Health Insurance Open Enrollment and What it Means for You

When it comes to enrolling in health insurance, there is typically a specific period of time in which you can choose your plan and enroll for the coverage that you and your family require. Enrollments have specific time periods to keep people from taking advantage of health insurance policies by signing up only when they need them and then dropping their coverage when their needs have been met and particular life events have subsided.  Having a health insurance plan is important, so it’s crucial to know when your special enrollment period is for both your employer insurance and government insurance, if you’re choosing to use the Affordable Care Act (ACA). Despite what you might hear, health coverage is available to most people, but it’s essential to know when and how to take advantage of the benefits. 

Navigating the ACA Open Enrollment Period

Open enrollment periods are an important part of obtaining health insurance. In most cases, if you miss open enrollment, you’ll be unable to receive coverage for that year, although this rule typically does not apply to pregnant women. Open enrollment periods can be confusing, so it’s important to know when and where they take place in your state. The ACA website is user-friendly, and as you navigate the open enrollment period, there will be consistent support on the other end. While phone calls may have longer waits than is ideal, you’ll often find the answer you’re looking for. It may take a bit of patience to get there, but most people enrolling in health insurance using the ACA have had a great experience.

What is Open Enrollment?

Open enrollment is present in every type of health insurance, regardless of the company issuing the policy. In any health plan, including Medicaid, open enrollment refers to the period of time during which you have to sign up for insurance or make changes to your existing health plan.  In most situations, open enrollment takes place at the end of the calendar year, and you’ll enroll for coverage throughout the upcoming year. While open enrollment typically happens once a year, in some cases it happens twice. Again, it depends on your insurance provider. It’s not uncommon to see extensions and enrollment periods added depending on the demand and volume of enrollments. The ACA marketplace information hotline is open during normal business hours to answer any questions you may have, and they’ll be able to provide you with ample information regarding the process and the coverage you’ll receive. 

When Is the Annual Open Enrollment Period?

Due to changes and demand for health insurance brought on by the COVID-19 pandemic, annual open enrollment periods for the ACA have changed a bit. Signed in early 2021, President Biden’s executive order created a 90-day enrollment period starting on February 15, 2021 until May 15, 2021. This order will allow all Americans to enroll in or change up their health insurance plan outside of the annual open enrollment period. Again, you’ll want to check for information regarding your state to ensure that you don’t miss the enrollment deadlines.  Typically. the open enrollment window for the Health Insurance Marketplace is only six weeks long. From November 1 through December 15. During this period, individuals can enroll in a plan for the subsequent coverage year. Those with current plans are encouraged to review plan details and costs to ensure that the existing plan is the best option. Of course, there is plenty of room to accommodate changes, and as the situation with the pandemic evolves, enrollment periods are doing the same. 

Why Open Enrollment Is Important

Open enrollment is important because it’s the only chance you’ll have to enroll in a health plan for the upcoming year. If you happen to miss it and face medical challenges, you will not have health insurance coverage and might end up with a pre-existing condition for the next open enrollment period, depending on your health issues and diagnosis.   Because open enrollment tends to last for (at least) a month, it’s crucial to take advantage of it while it’s happening. Education about open enrollment is key so those that need it don’t miss out!

Special Enrollment Is the Exception to Open Enrollment

There are a few situations, commonly referred to as special enrollment, that might help you qualify for enrollment outside open enrollment. If you find yourself in a position where you’ve suddenly lost your health insurance, either through job loss or change in employment, you may qualify for special enrollment. In addition, pregnant women often qualify for special enrollment, as they require a health insurance plan to move forward with the care they will need. The ACA website has ample information regarding qualifying changes, and you can easily sign up and log on to see if you qualify for insurance. 

What are Qualifying Life Events?

A qualifying life event (QLE) is a change in your life that makes you eligible to add or remove dependents from your healthcare plan or make new plan selections, outside of the typical Open Enrollment period. There are four types of QLEs:

• Loss of health coverage: Losing existing health coverage, including job-based, individual, and student plans.
• Changes in household: Experiencing a birth, adoption, death, marriage or divorce.
• Changes in residence: Changes in residence—moving to a new outside of your current coverage.
• Other qualifying events: Significant changes in income. becoming a citizen, for example, or leaving jail or prison.

Things to Consider During Open Enrollment

There are plenty of things to consider during the health insurance open enrollment period. You’ll have to think about who you’ll be covering on your insurance plan and the type of coverage you need and want. You’ll also have to consider the premium that you’re willing and able to pay, as premiums will differ between plans and insurance companies. 

Making Changes to Coverage

Many of you may want to make changes to your existing insurance plan during an open enrollment period. In fact, the need to make changes is one of the primary reasons that open enrollment exists.  People have to add family members to their coverage or remove them, depending on status. In addition, if you obtained health insurance through your employer, you’ll have to take yourself completely off your ACA insurance plan or see if you qualify for plans such as dental and vision only, which many employers might not cover. 

Changes to Costs

When open enrollment rolls around, most of us can count on a change in cost, whether we keep our plans the same or change them. Health insurance premiums are notorious for increasing, and you should always be prepared for that possibility as open enrollment draws nearer.  If you’re adding to or taking away from your plan, you’ll see a change in cost. The same is true if you’re looking to switch companies. Knowing that you may see an increase is the best way to go into open enrollment. 

Tips on Making the Most of Open Enrollment

You can make the most of open enrollment by taking a look at the available health plans before open enrollment actually begins. In addition, as discussed above, ensure that you (and your wallet) are ready for a potential increase in pricing.  Know exactly who will be on your health plan and what they need covered, along with the dates that open enrollment is available and the best times to use the system. Going into the process with knowledge of how to enroll or make changes is the best way to ensure a smooth process. 

Frequently Asked Questions

Many people have questions about open enrollment, as the process can be time consuming and, for many, confusing. Here are a few of the questions that we hear most often and our answers to them. 

What if I Miss the ACA Open Enrollment Period?

Typically, if you miss the open enrollment period, you won’t be able to receive insurance coverage until the next year. However, depending on your situation, you might qualify for special enrollment. Ask an expert at the marketplace because you never know until you ask.

Can I Make Changes Outside the Open Enrollment Period?

Typically, the system will not allow you to make changes outside the open enrollment period. You can inquire as to whether or not you can make changes to your plan when open enrollment isn’t happening, but it’s unlikely that you will be able to do so electronically without the help of a customer service representative. 

What if I Don’t Enroll in a Health Insurance Plan?

If you don’t enroll in a plan during open enrollment, you will not have coverage for the coming year. Because of the pandemic, health insurance has become incredibly important of late, so it’s crucial not to miss out, especially if you’re at high risk. At the very least, you can contact the ACA marketplace and see what your insurance coverage options are. 

Can I Go Without Health Insurance?

Technically, you can go without health insurance, but we don’t recommend it. You never know when life will throw you a curveball, and it’s essential to be prepared for it in the event of a health issue. Receiving coverage under the ACA is simple and applies to most people’s situations.  If you’re wondering about open enrollment and whether or not insurance coverage through the ACA is right for you, you can contact the ACA for more information; they will be happy to assist you on your journey to health insurance. We live in a time when health insurance is undeniably important, so don’t hesitate to call today!