What is Open Enrollment for Health Insurance?
Open enrollment begins every fall, allowing millions to select or update their health insurance for the following year. This is the set time annually to review your insurance needs and make changes.
Whether you’re new to the process or finding a plan due to life changes, understanding key dates and their impact on your health choices is essential to making the right decision for your coverage.
Dates and Timelines: When is Open Enrollment?
Open enrollment periods are designated times during which you can enroll or make changes to your health insurance. These intervals differ based on where you’re sourcing your insurance:
Federal marketplace: Initially started with the Affordable Care Act (ACA), the federal marketplace open enrollment period begins on November 1st and ends on December 15, with coverage starting on January 1st of the subsequent year.
State run marketplaces: Many align with the federal schedule, but some states have extended periods, allowing you to choose a plan before January 15.
Employer-sponsored plans: The dates differ across companies, but many employers announce their specific periods in the fall, starting in November.
Private health insurance: Enrollment windows can vary widely, with some insurers offering multiple periods or even year-round enrollment. For example, there are short term health insurance plans available at any time, which are ideal for bridging gaps in standard healthcare coverage.
Federal health insurance programs: Some federal programs allow you to enroll at any point during the year. For example, if you qualify, you can apply for Medicare or the Children’s Health Insurance Program (CHIP) anytime, based on your needs.
What Can You Change During Open Enrollment?
During open enrollment, you have the opportunity to sign up for or modify various insurance options and benefits, whether they’re offered by your employer or accessible through the government marketplace.
Here are typical actions you can take during this window:
Opt for new benefit plans
Tailor your coverage to either individual or family needs
Determine if you are eligible for premium reductions through a new affordable private health insurance plan
Decide on the right type of insurance structure for you, be it an HMO, PPO or HDHP with a self-employed health insurance deductible
Determine or alter your allocations to accounts like FSAs or HSAs
Refine your existing plan, which might include raising coverage limits or naming additional beneficiaries
Apply for tax credits based on your household income during the initial enrollment period for the federal marketplace
What is a Special Enrollment Period?
A Special Enrollment Period (SEP) is a critical time outside the regular open enrollment when you can sign up for health insurance. This period is triggered by specific life events that involve changes in your living situation or coverage needs.
Qualifying life events include:
Marriage
Divorce
Birth or adoption of a child
Loss of coverage due to losing your job, aging out of your parent’s plan or expiration of COBRA
Moving to a new residence that affects your health insurance options
Significant changes in income that affect the coverage you qualify for
Becoming a U.S. citizen or gaining lawful presence
If you experience one of these events, you typically have a 60-day window from the day of the event to enroll in a new health plan. This ensures you have the care services you need during a major transition.
What Happens if You Miss Open Enrollment?
If you miss the open enrollment period for health insurance, you won’t be able to secure coverage through traditional channels until the next enrollment window. This can potentially leave you without health insurance and facing out-of-pocket medical expenses.
However, you may still have options for coverage. Many private health insurance providers offer health insurance plans for individuals that allow you to enroll at different periods. This can include family health insurance plans and job-specific health insurance plans.
For instance, travel nurses, realtors and truck drivers may be able to choose specialized plans designed for their unique work situations to receive coverage matching their occupational risks and demands.
If you own your own company and need insurance, United National Healthcare also offers small business health insurance plans. These are ideal for private practices or local coffee shops.
How to Prepare for Open Enrollment
Ahead of open enrollment, it’s essential to be well-informed and organized. This can help you choose the most cost-effective plan for your specific situation. Here are a few tips for preparing this year:
Review your current health insurance policy for coverage gaps or unneeded services
Gather and organize medical records to ensure your conditions and necessary treatments are covered
Anticipate health needs for the upcoming year, such as surgeries or medications
Research and compare the benefits and costs of potential insurance providers
Prepare a list of questions for potential insurers regarding out-of-pocket costs or network restrictions
Set reminders for enrollment deadlines to stay on track
Contact private insurers to explore non-standard or specialized coverage options
Find Private Health Insurance For Your Situation
At United National Healthcare, we believe in a proactive approach to health coverage. With plans in 32 states, we make it easy for everyone, from families to businesses, to find a plan that suits their needs.
Our policies focus on preventive care, medication coverage and financial protection for your well-being. Contact us today to find health insurance near you and choose your plan during open enrollment.
