Open enrollment, also known as annual enrollment, is that time of the year when you can sign up for a health insurance plan. Most employers feature open enrollment season to help employees choose their workplace benefits such as health, life, and even pet insurance. You can change your ongoing plan, re-enroll, or dis-enroll if you do not want the coverage again.
Dis-enrollment mostly occurs in individual market health insurance. Open enrollment is often less than four weeks and can be as short as two weeks in some companies. If you do not sign up for health insurance within the space of time allocated for open enrollment, you will have to wait for another year. However, a life event could qualify you for a special enrollment program.
As long as you apply and are eligible during the open enrollment, the health plan must cover you without requiring a medical undertaking/writing. This factor could make it difficult for you to get health insurance.
Open Enrollment for Different Types of Health Insurance
Each health care plan has its own time of the year for open enrollment. The plan you decide on should depend on the medications you need and the pharmacies you prefer.
Medicare plans include the Original Medicare (which houses the Part A and B insurance), the Medicare Advantage (Part C), and the Part D program. Original Medicare is run only by the federal government, while the Part D health insurance is a cover for those that require prescription drugs. Private insurance companies run the Part C plan.
Medicare’s general open enrollment runs from October 15 to December 7 of every year. A particular enrollment period for persons with Medicare Advantage also runs from January 1 to March 31. During open enrollment, you can make changes from any Medicare plan to another, discontinue, or sign up for a new program. Enrollees can only make these changes once a year.
Unlike the other plans, the Medicare Supplement Insurance (also known as Medigap policy) has no annual open enrollment period. Medigap covers out-of-pocket costs of the Original Medicare programs. A one-time six-month enrollment window starts for persons who want to enroll in Medigap. These persons must have enrolled already in the Part B plan before attaining 65 years. Individuals who wish to register after this window are required to provide medical underwriting.
Job-based health insurance
These are open enrollment times that employers set for their workers. Job-based health insurance can occur at any time of the year, depending on the company. Generally, most companies fix their open enrollment periods to end a few weeks before the insurance providers require the enrollment forms. This time occurs mostly in fall, so that the new coverage begins on January 1 of the next year. Most companies partner with private insurance providers. These private providers are not affected by the type of exchange used in an area, by extensions, by timing, or by Navigator funding.
Individual market health insurance (on- and off-exchange)
Here, the individual buys coverage for him/herself instead of getting one from an employer. Due to the Affordable Care Act (known as the ACA or Obamacare), insurers cannot determine an individual’s eligibility based on his/her medical history, thereby saving people with pre-existing conditions from denied coverage. As such, only public health insurers that are compliant with the ACA attend to the individual market. Enrollment windows apply for both health insurance exchanges and outside the market.
Previously, enrollment in the individual market was available all year round. However, according to the HealthCare.gov schedule, open enrollment runs from November 1 to December 15. This schedule does not apply to all areas. So each area might end up with different enrollment windows of their own. Individual market health plans have longer windows and more extensions. Also, Native Americans can enroll in the programs through the exchange year-round without any limitations.
Special enrollment is the extended period given for a person with a qualifying life event. It allows him/her to enroll outside the open enrollment window. However, the person has about 60 days after that qualifying life event to apply for coverage. These events include
- Losing health insurance coverage: This could be due to leaving a parent’s health coverage or the expiration of a plan. A divorce could remove you from your partner’s own, leading to insurance loss. Other ways are getting fired or quitting a job, which also removes you from your employer’s benefit plan, and if your insurer exits the market/exchange before the end of the period. The special enrollment window will not apply if you lost the previous coverage due to non-payment of premiums or voluntary cancellation.
- Getting married
- Having a baby, gaining a dependent, or adopting a child
- Change in residence: This includes relocating to an area where the old plan is not applicable or moving to a new ZIP code.
When Open Enrollment Does Not Apply
There are some exceptions to the open enrollment system used by most health insurers. This set of insurers do not limit enrollments at any time. As a result, qualified or eligible individuals can enroll at any time. Example of such insurers are:
- Medicaid: This insurance program provides coverage to low-income earners. It has an eligibility requirement based on disability, age, income, and other household factors.
- Children’s Health Insurance Program (CHIP)
- Travel insurance: Travel insurance companies are available throughout the year but can restrict one’s ability to purchase a travel policy. This restriction usually is around the period after the individual has booked travel.
- Short-term health insurance: This policy is available year-round but is not applicable in every area. Here, private companies provide short term coverage, which is a temporary and non-guaranteed plan. Insurers use medical underwriting to determine eligibility for this coverage, eliminating persons with pre-existing medical issues.
- Medigap plans
Frequently Asked Questions (FAQs)
Do I have to wait for open enrollment to get health insurance?
Open enrollment means you cannot buy health insurance whenever you want to. This restriction was not always the case, but then, you had to have medical underwriting. Pre-existing conditions could also prevent you from being accepted. The ACA made it possible for individuals to get coverage despite their health status. However, it also came with the open enrollment condition. Exceptions to the window are people qualified for special enrollment. These persons are permitted to enroll at a time different from the enrollment period.
What happens if you miss open enrollment for health insurance at work?
Several job-based health plans hold open enrollments between November and December. These enrollments usually have a small window, and if an employee remains indecisive, he/she may miss it. If you cut open enrollment and you do not qualify for a life event, you risk going through an entire year without coverage.
However, all hope is not lost. You could qualify for a special enrollment. Other insurers available year-round include private companies (off-exchange), Medicaid, and short-term health plans. You have to meet the eligibility requirements for these.
Why is open enrollment so short?
Short open enrollment windows help keep the exchange pool stabilized. When open enrollment windows started from November and extended up to January, the coverage started as late as March. This time meant that people only had to pay premiums for ten months instead of twelve. The shorter windows, therefore, helps to ensure that every individual enrolled has a full-year coverage.
Open enrollment short period also helps prevent adverse selection risks, resulting when persons switch plans at any time they want. In addition to that, an efficient exchange process meant that longer windows were unnecessary.
What can you do during open enrollment?
During open enrollment, you can consider new benefits and compare them with your previous ones. Determine why you need the coverage, which benefits fit your needs more, and how much it will cost you. Even if you already have a plan, you could check to see others with better rates that fit your budget.
Open enrollment allows anyone to make changes to his/her benefit options. During this time, individuals and employees of companies may buy health insurance plans through exchanges. Unless you know you will soon qualify for special enrollment, it is best to use the open enrollment season to apply for health coverage. Obtaining the insurance outside enrollment could be difficult whether you go to public or private insurers.
Do not waive off health insurance altogether due to the expensive cost. Skipping insurance may be attractive if you are healthy, but the medical bill you could incur for a slight illness could be disastrous.