When you can enroll in health insurance

Insights:

People can sign up for most health insurance plans during initial enrollment, open enrollment or a special enrollment period if they qualify.

People can sign up for health insurance during the open enrollment period or when they first become eligible for coverage, such as starting a new job. You can also sign up and make changes to your health coverage if you have a qualifying event, such as losing other coverage, a spouse’s death, getting married or having a child.

Here’s what you need to know about when you can enroll in health insurance.

What is an open enrollment period?

Open enrollment when you can make changes to your health insurance plan. You can also sign up for a new plan during open enrollment.

You’re able to enroll in a plan through:

• Your employer
• An individual health plan through your state’s or the federal government-run insurance marketplace or directly through an insurance company
• Medicare

During the annual open enrollment period, you can change your current plan or obtain new coverage. It’s important to make these choices carefully, says Gretchen Jacobson, vice president, Medicare, for The Commonwealth Fund.

“The best plan for your friend may not be the best plan for you,” she says. “Each plan has different benefits, different drug coverage and different health care providers in their networks.”

Selecting the right health insurance plan can be challenging. Each year, millions of Americans have the opportunity to choose a new plan, or to tweak their existing coverage. But with so many options available, how can you know if you are making the right choice?

“Get educated,” says Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute. “There are potentially options out there for you.”

Fronstin adds that such alternatives may or may not be better than the plan you already have. “But that is something you have to figure out,” he says.

When is open enrollment 2021?

Open enrollment varies by how you get health insurance coverage.

Employers create their own open enrollment window. These are periods either once or twice per year. It’s up to you to make necessary changes within that time frame.

Individual health insurance purchased through a state insurance marketplace or directly from an insurance company also has a set open enrollment. This year, you can enroll in a marketplace plan through Aug. 15. The window has been extended due to the coronavirus pandemic.

Some states that run their own exchanges have extended the coverage deadline beyond Aug. 15. For example, in New York and New Jersey, you can now purchase coverage through the end of 2021.

In most years, though, the window for buying coverage is smaller — between Nov. 1 and Dec. 15 in many states. Some states that have longer open enrollment periods, including California, Colorado and the District of Columbia. Other states also tend to extend the window for getting coverage, so check with your state to make sure of the dates where you live.

For 2022 coverage and beyond, the Centers for Medicare & Medicaid Services has proposed extending the enrollment period for marketplace plans by an additional 30 days.

Meanwhile, Medicare’s open enrollment is Oct. 15 to Dec. 7 when you can make changes to your Medicare coverage. There’s a second, limited Medicare Advantage open enrollment period from Jan. 1 to March 31 in which you can only swap Medicare Advantage plans or switch from a Medicare Advantage plan to Original Medicare.

How do I prepare for open enrollment?

Choosing a health insurance package can be daunting, especially because you don’t know in advance what your expenses will be over the following year.

“You can’t always predict what the best plan’s going to be,” Fronstin says. “The whole point of insurance is to be there for unexpected expenses.”

Take time to understand what you are purchasing, whether during the standard enrollment window or a special enrollment period.

If you have questions about finding the right plan for your needs, you may benefit from finding a reputable, licensed insurance broker or working with one of your state marketplace’s navigators, whose job it is to point people toward workable plans.

However, in the end, remember that it’s often hard to know in advance whether you’re making the right choice. Fronstin offers the example of a young person who is healthy and rarely visits the doctor. Such an individual may try to save money by choosing a cheap plan with a high deductible.

“But that doesn’t mean in hindsight after a year that will have been the best option for you, because maybe you broke your arm riding your bike,” he says.

In the end, even a decision that’s correct at the time you made it might be something you regret later. “That’s the nature of insurance — you’re placing a bet,” Fronstin says. “Sometimes you win and sometimes you lose.”

What is special enrollment?

If you don’t sign up for health insurance during the allocated time, you must wait until the next open enrollment period unless you have a qualifying event that makes you eligible for a special enrollment period (SEP).

If you have a qualifying event, you can purchase health insurance or change your existing coverage without waiting until the next open enrollment. If you don’t have a qualifying event, you’re required to maintain your insurance as is until the following enrollment period.

What is a qualifying event for health insurance?

There are two types of triggers for SEPs:

• Loss of eligibility for health coverage
• Certain life events

Life events that create a special enrollment period include:

• Marriage
• Birth or adoption
• Death of a spouse or dependent
• Job loss
• Job change
• Retirement
• Reduction in work hours
• Relocation

Your state may offer additional rules for life events that create an SEP. For example, in New York, women who become pregnant may add or change coverage.

Most qualifying events trigger a special enrollment period whether you have a marketplace plan, individual plan or workplace plan. However, that’s not always the case. According to the Kaiser Family Foundation, some events only qualify you for a special enrollment period in the marketplace and don’t apply to the outside market. The exceptions are situations related to citizenship, native status and exceptional circumstances.

Also, the changes you make to your health plan due to a qualifying life event should be consistent with the event. For example, if you get married, you can drop your health insurance, but only if you’re enrolling in your spouse’s health plan.

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*Insure.com works to keep an updated and comprehensive list; however, the special enrollment chart may not apply to every benefit plan (especially dental and group life insurance that may be included in your workplace plan) and individual circumstances should be verified with your health insurance administrator.

How to change Medicare plans

Enrollment for Medicare comes with its own set of rules.

Medicare eligibility typically begins at age 65, unless you have been receiving disability and Social Security payments. The initial enrollment period (IEP) is seven months. It begins three months before the enrollee’s birth month, goes through the month of your 65th birthday, then continues for three months. Enrollment may be completed anytime within that window.

Each year, Medicare open enrollment period runs from Oct. 15 to Dec. 7. At that time, you can make changes to your Medicare plan, including Original Medicare, Medicare Advantage, Medicare Part D and Medigap coverage.

If you’re enrolled in Medicare, know that if your plan increases premiums or reduces its benefits, other plans might be better choices for you, Jacobson says.

Use the open enrollment period to explore your options. “It always pays to shop around and see if something else might be better,” Jacobson says. “The grass truly could be greener in another plan.”

If you want to make changes outside of the open enrollment period, certain living or coverage changes are considered qualifying events and will create a special enrollment period. You can find the full list on Medicare.gov.

If you didn’t sign up for Medicare Part A (hospitals) or Part B (outpatient care) when you were first eligible but enroll later, you will be hit with a late enrollment penalty. Part A doesn’t have premiums for nearly all Americans. So, sign up for Part A whether you plan to have another insurance plan or not if you’re eligible.

For Part B, if you failed to sign up when first eligible, you’ll have to pay a late penalty for as long as you have Part B. A late enrollment penalty up to 10% for each 12-month period that you could have had Part B but didn’t sign up for it.

The other Medicare option to Parts A and B is Medicare Advantage. Private insurers offer these plans. Medicare Advantage plans often have supplemental benefits, such as dental and prescription drug coverage, not found in Original Medicare (Parts A and B).

Also, don’t forget Medicare Part D, which is the program’s prescription drug coverage for people with Original Medicare. Shop around for this coverage because an individual plan’s prices and formularies change each year, Jacobson says.

“Just because their drug plan was the cheapest for them this year, doesn’t mean it will be the best for them next year, even if their drugs haven’t changed,” she says.

Beneficiaries should also check if their drugs may be less expensive if they got them at a different pharmacy or through the mail.

How to change ACA marketplace plans

Changing marketplace plans isn’t difficult. You can do so during open enrollment or if you qualify for a special enrollment period due to a life event.

If you live in a state that uses the federal marketplace, go to the federal marketplace website and either create an account or log in to your existing account. From that point, follow the prompts, which will differ depending on whether you’re changing coverage during open enrollment or making changes due to a life change.

You can also make changes by phone by calling 1-800-318-2596 (TTY: 1-855-889-4325).

If you’re enrolled in a plan through a state marketplace, go to your state’s website and follow the prompts there. If you’re not sure whether your state has its own marketplace, you can start with the federal website and it will direct you to your state marketplace if applicable.

How to change employer health insurance plans

To make changes with an employer-based plan, you typically will have to wait for open enrollment. This time period varies by employer, so ask your human resources department for more details.

Typically, employers who start new coverage options on Jan. 1 of each year will host open enrollment during the previous fall. Open enrollment typically lasts for two to four weeks, but it’s important to clarify these details with your employer.

You may also qualify for a special enrollment period if you face a qualifying life event like losing other coverage, having a baby or getting married. Check with your employer’s benefits department to determine specifics about your company’s open enrollment and special enrollment periods.

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