When to Get Health Insurance: Key Deadlines and Requirements

Missing health insurance deadlines can leave you without coverage for months or facing penalties in certain states. Knowing when to get health insurance helps you avoid gaps in coverage and protects you from unexpected medical bills. Understanding health insurance requirements in your state is essential for both employees and employers when making benefits decisions.

Health Insurance Deadlines: Key Dates to Know

Most Americans can only enroll in health insurance during specific time periods. The primary window is Open Enrollment, which runs from November 1 through January 15 for coverage in the following year. According to Healthcare.gov, if you enroll by December 15, your coverage begins January 1. If you enroll between December 16 and January 15, your coverage starts February 1.

Some states run their own marketplaces with different health insurance deadlines. California, the District of Columbia, New Jersey, New York, and Rhode Island extend their enrollment periods through January 31. Idaho typically closes enrollment on December 15.

Outside of Open Enrollment, you can only get health insurance if you qualify for a Special Enrollment Period. Qualifying life events include losing existing health coverage, getting married or divorced, having or adopting a baby, moving to a new zip code or state, changes in household income, and becoming a U.S. citizen.

Most Special Enrollment Periods last 60 days from the qualifying event. Acting quickly matters because you can't enroll once the window closes.

Consequences of No Health Insurance

While the federal penalty for going uninsured ended in 2019, there are still significant consequences of no health insurance, depending on where you live.

State-Level Penalties

Five jurisdictions require health insurance and impose tax penalties if you don't have it: California, Massachusetts, New Jersey, Rhode Island, and Washington, D.C. Vermont requires coverage reporting but doesn't impose a financial penalty.

California: The penalty is the greater of $900 per adult ($450 per dependent child) or 2.5% of household income above the state's tax filing threshold.

Massachusetts: Penalties are based on a sliding scale tied to income and can reach up to half the cost of the lowest available ConnectorCare premium.

New Jersey: The fine is calculated as a flat rate or percentage of income, whichever is higher. Some families pay thousands of dollars per year.

Washington, D.C.: The penalty is $745 per adult ($372.50 per child) or 2.5% of income above the filing threshold, whichever is higher.

Rhode Island: The penalty is the greater of $695 per adult ($347.50 per child) or 2.5% of household income, capped at the cost of bronze-level plans.

Financial Risk Without Coverage

Even in states without penalties, the consequences of no health insurance include massive financial risk. You'll pay full price for all medical care. A single emergency room visit can cost thousands of dollars out of pocket. Serious injuries or illnesses can cost tens of thousands of dollars.

Without coverage, you also miss out on preventive care like annual checkups, screenings, and vaccinations that catch health problems early.

How Employer-Sponsored Options Can Help

Many employees don't realize they have flexible options beyond traditional group health insurance. For small and mid-sized businesses and startups, ICHRA (Individual Coverage Health Reimbursement Arrangement) allows employers to provide a set amount of money that employees can use to purchase individual health insurance plans that fit their needs.

With ICHRA, employees can choose from plans available in their area, get reimbursed tax-free for premium costs, keep their plan if they change jobs, and select coverage that works for their family.

Medicare and Medicaid Enrollment

Different health insurance requirements apply if you're eligible for government programs. Medicare has its own Annual Enrollment Period from October 15 through December 7. You can sign up when you turn 65 or qualify due to disability.

Medicaid and the Children's Health Insurance Program (CHIP) don't have enrollment periods. You can apply year-round if you meet income requirements.

What to Do If You Miss Open Enrollment

If you miss the Open Enrollment deadline and don't qualify for a Special Enrollment Period, you have limited options. You can wait until the next Open Enrollment period, look into short-term health insurance plans (available in most states but with limited coverage), check if you qualify for Medicaid based on your income, or ask your employer about ICHRA or other benefit options.

Planning helps you avoid gaps in coverage. Mark health insurance deadlines on your calendar and gather necessary documents (income information, Social Security numbers, immigration documents) in advance.