Details for individuals and employees
Whether you get coverage from your employer or purchase it from the health insurance marketplace, knowing when your open enrollment period is and having a plan on how to approach it is important. Even if you want to keep your same coverage, it’s important to review your plan and options, because your plan may have changed, including cost, network of doctor’s, and prescription drug coverage. Below we outline important factors to keep in mind before, during, and after open enrollment.
What are the dates?
It’s important to know when your open enrollment period is because if you miss the window to sign up for or change your benefits you could be without insurance, or have coverage that doesn’t match your needs, for another year. Health insurance companies require a specific sign up period to counter adverse selection - the tendency to only buy insurance when you are sick and forgo it when you are healthy.
If you get your insurance through your employer, ask your HR leader about open enrollment dates. Most schedule open enrollment in the late fall, commonly starting November 1. However, dates and the length of the open enrollment period varies by employer.
For coverage through the healthcare.gov marketplace for next plan year open enrollment dates are typically as follows:
- Open Enrollment begins November 1
- Enroll by December 15 for coverage that starts January 1
- Open Enrollment ends January 15
However, states with their own exchange can have different open enrollment dates, so be sure to check what applies to your specific state.
In addition, you can apply and enroll in Medicaid or the Children's Health Insurance Program (CHIP) any time of year.
What is a qualifying life event?
There are a few exceptions when you can change or update your health insurance plans or coverage, which are referred to as a “Special Enrollment Period.” These can include:
- Birth or adoption of a child
- A death in the household
- Changes in residence (e.g. moving zip codes, leaving incarceration, moving to or from a shelter to or from traditional housing)
- Loss or change of employment,
- Loss of health insurance
- Becoming a US citizen
- Changes in your income that affect the coverage you qualify for
- Gaining membership to a federally recognized tribe
These are often referred to as a “qualifying life event.” Some benefits, like a Health Savings Account, can be opened at any time during the year.
As open enrollment approaches take time to consider your healthcare needs and any upcoming changes. Will you be experiencing a major life event, like starting a family, getting married, or moving? Will you need a different type of coverage in order to meet you changing needs?
Also think about whether you used your current plan this year. How much did you use your insurance coverage? Were you happy with the doctors you had access to and the level of care you received? Is what you’re paying for coverage now working for your budget? Assessing what you need from your coverage will help you make the best choice of care for you.
Use our calculator to compare health insurance plans and figure out what type of plan is right for you and your needs.
Best ways to prepare
To make sure you’re prepared for open enrollment follow these five steps:
- Make a plan: Understand your benefit options and when the period starts and ends.
- Know what’s changed: Costs, such as deductibles and copays, your network of doctors, and prescription drug coverage all may have changed this year, even if the plan name and administrator are the same.
- Define what you need from your healthcare coverage this year and take into account any major life changes.
- Compare plans to find one that can better suit your needs.
- Consider additional benefits that support financial wellness and help reduce costs, like an HSA.
Overall, open enrollment means options. It is an opportunity to ensure that you have the healthcare coverage you need, are prepared for the unexpected, and can take advantage of all of the benefits your employer may offer.