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When and How to Enroll During Open Enrollment Period

Learn what you need to prepare for the upcoming benefit year

Reviewed by: Ed McClane, Licensed Insurance Agent. Written by: Aaron Garcia.

Senior female discusses Medicare plan options over the phone while in her kitchen.

Key Takeaways

  • The Open Enrollment Period is the annual window of time during which you can enroll in a health insurance plan, effective for the following year.

  • You have roughly 45 days to shop and enroll in plans. After that, only Qualifying Life EventQualifying Life Events (QLE) are life changes that allow you to enroll in a new health insurance plan during a Special Enrollment Period. These include having or adopting a child, losing other coverage, marriage, a change of income and moving. will make you eligible for a Special Enrollment PeriodThe Special Enrollment Period is a 60-day period outside the Open Enrollment Period when you can enroll or change your coverage. Special Enrollment Periods are only granted if you experience a Qualifying Life Event. These are special circumstances that may change your health insurance needs. to register.

  • Before you enroll each year, consider which changes or improvements you’d like to make with your plan. Also, look at any services or medications you may need.

It’s hard to become an expert at something when you only do it once a year. Since it’s been roughly 365 days since the last Open Enrollment, we’ve put together a refresher that includes dates you need to know, common Open Enrollment answers, and what to do if you miss Open Enrollment.

What is the Open Enrollment Period?

Each year, individuals and families can sign up for private health insurance during the Open Enrollment Period (OEP). During the OEP, health insurance customers can shop for plans through the following:

  • Depending on the state, either the Federal Health Insurance Marketplace (Healthcare.gov) or your state’s local exchange system. Both were set up by The Affordable Care Act.
  • Health Insurance marketplaces like GoHealth
  • Directly with a private health insurance carrier

When is 2021 Open Enrollment?

Each year, the Open Enrollment Period runs from November 1 to December 15. Plans purchased during Open Enrollment are active on Jan. 1 of the following year.

Evaluating Your Current Coverage

OEP is your opportunity to review and change your health insurance coverage for the following year. To get ready for Open Enrollment, here are some questions you should ask yourself:

Do I like my or my family’s current coverage?

If you have existing coverage, determine whether or not it’s still a good fit.

  • Are monthly premiums too high?
  • Are your preferred doctors in-network?
  • Are you considering new locations for regular care?

Have my or my family’s health needs changed?

If anyone’s health status changes, keeping up with those changes impacts costs and available care.

  • Do you expect your or anyone’s prescription drug needs to change?
  • Do you or anyone in your family have scheduled or expected surgeries next year?
  • Did you or anyone in your family receive a health diagnosis for a major illness?

Has there been a change in my or my family’s life status or income?

  • Did you get married or divorced?
  • Did you have or adopt a baby?
  • Will any of your children age off your plan next year?

What to Know Before Open Enrollment

All plans must cover the 10 Essential Health Benefits.

Regardless of the plan you choose, rest assured knowing that the 10 Essential Health Benefits will be covered. All health insurance plans are required to cover the same essential benefits.

  1. Outpatient services
  2. Inpatient hospitalization
  3. Mental health and substance use disorder services
  4. Prescription drug coverage
  5. Laboratory services
  6. Emergency services
  7. Maternity and newborn care
  8. Pediatric services (including oral and vision care)
  9. Rehabilitative and habilitative services
  10. Preventive services

 

All plans must cover preventive care at 100%

Preventive services are covered in-network at 100% for all policies. 

 

You can’t be denied coverage for pre-existing conditions.

Under the Affordable Care Act (ACA), insurance companies can no longer deny coverage or charge you more for pre-existing conditions. Conditions such as cancer, pregnancy, asthma, and diabetes can no longer exclude you from coverage.

 

You may be eligible for financial help.

The Government provides financial help for health insurance costs in two ways: Premium Tax CreditsAdvanced Premium Tax Credits are tax breaks designed to lower the monthly premium payment you make to your health insurance company. Households with an income within 100-400% of the Federal Poverty Level may qualify. Premium Tax Credits are also called "tax subsidies." (or tax subsidies) and Cost Sharing Reductions (CSR)A Cost Sharing Reduction (CSR) is a discount applied to your out-of-pocket costs such as deductibles, co-payments and co-insurance. To qualify, your income must be within 100-250% of the Federal Poverty Level. Also known as a "extra savings.". Both are income-based and also factor in other details. Premium Tax Credits offset the cost of monthly health insurance premiums, while CSRs reduce your out-of-pocket costs for health care on things like deductibles, copayments, and coinsurance.

What if I Miss Open Enrollment?

See if you qualify for a Special Enrollment Period.

You may qualify for a Special Enrollment Period due to a Qualifying Life Event (QLE). If you experience a QLE, a temporary 60-day window will open to allow you to sign up for a new health plan. [1] QLEs include:

  • Marriage or Divorce
  • Birth, death or adoption
  • Moving to a new ZIP code or county
  • Loss of other coverage
  • Change in income

Look into Short-term health insurance.

Some insurance carriers offer short-term health insurance plans to help bridge the gap between coverage periods. Healthy individuals and families typically use short-term health insurance plans without comprehensive healthcare coverage. Individual states have different rules surrounding how long you can stay on a short-term plan and what they cover and exclude.

FAQs

Is the Open Enrollment Period the same for Medicaid and Medicare?

No. The enrollment periods for Medicaid, Medicare, and health insurance are different. You can enroll in Medicaid at any time as long as you meet your states’ requirements. Medicare enrollment follows the Seven-Month Rule, where you can enroll in three months before the month you turn 65, your birth month and the three months after.

Also, there is a separate enrollment period for Medicare Advantage and Medicare Part D.

Can I sign up for my employer’s coverage?

Employers with 50 or more employees are required to offer affordable health insurance to full-time employees. Your employer may have a different enrollment period. Remember, certain qualifying life events like getting married, having a baby, adoption, marriage or divorce may allow you to enter a Special Enrollment Period in the middle of your plan year. For all these reasons, ask your Human Resources department for further information.

Do I still pay a tax penalty if I don’t enroll?

Not from the federal government. In 2019, the U.S. Government abolished the Individual Mandate, a tax penalty for people not enrolled in a health plan. Several areas still enforce individual mandates, however. As of 2020, they are:

  • New Jersey
  • Rhode Island
  • Massachusetts
  • Vermont
  • California
  • Washington D.C.

What's Next?