Healthcare and medical services can be incredibly expensive. That’s why it is vital to have health insurance to help you cover the costs of your medical bills.
If you’ve spent any amount of time researching health insurance, you’ll have come across the term “Open Enrollment Period”. But what does it mean? How does it apply to you and when exactly is this period?
We’ll cover the answers to these questions and more in the guide below.
What Is Open Enrollment?
The Open Enrollment Period is a window of time that occurs once a year, usually in the fall. This is the period in which you can change or enroll in medical insurance.
Most major health insurance plans, workplace-based plans, and individual and family insurance plans under the Affordable Care Act (ACA) have an open enrollment period. While there are some exceptions, this is the only time during which you can enroll in a new medical insurance plan or change your current plan.
The Open Enrollment Period was set up as a method to discourage adverse selection. This happens when sick people sign up for health insurance and healthy people don’t. This skews the financial risk that health insurers take when insuring new clients.
The Open Enrollment Period aims to help protect clients from the risks they face in not having healthcare when incurring medical costs due to unexpected accidents or having a chronic condition.
During the Open Enrollment Period, no one can be rejected for ACA-compliant health insurance because of the current status of their health.
As mentioned, Open Enrollment also presents the opportunity to switch out your current healthcare insurance plan for a new one if you’re not satisfied.
Eligibility Requirements
When enrolling in an insurance plan during the Open Enrollment Period, you will need to meet the eligibility requirements for the plan you want to enroll in.
For ACA insurance plans, you will need to meet the following eligibility requirements:
- Be a legal U.S. citizen, national, or lawfully present non-citizen
- At least 18 years of age
- Do not have Medicaid coverage
- Do not qualify for employer-sponsored health insurance
- You cannot be incarcerated at the time of enrollment
- You do not have coverage from a spouse or parent’s health plan
Your income will also factor into the plans you are eligible for. For example, ACA Bronze plans are cheaper than Silver or Gold plans. The more expensive plans require you to have a higher income.
The cost of your plan is also influenced by any pre-existing conditions, your marital status, and whether you have any dependents.
So, while there are no requirements for Open Enrollment, the plan you choose might have requirements.
Now, unlike with Open Enrollment, the Special Enrollment Period does have eligibility requirements. These might vary from state to state but you are generally allowed to sign up for health insurance during a 60-day window if a significant life event has changed your circumstances as they relate to your health care plans.
The requirements for Special Enrollment Periods are explored in greater detail below.
Enrollment Periods
The federal annual Open Enrollment Period lasts for 45 days. However, it could vary depending on the state you find yourself in, since they might have their own permanent extended period in place.
Here are a few important dates regarding the Open Enrollment periods:
- November 1: The open enrollment period starts for health care for the following year. From this date, you can change your health care plan.
- December 15: This is the last day that you can enroll or change your insurance plan for the following year.
- January 1: Coverage begins for individuals who enroll in or change their plans by December 15, and have paid their first premium.
- January 15: On this date, Open Enrollment ends. It is the last day to enroll in or change your plan for this year.
- February 1: Coverage begins for individuals who have enrolled and paid their first monthly premium between December 16th to January 15th.
Keep in mind that these dates might change slightly depending on your state and are specifically for ACA-compliant insurance. Medicaid and employee-sponsored insurance will have different dates.
Open Enrollment For Employer-Sponsored Insurance
Open enrollment for employer-sponsored insurance varies from employer to employer. It can happen at any time of the year however, most employers generally schedule it close to the end of their financial year or at the start of a new year.
If you have employer-sponsored insurance, contact your HR representative to confirm the open enrollment dates.
General Enrollment For Medicare
The annual Open Enrollment Period for Medicare is from October 15th through to December 7th.
Special Enrollment Period
Certain life events may qualify you for special enrollment in health insurance. Unlike the usual Open Enrollment Period that occurs during the same timeframe annually, special enrollments depend on individual circumstances. They are also longer than the typical 45 days and run for 60 days.
The Special Enrollment Period is an exception to the Open Enrollment Period. It covers individuals who have suddenly, and unexpectedly, lost their insurance due to divorce or if they experienced any major life changes, such as marriage or a death in the family, that require them to change their insurance plan.
Special Enrollment gives individuals the opportunity to get health coverage within 60 days before or after a qualifying event.
The Benefits Of Open Enrollment
A major benefit of Open Enrollment is that it offers you the opportunity to change your insurance plan to fit your current and future needs. For example, if you’re planning to get married, or have gotten married, you might want to change your insurance to include your partner. Or, you might plan to have a baby and therefore need to switch to a different healthcare plan to accommodate your child.
Open Enrollment is also the perfect time to reevaluate your current health insurance and cancel any plans or benefits you no longer use.
Open Enrollment allows you to easily adjust your insurance plans and benefits to suit your current and future needs, thereby saving you money and ensuring that you have the coverage you need.
Costs Of Open Enrollment
The costs of Open Enrollment merely entail the cost of the insurance and benefits you choose. It is the monthly premiums you pay after you’ve chosen your new insurance. The average cost of health insurance is around $313 to $678 per month, depending on your level of coverage.
However, these rates are expected to increase annually.
Your premiums will fluctuate depending on the health care plan you choose. There are also subsidy programs that ensure individuals of low or moderate incomes are protected from the rate increase. These subsidy programs scale the cost of health insurance to a percentage of income.
For example, the Bronze plan might cost $30 per month for an individual that earns around $30,000 and could cost up to $214 per month for an individual that earns around $45,000.
How To Enroll In Insurance During Open Enrollment
We advise that you do your research on the various plans you qualify for and consider whether they’re an improvement on your current plan. You’ll also want to:
- Familiarize yourself with the enrollment dates.
- Confirm which insurance plans are available via a health insurance broker like Enhance Health or government insurance marketplace.
- Research insurance plans and companies to ensure that they meet your needs
- Review the associated costs. These include monthly premiums, copay and coinsurance options, and deductibles.
- Consider whether the plans you’ve reviewed will meet both your current and future needs.
If you’re purchasing health care from the Health Insurance Marketplace, you’ll receive notices via your mail or email. These notices will be from your insurance company and from the marketplace exchange.
The letter from your insurance company is similar to the one you would’ve received from your employer. It outlines your current plan, whether it will be available in the coming year, and any changes made to your plan. If your insurer has discontinued your current plan, it’ll also offer a few alternatives.
The notice from the exchange includes instructions on how to obtain tax credits and cost-sharing discounts. This usually requires you to submit your income tax returns and other important documents to see whether you qualify for subsidies.
While these are great options, none of them will cater to your needs, or offer you the guidance you need to choose the perfect insurance plan. Enhance Health offers you the tools, support, and insight you need to find a plan that works for you.
What Insurance Plans And Benefits Are Available During Open Enrollment?
Under the Affordable Care Act, or Obamacare, insurance providers have to provide minimum essential coverage. This includes coverage in 10 categories of health services:
- Outpatient care
- Emergency services
- Hospitalization
- Pregnancy, maternity, and newborn care
- Services for mental health and substance use disorders
- Prescription drugs
- Rehabilitation services and devices
- Laboratory services
- Preventive, wellness, and chronic disease services
- Pediatric services
When enrolling in health insurance, these benefits will be included in your policy with varying degrees of coverage depending on the plan you choose.
There are four metal tiers for health insurance plans. These are Bronze, Silver, Gold, and Platinum.
Bronze plans are the options with the cheapest monthly costs but they will usually have higher deductibles that you will need to meet before insurance will cover any costs.
Silver plans are more balanced and offer more coverage at a higher cost than Bronze plans.
Gold and Platinum plans are the most expensive options and are suitable for those who expect that they will need extensive medical care.
Open Enrollment Alternatives
So, what happens if you miss the Open Enrollment period? Are there any alternatives?
Well, the first option is Special Enrollment. However, unlike Open Enrollment, you’ll need to qualify for special enrollment due to certain life events like getting married, losing employer-sponsored coverage, or having a baby.
You could also consider going for Medicaid and CHIP. Medicaid and CHIP are free or low-cost health coverage options that aren’t included in open enrollment. This means that you’re able to register or enroll at any time of the year.
However, unlike the ACA plans available during Open Enrollment, you’ll need to be found eligible for these programs. Eligibility is primarily income-based, but there are also additional factors like whether you have children, dependents, or a disability.
Another option is to get a short-term health insurance policy to cover your medical needs until you can enroll in a new health insurance policy during the next Open Enrollment Period. Short-term health insurance can provide coverage for up to 364 days.
Conclusion
There you have it. Now you’re equipped with everything you need to know about the Open Enrollment Period.
If you’d like some help capitalizing on the enrollment period and choosing an insurance plan that suits your needs, we’ve got you covered. At Enhance Health, we help you choose the perfect insurance plan for your needs and help you apply and activate your policy during Open Enrollment.
