Posted: October 18, 2023
A waiting period in health insurance typically refers to the time between beginning a new job and waiting for your benefits to take effect. They can be frustrating and impact coverage, even resulting in fines in some states if you’re not careful.
A health insurance waiting period can refer to more than one thing, such as:
1. When Starting a New Job
Employees have to wait a little while before they can use their benefits after starting a new job or enrolling in a different plan. The waiting period refers to the length of time when the employee doesn’t have access to some or all of their benefits. Not every employer has a waiting period, but many make employees wait up to 90 days before accessing health coverage. Fortunately, the government ensures the waiting period is no longer than that — 90 days is the maximum amount.
Many things affect your waiting period, including your insurance carrier, insurance plan and employer. Always check for a waiting period before accepting a new position. You typically can’t enroll in a plan until your waiting period is over, but some employers take a different approach. You’re responsible for the entire cost if you receive care before your coverage begins.
2. When You Enroll in a New Plan
The term “waiting period” is sometimes used for the gap between coverage enrollment and when a plan takes effect. New plans often begin on the first of the next month or the month following it, but this type of waiting period is typically short. Somequalifying life events— like leaving a job, moving to a new place or losing your existing coverage — might exclude you from a waiting period altogether.
3. When You Have a Pre-Existing Condition on Certain Plans
Though rare, some employees have a pre-existing coverage waiting period. This only applies to Medicare supplemental insurance — also known as Medigap — and grandfathered plans. You may have this waiting period if your employer hasn’t changed plans in a very long time. In these situations, you can’t receive coverage for treatments related to those pre-existing conditions until the waiting period is finished. The Affordable Care Act (ACA) banned these types of waiting periods on nearly every other kind of plan.
A waiting period could cause you to be uninsured if you’re not careful. Some states charge a fee if you don’t have year-round coverage, including California, Rhode Island, Massachusetts, Vermont and New Jersey. We’ll take a closer look at ways to avoid these penalties in a little bit.
How Long Are Health Insurance Waiting Periods?
Typical waiting periods for health insurance are 30, 60 or 90 days, though some plans don’t have any. Employers often start plans on the first day of the month after 30 days of employment to keep things simple. This tactic helps them avoid cutting things too close to the 90-day deadline and risking non-compliance with the law.
Keep in mind that the ACA rule banning waiting periods over 90 days only applies to health insurance plans that countas minimal essential coverage. These plans include:
- Plans you get through a state or federal Marketplace.
- Most plans you get through your employer.
- Medicare and Medicaid plans.
- State-run insurance plans for children, like the Children’s Health Insurance Program (CHIP).
Some types of insurance don’t fall under the same guidelines and have longer waiting periods, including short-term health insurance, vision insurance and dental insurance. For example, your dental insurance won’t cover some kinds of care — like filling and implants — for three to six months but may cover preventive services immediately.
Be mindful of waiting periods when shopping for non-ACA plans like dental and vision. Many don’t have them, but some do.
How to Stay Covered If You Have a Waiting Period for Health Insurance
If you have a waiting period for health insurance but need coverage in the meantime, possible options include:
1. Keeping Your Old Plan
Some insurance policies offer a grace period to help you maintain coverage after leaving a job. This approach might be a good fit if the waiting period is short, such as a month. It lets you keep the plan from your old job until your new plan starts. If this isn’t a good option for you, consider extending your health coverage withthe Consolidated Omnibus Budget Reconciliation Act(COBRA) or state continuation.
COBRA lets you keep your health benefits — to some extent — after losing a job. A portion won’t be paid under COBRA if your previous employer paid part or all of your premium. Costs will likely increase, but you maintain coverage while waiting for your new plan to begin.
2. Finding a Short-Term Solution
Enrolling ina short-term health insurance planthat doesn’t have a waiting period is another possibility. These plans are typically more limited and may include exclusions for pre-existing health conditions, but they can also help fill coverage gaps and assist with emergencies while waiting for your new plan to start.
Short-term plans don’t satisfy the ACA’s requirement for minimum essential coverage — that means some states impose a fee and consider you uninsured while using this coverage.
3. Enrolling in a Standard Plan With a Qualifying Life Event
Some states, like California, don’t allow short-term plans at all. Instead, you can use the loss of your job as a qualifying life event to enter a standard health plan until your new benefits start.
You may need to work with an insurance expert to find other options within standard ACA-compliant plans. An insurance broker can offer an unbiased opinion backed by expertise in the complex workings of insurance. An insurance broker can also help mediate between you and your possible insurer so you get the best possible option for your needs.
Contact Health for California to Learn More
In the Golden State, a waiting period can make it hard to maintain coverage and avoid penalties after switching jobs. Fortunately, you have options, and our licensed insurance brokers can help you navigate them. Changing jobs is stressful enough, so let us make your health insurance a little less complicated. We use plain language and focus on helping you understand your options to make an informed decision.
Our services are completely free for enrollees, and we can talk with you over the phone or in person at our Santa Rosa, California, location. See what’s available with ourfast and free online quote tool, orreach out todayto schedule an appointment to learn more!
