Open enrollment is the period during which people can stop, begin or change their health insurance coverage. The federal deadline is December 15th; however, each state marketplace can set its own dates.
As of March 2019, renewal notices for Medicaid, Child Health Plus, and Essential Plan enrollees are being distributed on an ongoing basis according to their enrollment end dates. Take action as soon as you receive one to ensure no gaps occur in coverage.
Open Enrollment Period
Annual enrollment or open enrollment is the time each year when individuals can make changes to their health insurance. It is an essential opportunity to review coverage if there have been major life events that will impact both medical needs and budget, while simultaneously looking for ways to lower insurance costs by increasing deductibles or dropping unnecessary coverage.
Dates for annual enrollment or open enrollment can differ by state, but usually take place from November through mid-December. Employer-sponsored health plans should consult their business to find out when open enrollment takes place; individuals purchasing coverage through Medicare Marketplace or Individual Exchange need to heed to its open enrollment period from November 1 – January 15.
Individuals have one opportunity each year to change their health insurance plan during open enrollment period, and whatever plan you select during this period will remain active throughout the calendar year. If you miss an enrollment or change period, however, then any change must wait until another open enrollment period opens up unless there has been a qualifying life event that allows you to sign up privately outside the marketplace.
Individuals have access to health plans available via their state’s health insurance marketplace or federal marketplace during open enrollment period, which will determine their premium costs and out-of-pocket expenses. Plans typically range from bronze to platinum tiers offering various levels of coverage and cost sharing arrangements for healthcare providers such as Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), or Exclusive Provider Organization (EPO).
If you are changing your plan during open enrollment due to a qualifying life event, such as marriage, childbirth, moving to a different city or job loss, then you have up to 60 days from its date to enroll or make changes. Qualifying events include things such as getting married, giving birth or losing one’s job.
Special Enrollment Period
Individuals in the individual market (both on and off exchanges) who experience qualifying life events may qualify for special enrollment periods in order to access affordable healthcare coverage outside of open enrollment windows. You typically have 60 days from when this event occurred to select and enroll in a plan; your coverage should begin the first of the following month.
The most frequent qualifying events include losing employer-based coverage, moving to a different state, getting married and having a baby. Other qualifying events can include changes in household size or composition, income fluctuations or relocation for work as well as involuntary loss of health coverage. There may also be events specific to health exchange plans that qualify – for instance becoming part of American Indian and Alaska Native population or becoming citizen or lawful presence within US borders are both considered qualifying events.
Divorcing or separating from your spouse entitles you to a special enrollment period (SEP), during which time either new partners can be added onto existing plans, or you can switch them for different ones altogether. Just keep in mind that premium payments must be made before coverage can begin.
Special enrollment periods offer another means of enrolling in Medicare outside the annual Open Enrollment Period if life events qualify as qualifying circumstances. For instance, if your employer-based coverage ends unexpectedly or you relocate out-of-state, Medicare enrollment during a Special Enrollment Period that starts when notified and ends six months after your last day of covered employment is possible.
If you miss your Special Enrollment Period for Medicare enrollment, then the next general open enrollment period could become the only opportunity to do so and could incur a late enrollment penalty. For more information about these periods please see our guide to the Affordable Care Act’s Special Enrollment Periods; for any inquiries about your particular circumstances contact your State Health Insurance Assistance Program for help.
Enrollment Periods
As part of the Affordable Care Act marketplace, there are specific times each year where you can enroll or make changes to your health insurance plan during Open Enrollment and Special Enrollment periods. Usually this period runs between November 1-December 15, with coverage commencing the first of January following open enrollment for Affordable Care Act plans (also referred to as Marketplace plans).
Enrollment periods for private health insurance plans vary. If your employer provides insurance, their human resources department or employee benefits coordinator should be able to give more specific instructions about when you can sign up for their plan – for instance after experiencing life changes like job loss or birth there may only be 30 days available for making changes.
Individuals and families looking for coverage through the Marketplace need to enroll by December 15 for coverage to begin within one month. Otherwise, coverage won’t start until February.
If you miss Open Enrollment period and don’t qualify for a Special Enrollment Period, coverage will need to wait until the next Open Enrollment period. However, you may qualify for one if a Qualifying Life Event such as marriage, birth or losing coverage occurs – for more information regarding qualifying life events and how to apply for one visit NY State of Health Individuals & Families.
Report any Qualifying Life Events within 60 days. Need assistance finding health insurance? NY State of Health’s certified enrollment specialists and volunteers are in communities across New York ready to answer your questions, assist with the application process and find plans that meet both your needs and budget. Furthermore, this holiday season they are sending Certified Enrollment Specialists directly into thousands of food pantries to help New Yorkers sign up and avoid gaps in coverage that could otherwise cause costly gaps in coverage.
Renewal Period
As healthcare continues to transform, companies need to keep up with changes in rules and regulations. Renewal periods provide one way for this. Furthermore, they provide companies with an opportunity to reassess risks and plan accordingly; for instance if their workforce has aged since their last renewal period it could cost more to offer health insurance; similarly if claims increased significantly renewal rates could rise accordingly.
People with health insurance through the marketplace must renew their coverage on time to take full advantage of all available plans and get the best value possible for themselves. Missing their renewal deadline could mean missing out on tax savings for 2019.
Individuals should review their renewal dates on online accounts to make sure all information is current, enroll in appropriate coverage types, and update expected income/household information for next year so they can compare available plans with appropriate savings potential.
As Medicaid, Child Health Plus, and Essential Plan renewals resume after being suspended during COVID-19 public health emergency, it’s crucial that people keep an eye out for renewal notices being sent by NY State of Health, HRA and local Departments of Social Services to enrollees enrolled in these programs – individuals should act upon these notices by their certification period’s end to avoid gaps in coverage.
Auto-renewals may help many maintain their coverage, but they may not always be the optimal choice. Auto-renewals don’t protect people against losing premium subsidies if they fail to file their tax return and reconcile tax credits with the IRS. Individuals receiving such subsidies must actively search for better plans or risk losing financial support altogether.
People enrolled in small group or individual health coverage whose renewal falls outside the open enrollment period also can take advantage of special enrollment periods (SEP). Although they cannot switch plans during open enrollment, when their coverage is up for renewal they can take advantage of their special enrollment period (SEP).
