What Is Open Enrollment for Health Insurance? Staff Profile Picture
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Open enrollment is the annual time period where individuals can change, cancel, or register for a health insurance plan. Unless there are special circumstances, it is likely to be the only opportunity to change your coverage within a 12-month period. Medical bills add up quickly and insurance can help relieve the burden of those costs, allowing you to pay a fraction of the price for your healthcare needs. By the end of this article we hope to provide a clear understanding of enrollment periods and how to make sure you are covered. 

Annual Open Enrollment Period

Enrollment periods will differ depending on where you are getting your insurance. Whether that be through federal or state-run marketplaces, employer-sponsored plans, Medicaid, or private insurance, it is important to note when open enrollment begins so you do not miss the chance for a new or better-fitting plan.  

The Affordable Care Act Marketplaces typically open enrollment on November 1st and closes on January 15th. The timing may depend on whether the marketplace in your state is federally run or fully state-run. Fully state-run marketplaces set their own open enrollment periods though the enrollment period may not close before December 15th. California, Colorado, and Washington, DC, have all set permanent extensions to their open enrollment period. 

Medicare starts early, with enrollment opening on October 7th and closing on December 7th. Private insurance may be offered outside of enrollment periods but options will be limited. Due to limited options it is a good idea to explore and compare the options offered to you so that you are not left without coverage. 

Coverage effective dates

For those who enroll in ACA Marketplace Plans before the 15th of December, coverage will begin January 1st. For those who enroll in the second half of the period, your coverage will start February 1st.  

Medicare plans go into effect on January 1st for those who signed up before December 7th of the previous year. The exception here is the initial enrollment period which begins three months before you turn 65 and ends three months after your birthday. Plan details for the next year are released in October, giving time to explore the available options. 

Employer-Sponsored Plans will vary depending on when the company sets its enrollment period. Many companies mimic the ACA timing in order for benefits to begin at the start of the year. However, this may not always be the case. Once you have been hired, discuss when benefits may become available. 

You cannot always plan for medical services, but when you can, it is important to use your plan to your advantage. This may mean planning expensive operations strategically. There is an out-of-pocket sum called a deductible that you will have to pay before insurance kicks in. An individual might plan a surgery at the beginning of the year so that they meet their deductible and know the rest of the year's applicable health services will be covered. 

Special Enrollment Periods

Qualifying life events may allow a person access to healthcare plans outside of the strict annual enrollment period. This eligibility is called a special enrollment period. Three main types of life events may qualify you for a special enrollment period; loss of coverage, changes in household, and changes in your residence. Let’s break those down in the next paragraph. 

Examples of qualifying life events

Loss of health coverage may be caused due to the loss of employer or student health care plans, changes in your eligibility for government-sponsored aid, or turning 26 and you are no longer eligible to be on your parent’s plan. 

Changes in a household occur when adding or subtracting a member of the family such as getting married, divorced, having or adopting a child, or having a family member pass away. 

Changes in residence can be moving into a new zip code or county, students moving to or from school, those who are in transitional housing, and seasonal workers moving between work and home. 

Outside of those big events, there are a few more special cases that can affect your eligibility. Individuals who become US citizens, gain tribal recognition, or get out of incarceration may have the opportunity to apply outside of the annual enrollment period. Changes in your income may allow you eligibility for government-sponsored programs like Medicare. If you are unsure of your eligibility, check your status on the website.

Medicaid and CHIP Enrollment

There are no specific enrollment periods for Medicaid or CHIP programs as your qualifications may change anytime throughout the year. This is because eligibility is based primarily on income but may also become available if you become pregnant, have children, or have a disability. Coverage under Medicaid and CHIP programs can kick in on the date of application or the first day of the month of application once approved. For CHIP applicants, if your eligibility changes within the year, states may continue to provide 12-month continuous coverage.

Marketplace and Employer-Sponsored Plans and state-based marketplaces

The state and federal marketplaces have the same open enrollment period from November 1st through January 15th unless you have a qualifying life event. Eligibility for marketplace programs is dependent on not having access to other healthcare options and meeting the financial requirements. Options are offered through either federal or state-run programs. Dates may vary for a fully state-run marketplace as they have control over their enrollment period. For consistency, enrollment must continue through mid-December to give applicants sufficient time to explore and apply. 

Employer-sponsored health insurance

Employer-sponsored programs may follow a similar timeline as marketplace options. However, it is up to the company to set their enrollment period, notify employees, and provide specific information for their plans. Selections must be made before midnight on the final day of the enrollment period to be valid. Employers often offer 2-3 different plans and they can change yearly. That means, even if you have already been enrolled and your benefits will carry over, it is worth it to check out the year's offerings to make sure something better hasn’t been added. 

Penalties for Late Enrollment

The United States requires most Americans to maintain health coverage. However, there is no longer a fine if a person fails to do so. In 2019, a law was enacted to end the penalty though residents in California, DC, Massachusetts, New Jersey, and Rhode Island are still required by the state to maintain coverage. Those who do not secure coverage may pay fines/penalties to their state when filing their tax return. 

The main issue that may arise from missing enrollment is simply the lack of financial protection against expensive medical costs. Those who require consistent medications or services will find themselves either without or paying out-of-pocket to continue. 

How To Enroll During Open Enrollment

For Marketplace plans enrollment through the online portal is easy and accessible. Start at the federal or state marketplace website. From there, your eligibility will be checked. Enter the required information to find out whether you are able to continue with your application. You can explore all the options available until you select the plan that best fits your needs. 

Employer sponsored plans are usually sent to you through a work email or portal link if you are eligible. From there you can browse all the options available to you. Here is where you look into premiums, deductibles, and coverage to compare the plans based on your healthcare needs. You can make your elections directly on the insurance portal or in the meeting with your HR representative. 

Most insurance brokers are able to be reached through phone, email, or in-person appointments. To apply for Marketplace plans check out the application website to find partnering locations for in person applications or contact information for virtual assistance. 

The same website as above may be used to locate the paperwork for a physical application sent through the mail. Postal applications can take up to two weeks to hear about eligibility and a few more once a plan has been selected to account for travel time. Unless you are applying or receiving paperwork in person a computer and printer may be necessary. It is important to stay ahead of enrollment closing in order to maintain benefits. 

Frequently Asked Questions (FAQs)

How To Find a Health Insurance Agency

Navigating the world of health insurance can be confusing and the risks of missing out on benefits can be financially or medically devastating. If you need help finding health insurance agencies and coverage options allow our online directory and concierge service to assist you. Our directory is filled with agencies that have been put through our rigorous testing and passed with excellent marks. Expertise offers a concierge service where you can explore specifically selected plans with our agents at no cost. Our agents can save you time and money in your search for health insurance coverage.

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