covered in your plan.

  3. Pediatric Services

  4. Required Pediatric Services include dental & vision through the age of 18, wellness checks, vaccination & immunizations.

  5. Preventive and Wellness Services & Chronic Disease Management

  6. Coverage requirements include services such as diabetes screenings, diet counseling, colorectal cancer screenings, and immunization vaccines.

  7. Emergency Services

  8. A trip to the emergency room when you need care as soon as possible – you won’t be penalized for being admitted to a hospital that is outside of your health network.

  9. Hospitalization

  10. Treatments that you receive during inpatient care visits, different plans may have different coverage limitations for extended stays depending on a number of different factors.

  11. Mental Health and Addiction Services

  12. This includes many different types of services to treat behavioral health, provide counseling, or psychotherapy.

  13. Pregnancy & Newborn Care

  14. These are health care services to help you and your baby before, during, and shortly after giving birth.

  15. Ambulatory Patient Services

  16. This is outpatient care that you receive without being admitted to a hospital.

  17. Laboratory Services

  18. This includes testing to diagnose & gauge the effectiveness of past treatments or operations, as well as preventative screening.

  19. Rehabilitative & Habilitative Services and Devices

  20. These services include aid to recovery from an injury, disability help, and chronic condition care. Services may include physical therapy, occupational therapy, or even speech therapy.

Where Can I Purchase a Qualified Health Plan?

There are many places where you can purchase a qualified health insurance plan online, because of this, it can become very confusing if you’re actually getting the best price for the coverage you need. Luckily for you, we have built a system to help provide you access to the best-priced plans that are tailored to your personal needs.

Click on the button below, fill out the form, and find the perfect healthcare plan.

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