Open enrollment is the time period when you can enroll in health insurance. This enrollment period usually spans a specific period of time, and you must purchase health insurance coverage during that period, otherwise you will not be able to purchase coverage until the next open enrollment period; the only exception is if you experience a life event that would qualify you to purchase coverage at a different time, such as having a baby or getting married.
If you are eligible for health insurance and you apply for coverage during the open enrollment period, a health insurance provider is required to cover you; health insurance providers cannot force you to provide proof of your ability to be insured or make use of underwriting; two factors that often make it more difficult to get coverage.
Sources of Health Insurance that use Open Enrollment
Open enrollment is used for several sources of health insurance coverage, including:
- Employer-based health insurance
- Individual market coverage via the Affordable Care Act
When does Open Enrollment Take Place?
The open enrollment period varies and depends on the source you are using to acquire health insurance coverage:
- Employer-based coverage. If you are purchasing health insurance through your place of work, your employer will let you know when their open enrollment dates are. While the open enrollment period for employer-based insurance can take place any time, typically, it occurs in the fall and coverage for new policies purchased during that time period start on the first day of the new year; for example, if your employer’s enrollment period was in October of 2018, your coverage would have started on January 1, 2019.
- Medicare coverage. If you are applying for health insurance coverage through Medicare, the open enrollment period runs from October 15 through December 7 every year. If you applied for and were eligible for Medicare during this open enrollment period, your coverage would also begin on January 1 of the New Year.
- Individual marketplace coverage. Through the Affordable Care Act, you can purchase individual marketplace health insurance. The open enrollment period for this type of coverage varies; however, it usually falls between the beginning of November and the middle of December. For example, open enrollment for 2019 coverage was between November 1 and December 15 of 2018. However, the dates do vary from state-to-state, as some states do extend their enrollment periods; for example, in New York, there were three deadlines: policies that were purchased between November 1 and December 15, 2018 went into effect on January 1, 2019; policies that were purchased between December 15 and January 15, 2019 had an effective date of February 1, 2019, and policies that were purchased between January 15 and January 31 go into effect on March 1, 2019.
What Happens if You Miss the Open Enrollment Date?
As mentioned, if you miss the open enrollment date for the type of health insurance you are planning on purchasing, you will not be able to buy coverage until the next open enrollment period; however, there are exceptions. Special enrollment makes it possible to purchase coverage outside of the open enrollment period; but this is only applicable in certain situations, which are referred to as “qualifying life events”.
With special enrollment, you can sign up for coverage outside of the open enrollment period if you lost the coverage you were carrying for any of the following reasons:
- You got married or divorced
- Your spouse passed away and he/she was the policyholder
- You lost your job
- You were covered by your parent’s policy and you aged out
- You relocated
- You had a baby
- Your COBRA insurance policy expired
It’s important to note, however, that you do have to provide documentation that certifies your eligibility for these life events. Furthermore, if your coverage was dropped because you failed to pay the monthly premiums on your previous policy, you will not be eligible for special enrollment; the same is true if you elected to cancel your previous coverage.
Are there any Health Insurance Sources that Don’t Use an Open Enrollment Period?
The majority of sources for health insurance in the US do utilize an open enrollment period; however, there are a few exceptions. These exceptions include:
- CHIP (Children’s Health Insurance provided by the United States government)
- Short-term coverage
- Travel health insurance
These sources of health insurance do not have an open enrollment period; if you qualify, you can enroll any time of the year.
Summing It Up
Though there are some exceptions, if you want to purchase health insurance, it is likely that you will have to sign up during a specific enrollment period. To find out more information about open enrollment, speak with a reputable health insurance agent.