What is Open Enrollment?

If you’ve ever had to get health insurance, chances are you’ve heard the term “open enrollment.” But do you really know what that means?
by Starship September 26, 2019

Open enrollment (OE) is an annual period of time, anywhere from a few weeks to 3 months, when individuals and families have the chance to change health insurance plans, enroll in coverage for the first time, or apply for subsidies to help pay for health insurance for the coming year.

As if this wasn’t (perhaps) confusing enough, which OE applies to you depends on what kind of health coverage you qualify to receive. Generally speaking, there are three types of open enrollment: 

  • Employer Coverage – Set by your employer, based on whether you qualify for employer-sponsored health insurance and other benefits. 
  • ACA/individual Coverage – The annual period to see if you qualify for subsidies to help pay for your health insurance and/or get insurance for the coming year if you don’t qualify for the other two kinds of coverage listed here, or military (Tricare) coverage.
  • Medicare Advantage/Supplement Coverage – Additional coverage for those who qualify — basically anyone 65 years and older, or those with permanent disabilities.

Read on for the enrollment dates.

Note: some states have extended the Open Enrollment period until January to give people more time to sign up.

Employer-Sponsored Coverage

When it comes to employer-sponsored coverage, open enrollment is clutch! Why? Well, this is generally the only period of time during which employees can add, drop or change their health insurance as well as other employer-sponsored benefits like dental, vision and supplemental life insurance.. It’s also typically the main (or perhaps only) time that you can set a pre-tax contribution to your health savings account directly from your paycheck. So if a change might be in your future, and your employer is your coverage sponsor, be sure to do your due diligence so you can make the right decision during this time.

As a general rule of thumb, it’s best to check with your employer directly as to when their open enrollment period is. It’s almost always going to be a 1-3 week duration between October and December. Some employers move their OE to the middle of the year, with an enrollment period some time in May or June for a July 1 effective date. So, always best to check with your manager or HR department!

ACA/Individual Market Coverage

Open enrollment period has existed for a long time, sure. But it’s been a largely standard feature of employer-sponsored health insurance only. In 2013, open enrollment became much more important in the individual market (e.g. people buying insurance directly and not through their employer), with the launch of HealthCare.gov and state-specific health insurance Marketplaces created to sell subsidized Affordable Care Act (ACA) coverage..

This year, individual market open enrollment for 2020 begins on November 1, 2019, and ends December 15, 2019. December 15 is the last day to enroll in or change plans for coverage that begins January 1, 2020.

Be advised that in all circumstances, open enrollment period is “generally the only time that people can sign up for a plan, or switch to a different plan.” This may not be the case in very few circumstances, one of which being if a qualifying event triggers the need for a special enrollment period.

If you want to learn more about whether you qualify for individual coverage, check out HealthSherpa or Stride, both of which specialize in selling ACA-compliant health plans.

Medicare Advantage/Supplement 

Every U.S. citizen who is aged 65 or older, or is under 65 but has a qualifying permanent disability, gets Medicare coverage. Medicare Advantage and Medicare Supplement coverage give you some of the benefits of a private health insurance plan in addition to Medicare coverage. During the annual Medicare Advantage/Supplement OE, you can make changes to this extra coverage. Options include switching from Original Medicare to Medicare Advantage, from Medicare Advantage to Original Medicare, or from one Medicare Supplement plan, like Part D (prescription drug), to another. 

Additionally, according to medicareresources.org, “if you didn’t enroll in a Medicare Part D plan when you were first eligible, you can do so during the general open enrollment, although a late enrollment penalty may apply”.

For 2020 Medicare Advantage and Supplement coverage, open enrollment will run from October 15, 2019, to December 7, 2019.

The decisions you make during open enrollment can have a significant financial impact on you for the following year, so be sure to read up, think of your options, and select carefully!

 

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