Can I get health insurance outside Open Enrollment?

Yes. You may qualify for a Special Enrollment Period after life events (loss of coverage, marriage, birth/adoption, move). Some applicants may use an income-based SEP in certain situations. Private, medically underwritten PPOs may also enroll year-round if eligible.

What qualifies me for a Special Enrollment Period (SEP)?

Common QLEs include: loss of qualifying coverage, marriage/divorce, birth/adoption, moving residence, gaining lawful presence, or major income changes affecting eligibility. Most SEPs last 60 days from the event.

Are there year-round options if I don’t have a QLE?

For eligible applicants, certain private medically underwritten PPOs can start any month after underwriting and network checks. Availability varies by state and health history.

When will my coverage start?

Marketplace plans typically start the first of the month after you select a plan by the monthly cutoff. Private PPOs begin after approval and chosen effective date—often the 1st or 15th of a month.

Why shouldn’t I go solo during Open Enrollment?

Navigating enrollment alone may limit your options and lead to higher premiums. Licensed advisors know both ACA and private PPO markets, helping you avoid costly mistakes and uncover better coverage.

How can a licensed advisor save me money?

Licensed advisors compare ACA subsidies and private underwriting options. Healthy households may qualify for lower premiums through private PPOs, while income-based savings apply to ACA plans.

When are the Open Enrollment 2025 deadlines?

Open Enrollment runs November 1, 2024 – January 15, 2025. Apply by December 15 for January 1 coverage, or by January 15 for February 1 coverage.

Robert Adams 1/28/25 Robert Adams 1/28/25

Year-Round Health Insurance Options – How to Get Covered Outside of Open Enrollment

Year-Round Health Insurance Options Outside Open Enrollment | RKA

Enrollment Guides • Year-Round Options

Year-Round Health Insurance Options Outside Open Enrollment

Fast take: Missed Open Enrollment? You still have paths. Qualify for a Special Enrollment Period (life event or some income situations), or—if eligible—apply for a private, medically underwritten PPO that can start any month. We’ll verify doctors, prescriptions, and start dates to avoid gaps.

Path #1: Special Enrollment Period (SEP)

If you’ve had a Qualifying Life Event, you can enroll in ACA Marketplace coverage outside the normal window. Common QLEs:

Loss of coverage: losing employer coverage, aging off a parent’s plan, COBRA ending.
Household changes: marriage, divorce, birth/adoption, death.
Residence changes: moving to a new ZIP/state with different plan options.
Income changes: shifts that affect subsidy eligibility (varies by state and year).

Timing: Most SEPs last 60 days from the event. We’ll help confirm your documentation and the correct effective date.

Path #2: Income-based options (some situations)

In certain circumstances, income within specific ranges can create ongoing or monthly SEP eligibility. If your income is variable, we’ll model your estimated MAGI and confirm your current-year eligibility.

Path #3: Private, medically underwritten PPO (if eligible)

Year-round starts: Many private PPOs offer effective dates any month after underwriting.
Broader networks: Often nationwide PPO access—great for frequent travelers or multi-state households.
Underwriting: Health questions apply; we pre-screen quickly and verify your doctors/hospitals.

Avoid gaps: simple checklist

List your providers (names, locations) and prescriptions.
Note your QLE date and keep documents handy.
Share your target start date so we align deadlines and carrier cutoffs.
We’ll show total annual cost (premium + likely usage) for each option.

Quick FAQs

How fast can coverage start?

Marketplace plans often begin the 1st of the next month if you enroll by the cutoff. Private PPOs can start after approval on the 1st or 15th, depending on carrier.

What if I don’t have a QLE?

We’ll explore private PPO options (if eligible) or the next Open Enrollment timeline. We’ll also check if income-based rules could open a SEP.

Can you confirm my doctors?

Yes. Send your provider list and we’ll verify participation across ACA plans and private PPO networks before you enroll.

For education only; eligibility, plan availability, and dates vary by state and carrier. Always review official Marketplace and plan documents.

Robert Adams 10/23/24 Robert Adams 10/23/24

Open Enrollment 2026: Why Working with a Licensed Advisor is Essential

Open Enrollment 2025 is here. Don’t go it alone—licensed advisors know ACA vs. private PPO options, deadlines, and ways to save. Acting early avoids rate hikes and limited plan choices.

Open Enrollment 2025: The Hidden Costs of Doing It Alone | RKA

Enrollment Guides • Open Enrollment 2025

Open Enrollment 2025: The Hidden Costs of Doing It Alone

Fast take: Open Enrollment is your only chance each year to secure or update coverage—but going solo can cost you. Licensed advisors know deadlines, subsidies, and private PPO alternatives to help you avoid higher premiums and missed benefits.

Why working with an advisor matters

A licensed advisor not only has access to all available plans—including ACA Marketplace and private options—but also the expertise to evaluate your needs and recommend coverage tailored to your situation. Many unlicensed brokers push limited-benefit plans that don’t protect you when it matters most.

Key benefits of guidance

Accurate info on what your plan covers.
Verification of which doctors are in-network.
Projection of maximum out-of-pocket costs.
Strategies to maximize savings based on income & health.

How a licensed advisor may save you money

Private PPOs can reward good health with lower premiums—similar to car insurance rewarding safe drivers. ACA Marketplace plans offer income-based savings. By reviewing both, advisors help you avoid costly mistakes and secure the best value.

Quick steps to start enrollment with confidence

Open Enrollment runs November 1 – January 15, but acting early locks in better options:

Nov 1: Open Enrollment begins.