Open Enrollment for Health Insurance

Highlights:

• Open enrollment is the annual period when individuals can renew, change or cancel their health insurance.
• Missing an open enrollment period can put you at risk for losing health coverage for a full year until the next annual open enrollment period.
• If you miss the open enrollment period, you may be able to secure health insurance either during a special enrollment period or through Medicaid and the Children’s Health Insurance Program (CHIP).

Whether you’re getting health insurance through your employer or from the Health Insurance Marketplace®, open enrollment is the annual period when individuals can renew, change or cancel their health insurance.

How does open enrollment work?

Most types of insurance — Medicare, employer-sponsored and marketplace health insurance — have open enrollment periods. These periods typically happen in the fall, just in time for coverage to begin January 1 of the following calendar year. Depending on your employer, open enrollment may also include vision and dental coverage, as well as other benefits.

During this period, applicants can shop for health plans:

• Through their employer
• On the federal and state marketplaces via Healthcare.gov
• Through the marketplace call center at 1-800-318-2596
• Directly from an insurer
• From a local health insurance broker

Missing open enrollment can put you at risk for losing health coverage for a full year until the next annual open enrollment period. However, if you have what’s known as a “life event,” which includes changes in residence, marriage, divorce and having a baby, you may qualify for a special enrollment period outside of the normal annual dates.

When is open enrollment?

Open enrollment happens annually, usually in the fall. However, the exact window of time depends on the source of your insurance. You can verify the exact dates for open enrollment with your employer or insurer.

• Open enrollment for marketplace insurance. Health insurance marketplaces, or simply marketplaces, were created by the Affordable Care Act (ACA) to expand the accessibility and affordability of healthcare. Under the ACA, each state has one official marketplace that is operated federally, at the state level or both.
  
  Currently, there are 24 federal marketplaces, 18 fully state-run marketplaces, three state-run marketplaces that use the federal platform and six state-federal partnership marketplaces; however, the marketplace options can change from year to year. More on each state’s marketplace can be found here.
  
  All marketplaces, except for those that are fully state-run, follow the U.S. Department of Health and Human Services open enrollment period of November 1 to January 15. Fully state-run marketplaces can set their own open enrollment periods, provided the final deadline isn’t before December 15.
   
• Open enrollment for employer-sponsored insurance. For employer-sponsored insurance, the open enrollment window varies by employer and can happen at any time of the year. Some employers schedule open enrollment in the fall, so coverage can begin January 1. Others may connect open enrollment to the start of their fiscal year, which may be different from the calendar year. If you choose job-based insurance and are unsure when open enrollment occurs, check with your employer to find out.
   
• Open enrollment for Medicare. Medicare has an annual open enrollment period from October 15 to December 7. During this period, those who qualify for Medicare can enroll in, change or drop a Medicare plan, and benefits become available January 1 of the following calendar year.
  
  An exception to annual open enrollment for Medicare is the initial enrollment period, which gives newly eligible individuals a 7-month window to apply for Medicare. The initial enrollment period begins three months before you turn 65 and ends three months after your 65th birthday.
   

What if I miss open enrollment?

If you miss the open enrollment period, you may be able to secure health insurance either during a special enrollment period or through Medicaid and the Children’s Health Insurance Program (CHIP).

• Special enrollment period. Once open enrollment ends, you can only enroll in or change marketplace health plans if you qualify for special enrollment. Certain life events may make you eligible for special enrollment (for example, getting married or divorced, moving, having a baby or losing employer-sponsored coverage). Visit the Health Insurance Marketplace and use the online screener to see if you qualify.
   
• Medicaid and CHIP. Medicaid and CHIP are free or low-cost health coverage options that do not have open enrollment periods, meaning you can enroll during any time of the year. Eligibility for both programs is primarily income based, but other factors may help you qualify (for example, if you become pregnant or if you have children or a disability).
  
  Medicaid benefits vary from state to state, but there are certain benefits each program must have, such as coverage for inpatient and outpatient medical services, lab and X-ray services and physician services. Learn more about Medicare and CHIP, including how to qualify and apply for benefits, here.
   

It’s important to understand the details of open enrollment and the health insurance options available to you. Be sure to review the terms of any existing coverage carefully so that you can be ready when it’s time to renew or change your plan.