The period of time each year when you can sign up for health insurance is referred to as open enrollment. If you don’t sign up for health insurance during this open enrollment period, you probably cannot sign up for coverage until the next open enrollment period comes around, unless you undergo a qualifying experience. If you are eligible for health insurance and apply for it during the open enrollment period, you will certainly receive coverage. The company will not use underwriting or need any evidence of insurability, both of which make it difficult to get health insurance.
Which health insurance sources use open enrollment periods?
Open enrollment for health insurance is used by several health insurance providers, including:
- Job-based health insurance
- Individual market health insurance, because of the Affordable Care Act (ACA)
What is open enrollment?
The time of year when the open enrollment period begins will depend on the healthcare plan you opt for. Let’s take a look at some common ones:
- The open enrollment period for Medicare runs from October 15th to December 7th every year. This doesn’t apply to Medigap plans and they are only available without medical underwriting in your initial enrollment period or during the special enrollment periods that are applicable to those plans.
- The open enrollment for health insurance in job-based insurance will vary for every employer and they can be opened during any time of the year. However, for most employers, it usually happens in the autumn so the new coverage applies from January 1st.
- In the open individual market, the open enrollment for health insurance has varied quite a lot in the last few years. Beginning with 2018 coverage, the open enrollment period was decided at November 1st to December 15th and all plans are put into effect from January 1st. This time frame is to be used for the next few years. The open enrollment period for 2018 was the first time that enrollment had ended before the beginning of the year and plan selections cannot be made after the beginning of the year.
Before 2014, it was possible to enroll for health insurance in the individual market throughout the year. However, in most of the states, the eligibility of the applicants was decided by insurance companies based on the medical history of the applicant, which meant that those with pre-existing medical conditions could be denied coverage. This is no longer applicable, after the ACA.
What is special enrollment?
There are exceptions where you can apply for health insurance outside of the enrollment period; it is called special enrollment. It is provided under extenuating circumstances, which are referred to as life events. Some of these life events that allow you to apply for health insurance include:
- Losing a job
- Getting divorced or married
- Becoming a widower or widow
- Having a baby
- Expiry of COBRA insurance
- Aging off of a parent’s plan
If you lose your health insurance because you didn’t pay your monthly premiums on time, the special enrollment period will not apply to you.