Open enrollment allows you to sign up for or modify your health insurance plan. If your plan is offered by an employer open enrollment gives you the opportunity to unsubscribe if you don’t want the coverage. Unless you have a qualifying event, you can’t sign-up for health insurance if you don’t register during open enrollment.
The health plan must provide coverage if you are eligible to apply for open enrollment health insurance. You cannot use medical insurance and you must provide proof of insurability. This could make it more difficult to obtain health insurance.
What types of health insurance use open enrollment periods?
For most types of insurance, open enrollment is possible.
- Medicare
- Health insurance that is job-based
- The Affordable Care Act has resulted in individual market health insurance, which is coverage people purchase for themselves rather than getting from their employer. Enrollment windows are available both within and outside of the insurance exchanges.
What is Open Enrollment?
The healthcare plan you select will determine the time of year that open enrollment takes place.
- Medicare open enrollment is for Part D and Medicare Advantage plans from October 15 through December 7, and a separate period from January 1 through March 31, for those who have Medicare Advantage.2 Medigap plans don’t have an open enrollment period. Medigap plans can only be enrolled without medical underwriting during the initial enrollment period, or one of the very few special enrollment periods. However, some states have rules that permit Medigap enrollees make annual changes to their plans.
- Your employer can set the open enrollment period for job-based health insurance. It can take place at any time during the year. Employers prefer to open their enrollment period in the fall so that new coverage can begin on January 1. Some employers opt to have a different year for their health plan. For example, your employer might offer open enrollment in June and a new plan in August.
- The open enrollment period for the individual market (on- and off-exchange), runs in most states from November 1 through December 15. This schedule is used by HealthCare.gov. It’s the exchange platform that’s used across 38 states as of 2020. The number of states using it will drop to 36 in 2021 as Pennsylvania and New Jersey have their own platforms. 4 The District of Columbia, 12 other states (14 in 2021), and many of them offer more flexibility in their enrollment schedules and longer enrollment windows. California, Colorado, and DC have extended their enrollment windows permanently. A few other state-run exchanges also announced extensions to the open enrollment period in 2021 for individual market plans.5 Native Americans can enroll through the exchange all year.
The Exception to Open Enrollment is Special Enrollment
Open enrollment insurance plans have an exception that allows you, under certain circumstances, to enroll outside of the open enrollment process. These are called qualifying life events. You can sign up for insurance without open enrollment if you have experienced a qualifying event. Qualifying life events can be categorized as 6,, and many other circumstances.
- Involuntary loss of other insurance coverage due to the following: losing or quitting your job, aging off a parent’s health plan, COBRA expiring, divorce, etc.
- Moving out of the service area for your current plan or to another area with different health plans.
- Married life
- Adopting a child or having a baby
If you have lost other insurance, you won’t be eligible to enroll in a special enrollment period. This is if you haven’t paid the monthly premium or canceled your previous coverage.
While the special enrollment periods and qualifying events in the individual market may be similar to those for employer-sponsored plans, these are not identical. Healthinsurance.org offers a guide to special enrollment periods for the individual market. The Society for Human Resource Management also has a summary of the qualifying events that can trigger special enrollment periods for employer sponsored health insurance.
What types of health insurance don’t use open enrollment?
The majority of American health insurance companies use an open enrollment program, which limits sign-ups to certain times each year. These are exceptions:
- Medicaid is state-based insurance that covers health care. It doesn’t have a set enrollment period. You can enroll anytime if you are eligible for Medicaid.
- CHIP is the U.S. government’s Children’s Health Insurance Program. It doesn’t restrict enrollments to any particular time.
- Open enrollment is not allowed for travel insurance. Open enrollment is not possible due to the short-term nature and cost of travel insurance policies. Some travel insurance companies limit your ability to buy a policy for travel insurance within the time period immediately following your booking.
- Short-term insurance does not have open enrollment periods. Short-term insurance is not regulated by ACA. Plans are available all year in states that allow them. Medical underwriting is used for eligibility determination, and short-term plans don’t generally cover pre-existing conditions. Short-term plans are not available in 11 states. There are also restrictions that are placed on short-term plans by states that are more restrictive than what the federal government requires.
- Supplemental insurance products may be available in certain cases. Individuals can purchase supplemental insurance all year. However, if your employer offers supplemental coverage, you will be limited in your ability to enroll. Medigap plans are available year-round. They are intended to supplement Original Medicare. After the initial six-month enrollment window, Medigap insurances in almost every state allow applicants to undergo medical underwriting to determine their eligibility for coverage.
More open enrollment opportunities
Open enrollment is a time when most employers permit you to change or sign up for other benefits related to your job. These changes can only be made during open enrollment. You may be eligible to:
- You can set up a flexible spending or health savings account. FSA contributions must be established before the start of the plan year. However, HSA contributions cannot be stopped, started or changed at any time. HSA-qualified insurance is required to contribute to HSA-qualified plans. The IRS has allowed employers to relax FSA contribution rules 10 to combat the COVID-19 pandemic.
- Register for or adjust the amount to life insurance, vision insurance and disability insurance.
