MISSED ENROLLMENT? WHAT'S NEXT - PRIVATE OPTIONS
Missed Open Enrollment? Here's What's Next – Private PPO Options & Special Enrollment Periods
Fast take: Missed the January 15 Open Enrollment deadline? You still have options. Qualify for a Special Enrollment Period after a life event, or—if eligible—apply for a private, medically underwritten PPO that can start any month. We'll verify doctors, prescriptions, and timing to avoid gaps.
Missed Open Enrollment? Let's find your path to coverage.
We'll check if you qualify for an SEP, compare income-based options, and review private PPO alternatives—then enroll you quickly.
Get Free Quotes Book a CallYour coverage options after January 15
Missing Open Enrollment doesn't mean you're stuck without coverage for the entire year. There are legitimate pathways to get health insurance outside the standard enrollment window—you just need to know which one applies to your situation.
Path #1: Special Enrollment Period (SEP)
If you've experienced a Qualifying Life Event (QLE), you can enroll in Marketplace coverage outside Open Enrollment. The government recognizes that life doesn't wait for enrollment windows, and certain events create immediate coverage needs.
Common Qualifying Life Events:
- Loss of coverage: Losing employer coverage, aging off a parent's plan at 26, COBRA ending, losing Medicaid eligibility
- Household changes: Marriage, divorce, legal separation, death of a spouse
- New dependents: Birth, adoption, foster care placement
- Residence changes: Moving to a new ZIP code or state with different plan options (not just moving addresses within the same service area)
- Income changes: Gaining or losing eligibility for premium tax credits or cost-sharing reductions
- Other coverage changes: Gaining citizenship, release from incarceration, enrollment errors by the Marketplace or insurer
Timing matters: Most SEPs last 60 days from the date of your qualifying event. You'll need documentation (termination letter, marriage certificate, birth certificate, lease agreement, etc.) to prove your QLE.
We'll help you determine if your situation qualifies, gather the right documentation, and set the correct effective date so there are no gaps in coverage.
Path #2: Private, medically underwritten PPO
Private PPOs operate outside the ACA Marketplace system and are available year-round for applicants who pass medical underwriting. These plans offer significant advantages for the right people:
Key features of private PPOs:
- Year-round enrollment: Apply any month—no need to wait for Open Enrollment or have a qualifying life event
- Broader networks: Often nationwide PPO access with major carriers, great for travelers or multi-state households
- No referrals: Typically direct access to specialists without PCP gatekeeping
- Flexible start dates: Many carriers offer 1st or 15th of the month effective dates after approval
- Competitive pricing: For healthy applicants, premiums can be lower than unsubsidized Marketplace plans
Medical underwriting requirements:
Unlike ACA Marketplace plans (which are guaranteed issue regardless of health status), private PPOs require you to answer health questions. Approval depends on:
- Pre-existing conditions and their severity
- Current medications and dosages
- Recent hospitalizations or surgeries
- Overall health profile and risk factors
We pre-screen applications quickly (usually within 24 hours) to let you know if you're likely to be approved before you formally apply. This saves time and avoids unnecessary declinations on your record.
Path #3: Income-based Marketplace options
In certain situations, changes in income can create Special Enrollment Period eligibility, even without a traditional qualifying life event. This typically applies when:
- Your income drops below 150% of the Federal Poverty Level and you become newly eligible for enhanced subsidies
- You gain or lose access to employer coverage due to income changes affecting your job status
- You move and your new location affects your subsidy eligibility
If you're self-employed or have variable income (1099 contractor, gig worker, commission-based), we can model your expected 2026 MAGI and determine if income-based SEP rules might apply.
How to decide which path fits you
Choose SEP if…
✓ You had a qualifying life event in the past 60 days
✓ You qualify for Marketplace subsidies
✓ You need guaranteed issue coverage regardless of health
✓ Your doctors are in Marketplace networks
Choose Private PPO if…
✓ You're in good health and can pass underwriting
✓ You want nationwide PPO access
✓ You don't qualify for meaningful subsidies
✓ You need coverage to start quickly
Consider short-term if…
✓ You need temporary coverage for 1-3 months
✓ You're between jobs or waiting for employer coverage
✓ You understand limited benefits and exclusions
✓ You're healthy and have minimal ongoing care needs
Simple coverage checklist
To get started, gather this information so we can move quickly:
- Your providers: Names and locations of your doctors, specialists, and preferred hospitals
- Current prescriptions: Medication names, dosages, and frequency
- QLE documentation (if applicable): Termination letters, marriage certificates, birth certificates, lease agreements
- Target start date: When you need coverage to begin
- Health summary: Major conditions, recent surgeries, current treatments (for private PPO pre-screening)
We'll verify which path you qualify for, confirm your providers are in-network, model total annual costs, and enroll you with the correct effective date.
Quick FAQs
How fast can coverage start?
Marketplace SEP plans typically start the 1st of the month following enrollment (if you enroll by the 15th). Private PPOs can start on the 1st or 15th after underwriting approval, depending on the carrier—usually 3-7 business days.
What if I don't have a qualifying life event?
If you don't qualify for an SEP, private PPO options may still be available if you pass medical underwriting. We'll pre-screen your health profile and let you know quickly if it's a viable path.
Can you confirm my doctors are in-network?
Yes. Send us your provider list (names, specialties, locations) and we'll verify participation across both Marketplace SEP plans and private PPO networks before you enroll.
What if I get declined for a private PPO?
We'll explore other options immediately—checking if you qualify for any SEP pathways, Medicaid eligibility, or short-term coverage as a bridge until next Open Enrollment.
For education only; eligibility, plan availability, and dates vary by state and carrier. Always review official plan documents.
