If you’re at all familiar with health insurance, odds are you’ve heard of open enrollment, the Annual Enrollment Period (AEP), or the Open Enrollment Period (OEP) as it is also called. Many people understand this time to be the time of the year when they can review and change their health plan. While most Americans have health insurance through their employer, we’ll be focusing on open enrollment for individual/family health plans through the Health Insurance Marketplace, also known as Obamacare or the ACA.
As the name implies, open enrollment is the time of year when anyone can enroll or change their health plan for the coming new year. Aside from a few special circumstances, this is the only opportunity to change plans or get a new one entirely. Even if you’re not sure you want to change plans, open enrollment is a good time to reassess your coverage needs and cost concerns to determine if a plan change might be right for you.
When is Open Enrollment?
Generally speaking, the health insurance open enrollment period takes place from November 1st to December 15th each year. When you enroll in a plan during the OEP, the coverage will take effect on January 1st of the new year.
In recent years, the OEP deadlines have been extended through December 31st and January 15th, allowing consumers the option to enroll in February 1st coverage at the latest. These deadline extensions are at the discretion of the Marketplace and aren’t typically announced until later in the OEP. It’s important to select and enroll in a plan by the traditional December 15th deadline just to be safe because deadline extensions are not guaranteed.
What Plans Can I Enroll in During Open Enrollment?
When discussing open enrollment and individual/family health insurance, plans through the Health Insurance Marketplace are the main focus. During the OEP, you can review the Marketplace plans available in your area, see if you qualify for a subsidy, and enroll once you’ve made a decision.
Marketplace plans provide major medical coverage, as well as coverage for routine care such as preventative, prescription drugs, and doctor visits. Marketplace plans are the only type of individual/family health insurance that do NOT consider your current or pre-existing health conditions for eligibility. Rates for marketplace plans vary greatly depending on your age, location, number of dependents, household income (used to determine subsidy), and the plan you choose.
The Marketplace offers many different health plans from many different insurance carriers, many of which have subtle differences from one another. A licensed health insurance agent/broker can help you sort through which plans would be a good fit for you and help you with the application process.
What Happens if I miss Open Enrollment?
If you miss open enrollment, you will not be able to change your health plan for the coming year. If you were in need of a new plan and missed open enrollment, you would not be able to enroll in a Marketplace plan until next year’s open enrollment.
Because of the Marketplace’s strict deadlines, it’s extremely important that you don’t wait until the last minute to get a new plan or make a plan change if you want to. The best time to review plans is as soon as the OEP begins because you’ll have plenty of time, and it can be easier to get in contact with an agent/broker before it gets really busy later on.
Can I Get a Health Plan Outside of Open Enrollment?
The only situation where you can enroll in a plan through the Health Insurance Marketplace outside of open enrollment is if you qualify for a Special Enrollment Period (SEP). To qualify for a SEP, you have to meet one of a few specific scenarios. A few examples include losing qualified coverage, such as losing coverage from a previous employer or COBRA, having a baby, or moving to a new primary residence. When applying for a plan through the Marketplace during a SEP, you may be required to submit documentation to prove your SEP eligibility.
Certain non-marketplace plans can be enrolled in at any time of the year, such as short-term medical and supplemental coverage like defined benefit, accident, and critical illness coverage. However, depending on your situation, coverage needs, and cost concerns, these types of plans may not be a good fit, and you will have to qualify based on your health history.
Conclusion
Open enrollment is the most important time of the year when it comes to reviewing your options for health insurance. It can mean the difference between being stuck with a plan you don’t want or securing a plan that best fits your coverage needs and cost concerns.
At a time of year when a lot of other things are going on, such as the holidays, family get-togethers, and social events, open enrollment can be a hectic time. The last thing anybody wants is to stress over health insurance instead of enjoying the last few months of the year.
Our biggest tip is to get open enrollment out of the way early and do so by enlisting the help of a knowledgeable agent/broker who can make things easier. A great agent/broker can make the often confusing language of insurance easier to understand so you can make an informed decision about your health coverage.
This information is provided by HealthCare Advisors, a Cincinnati, Ohio-based individual health insurance broker dedicated to helping folks find the coverage thats right for them, for the right value. Our services are available for residents of OH, KY, IN, FL, GA, NC, MI, AZ, MO, SC, and TN. CLICK HERE to schedule a free, no-obligation phone consultation to learn more about your health insurance options.