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

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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.

Key Takeaways

  • Open enrollment is a time to sign up for health insurance or make changes to your coverage.ACA marketplace, employer and Medicare plans have their own open enrollment periods.
  • You can also sign up for coverage during your initial enrollment period, such as after becoming eligible for coverage with a new job.
  • To qualify for a special enrollment period, you must have a qualifying event, such as having a child, getting married or losing your health coverage.
  • Some types of coverage, such as Medicaid, don’t have open enrollment periods, so you can sign up any time if you’re eligible.

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.

QUALIFYING LIFE EVENT

OPTIONS

 

CHANGE IN FAMILY SIZE

 

Marriage

  • You may enroll in new coverage for you and/or your spouse.
  • You may change your coverage to add new dependents.
  • You may cancel coverage if you become covered by your spouse’s plan.

Dissolution of marriage

(includes divorce, annulment and legal separation)

  • You may enroll in new coverage if you lost your coverage in the separation.
  • You may change coverage if your dependents lost coverage in the separation.
  • You must remove your former spouse from your policy.
  • You may not remove dependents from your policy unless they become covered by your former spouse’s policy.

Death of spouse

  • You may remove your spouse from your coverage.
  • You may enroll in new coverage if the death caused you to lose your coverage.
  • You may change your coverage to include dependents who lost coverage due to the death.

Birth

Adoption

Placement for adoption

  • You may enroll yourself, your spouse and your dependents.
  • You may change your plan to reflect the new size of your family.
  • You may cancel coverage if you become covered by your spouse’s plan.
  • Newborn added during SEP has coverage from day of birth applied retroactively.

Pregnancy

(New York only)

  • You may enroll in coverage as of the first month of pregnancy.

Dependent moves to own policy

  • You may remove a dependent from your policy.

Dependent becomes ineligible at age 26

  • You may remove a dependent from your policy.

Dependent’s death

  • You may cancel enrollment for the deceased dependent.

 

CHANGE IN EMPLOYMENT STATUS

 

Job change within the same organization

(includes promotion, demotion and transfer)

  • You may change coverage if your current plan is no longer available to you in your new position.

 

Loss of employment

  • You may continue your employee coverage through COBRA at your own expense for 18 months.
  • You may enroll in your spouse’s health plan, if available.

Loss of full-time status

(30-39 hours per week)

  • No change is permitted.

Loss of full-time status 

(20-29 hours per week)

  • You may cancel coverage for yourself and family members.
  • You may change your coverage.

Loss of full-time status

(0-19 hours per week)

  • If your employer doesn't provide insurance for part-time employees at this level, your coverage will lapse at the end of the month.
  • You may continue your employee coverage through COBRA at your own expense for 18 months.

Newly benefit-eligible

  • You may obtain new coverage for yourself and for your family members.

Part-time to full-time

  • You may obtain new coverage for yourself and for your family members.

 

Spouse loses employment

  • You may enroll yourself and eligible family members in a plan if the job loss caused you and your dependents to lose insurance.
  • You may change your plan if you’re adding dependents that lost coverage.

Spouse becomes employed

  • You may cancel your coverage if you or your dependents become covered under the spouse’s new plan.

 

Spouse’s employment status changes

  • You may enroll in a plan if the change caused you or your dependents to lose insurance.
  • You may add dependents to your plan if the change caused dependents to lose insurance.
  • You may change or cancel your plan if the change causes the spouse’s insurance to be a better option for you or your dependents.

 

Retirement

(with no retiree health benefits from former employer)

  • You may enroll in Medicare, if eligible.
  • You may continue your employee coverage through COBRA at your own expense for 18 months.
  • You may enroll in a Medicaid plan if you meet the income requirements. 
  • You may enroll in a marketplace or individual health insurance plan.

Spouse loses traditional or retiree coverage

  • You may add your spouse to your coverage.
  • You may change your health plan.

Begin unpaid leave

(30+ days)

  • You may change your coverage.
  • You may cancel your coverage.

Return from unpaid leave

(30+ days)

  • You may change your coverage.

 

Return from military leave

  • You may enroll yourself, spouse and dependents to your coverage.
  • You may change your health plan.

 

CHANGE IN RESIDENCE

 

 

 

Change of residence

  • You may cancel coverage if you, your spouse or a dependent has become ineligible for your insurance due to a move.
  • You may change coverage if you, your spouse or a dependent has become eligible for your insurance due to a move.
  • You may add or change coverage if you or a dependent have become ineligible for your spouse’s insurance due to a move.

 

MEDICARE or MEDICAID ELIGIBILITY

 

Become eligible

for  Medicare or Medicaid

  • You may cancel private coverage for the person who has enrolled in Medicare.

Lose eligibility

for Medicare or Medicaid

  • You may add coverage for the affected family member.

 

OTHER

 

Court order

  • You may add, change or suspend coverage if a court order or other official decree requires it.

Significant

coverage changes

  • You may change plans if services are drastically curtailed; for instance, if a large health network opts to stop accepting your insurance.

Changes in your income that affect the coverage for which you qualify (Marketplace plan)

  • You may make changes to current coverage plan.

Become a U.S. citizen (Marketplace plan)

  • You may enroll in coverage.

Leaving incarceration -

prison or jail

(Marketplace plan or with private insurer)

  • You may enroll in coverage.

Survivor of domestic abuse/violence or spousal abandonment

(Marketplace plan)

  • Enroll yourself and your dependents in your own health plan separate from your abuser or abandoner. (If you are married to abuser/abandoner, you can list “unmarried” without penalty for mis-stating your marital status.)

Had a serious medical condition or natural disaster that kept you from enrolling

(Marketplace plan)

  • Can enroll you and dependents in health plan if unexpected hospitalization, temporary cognitive disability or natural disaster (e.g. earthquake) kept you from enrolling.

 

WHO DOESN’T NEED A QUALIFYING EVENT?

 

Medicaid enrollment

 

  • No limited enrollment period. If you qualify, you can apply at any time and coverage will begin immediately.

CHIP (Children’s Health Insurance Program) enrollment

 

  • No limited enrollment period. If you qualify, you can apply at any time and coverage will begin immediately.

American Indians & Alaska Natives

(Marketplace plans)

  • Under the Indian Health Care Improvement Act, American Indians can enroll anytime during the year.

*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.

Frequently Asked Questions

What types of health insurance use open enrollment periods?

Most types of health insurance use open enrollment periods. These include:

  • Employer-based plans
  • Individual health plan coverage that you get through a state or federal marketplace or directly through an insurer
  • Medicare

What types of health insurance don’t use open enrollment?

A handful of health insurance types don’t use open enrollment. They include:

  • Medicaid
  • Children’s Health Insurance Program (CHIP) plans
  • Short-term health insurance

Instead, you can sign up for that coverage, if you’re eligible, any time of the year.

Can I change my plan during special enrollment?

Yes, you can change your plan if you qualify for a special enrollment period. However, your choices may be a bit more limited than during open enrollment. Most people who qualify for an SEP in the ACA marketplace are limited in the number of health plan "metal" categories.

If you want the opportunity to select from all four metal categories, you will need to wait until the next open enrollment period.

What happens if you don’t enroll during open enrollment?

If you don’t enroll during open enrollment, you might end up covered anyway. For example, Fronstin says that if you already have health insurance through an employer but don’t choose coverage the next time open enrollment comes around, typically “you’re automatically re-enrolled in the same plan if you don’t do anything.”

You may also qualify to purchase coverage if you take on a new job that offers health care benefits. Another way to get insurance outside of the open enrollment period is to qualify for a special enrollment period or to qualify for a program such as Medicaid.

However, in other situations, you may not be able to find health insurance coverage until the next open enrollment period.

When is Medicare open enrollment 2021?

Medicare's open enrollment is currently scheduled for between Oct. 15 and Dec. 7. However, 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.

There is a second, limited Medicare Advantage open enrollment period from Jan. 1 to March 31 in which you can change Medicare Advantage plans or switch from a Medicare Advantage plan back to Original Medicare.

Why are some Medicare Advantage plans free?

Many Medicare Advantage plans don’t charge a premium. However, it’s a mistake to assume a Medicare Advantage plan is truly “free.”

For example, you may still be responsible for paying copays and deductibles associated with these plans. In addition, you will still have to pay the Medicare Part B premium.

Often, health plans with low or no premiums have much higher out-of-pocket costs than other health insurance options. So, make sure to compare both premiums and out-of-pocket costs when deciding on a health plan.

What qualifies for a special enrollment period?

If you experience a qualifying event, you may be eligible for a special enrollment period (SEP) that allows you to get health insurance coverage outside of the normal open enrollment period.

A sudden loss of eligibility for health coverage can trigger an SEP, as can life events, such as:

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

How do I get health insurance without a job?

If you’re unemployed, you have several options for health insurance coverage. If you just recently lost your job -- and also lost the health coverage associated with your employer -- you may qualify for COBRA coverage that can help you keep continuous health insurance coverage. COBRA coverage allows you to keep your former employer’s plan, but it’s much more expensive.

Losing your job for any reason also qualifies you for a special enrollment period through the health insurance marketplace. This allows you to enroll for coverage at any time of the year. You usually have 60 days after you lose your coverage to enroll in marketplace coverage.

Finally, you also might qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP). Your household size and income determine your eligibility. There’s no enrollment period for these types of coverage -- you can sign up at any time.

What can I do if I can’t afford health insurance?

If you can’t afford health insurance, you might qualify for free or low-cost programs, such as Medicaid. This program is available to those whose incomes are low enough that they qualify. However, others also might be eligible, including pregnant women, the elderly and people with disabilities.

If you don’t qualify for Medicaid, you may still be eligible to purchase marketplace coverage with subsidies that can dramatically reduce your costs.

You could also be added to your spouse’s health insurance or find some coverage through a short-term health insurance plan. Just be aware that short-term plans have coverage limitations.