If you want to make a change or update your health insurance, OEP is your chance. Here’s what to know about this annual window for enrolling in a plan.

1. What is the Open Enrollment Period?
2. When is the Open Enrollment Period?
3. Can you buy health insurance that’s not an Affordable Care Act plan?
4. What happens if you miss Open Enrollment?
5. What is a Special Enrollment Period (SEP)?
6. Why might you want to change your plan during Open Enrollment?
7. What’s the best way to choose a plan that works for you?

Affordable Care Act (ACA) plans are primarily for people who want comprehensive health insurance but don’t receive insurance through an employer and who don’t have Medicare. If that’s you, the Open Enrollment Period (OEP) may be your best opportunity to buy a new plan or make changes to your existing coverage.

Even if your current plan seems to be working, OEP is a good time to look it over. You want to be sure it lines up with your goals and predictions for the coming year.

Need health insurance? Explore your plan options now, or contact a licensed insurance agent at 1-844-211-7730.

What is the Open Enrollment Period?

“Open Enrollment is the period of time where people can enroll in a new health insurance plan, renew their current plan or make changes,” says Noor Ali, M.D. She’s a health insurance adviser at Dr. Noor Healthcare Advisor in Tampa, Florida.

Typically, the Open Enrollment Period for ACA plans runs from November 1 to January 15. If the 15th falls on a holiday, the closing date can be extended. If you miss OEP, you may not be able to make changes to your insurance plan until the following year.

What’s the point of this small window? OEP makes it easier for insurance companies to assess the health needs of their customers, so they can calculate anticipated costs, says Dr. Ali.

“This is so they can figure out how much to charge in premiums and the claims they can expect in that year,” she says. (Premiums are what you pay on a monthly basis for insurance; claims are a formal request you might make to an insurer for coverage or compensation for health services.)

In other words, limiting changes to a 10-week window helps the entire insurance market run more smoothly.

When is the Open Enrollment Period?

Here are the important dates you’ll want to mark on your calendar:

• November 1: The Open Enrollment Period starts. This is the first day to purchase a new plan, change your existing plan or reenroll in your current plan. (Some people rely on automatic reenrollment, but that that might not be a good idea.)
  
• December 15: You need to enroll in a health plan by this date for your coverage to start on January 1.
  
• January 1: For those who purchased a health plan on or before December 15, coverage will start on this day and your first monthly bill will be due as well.
  
• January 15: The Open Enrollment Period ends. This is the last day you can purchase health insurance for this calendar year, unless you qualify for an exception. (You’ll find more on exceptions below.)
  
• February 1: Insurance coverage kicks in for anyone who purchased a plan from December 16 through January 15. At this time, your first monthly insurance bill will be due.

If you live in a state with its own health insurance exchange, these deadlines may differ slightly. For example, in Massachusetts, Open Enrollment ends on January 23.

Can you buy health insurance that’s not an Affordable Care Act plan?

Yes. Some examples include employer-sponsored health plans, Medicare and certain private health insurance plans.

Have questions about where else you can purchase insurance? Browse insurance plans now or call a licensed insurance agent at 1-844-211-7730 to discuss your options.

Employer-sponsored health plans. If your employer provides health insurance, the OEP dates may not apply to you. You will be eligible to sign up when you are hired. Beyond that, you’ll have to check with your employer’s human resources (HR) department to find the relevant dates.

“Open Enrollment for employers is usually a month prior to the policy renewal date,” says Adria Goldman Gross. She’s the president of MedWise Insurance Advocacy in Monroe, New York. But the dates can vary considerably, she adds.

Reach out to your hiring manager or HR department for your plan’s details.

Medicare. Medicare is the federally sponsored insurance program for adults ages 65 and older (and some people with end-stage renal diseases and disabilities). You will become eligible to sign up 3 months before your 65th birthday.

This program also has its own enrollment periods, which vary depending on whether you have Original Medicare or Medicare Advantage. (If you have Medicare Parts A and B, that’s sometimes known as Original Medicare. Medicare Advantage, sometimes called Medicare Part C, is a type of plan you get through a private insurer that has to abide by the same rules as Medicare.)

• Original Medicare Annual Enrollment Period: October 15 to December 7
• Medicare Advantage Open Enrollment: January 1 through March 31

Private insurance plans. Some private insurance plans do not have an Open Enrollment Period. Examples could include short-term medical insurance or TriTerm Medical insurance, which are both underwritten by Golden Rule Insurance. You may be able to purchase these plans any time by going directly to an insurance company or working with an agent and broker. If you do pursue these types of plans, be aware that they are subject to medical underwriting and generally don’t provide coverage for preexisting conditions.

While this option is not as widely known, “there’s a big population who’s a great fit for getting a plan on the private market,” says Dr. Ali.

(And if you’re curious about Medicaid, there’s no Open Enrollment Period for that either. You can apply for this program any time of year.)

What happens if you miss Open Enrollment?

In most cases, if you miss OEP, you will not be able to enroll in a plan until the following year. But there is an exception if you qualify for a Special Enrollment Period (SEP). This means that you’ve had a qualifying life event that justifies buying insurance outside of the OEP. (More on that below.)

Alternatively, if you miss OEP, you might choose to purchase a health plan through a private insurer or opt for a short-term medical or TriTerm Medical plan. While they’re not a replacement for a traditional insurance plan, they may be available in some states to help bridge a gap in health care coverage.

Want to explore a short-term medical plan? Take a glance at the benefits and compare insurance plans, or contact a licensed insurance agent at 1-844-211-7730.

What is a Special Enrollment Period?

A Special Enrollment Period, or SEP, is for people who experience major life changes outside of the OEP. These changes can qualify you to apply for coverage any time of year.

These major life changes are called qualifying life events. “You usually have to report the qualifying life events within 60 days of the event,” Gross explains. “There are many reasons why someone would be newly eligible for health insurance.”

Qualifying life events include:

• Adding a new child to the family through birth, adoption or foster care
• Becoming a citizen of the United States
• Changes in residence — moving to a new county, ZIP code or state, or moving to the United States from another country
• Gaining new membership in a federally recognized tribe or shareholder status under the Alaska Native Claims Settlement Act
• Getting married
• Leaving incarceration
• Losing health insurance through leaving a job, divorce, legal separation or other reason

Why might you want to change your plan during Open Enrollment?

Ideally, you should review your health plan every year, says Dr. Ali. You’ll do this to consider whether it’s working for your needs or if there’s another option that might be a better fit.

“But not everybody has the time,” she says. “While it would be best practice to do it every year, at the very least, do it when you have a major life change.” Changes in income, family life and health status are all good reasons to consider whether trading an old plan for a new one is a good option.

What’s the best way to choose a plan that works for you?

There’s no one right way to pick a health insurance plan. The plan that works best for you and your family will depend on a number of factors, including lifestyle, budget and personal preferences.

When helping her clients find a plan, Dr. Ali considers geography (where you live), income (whether or not you qualify for a government subsidy), specific medical needs and more. (Subsidies are premium tax credits you get through the government based on your income.)

“If you’re not as literate in health insurance (like most of America), working with a health insurance adviser or consultant can help take out a lot of the guesswork,” she says.

If you are purchasing an Affordable Care Act plan, you should also consider which metal category is right for you. Metal categories are classified into bronze, silver, gold or platinum plans. Bronze plans have the lowest monthly premiums, but you’ll pay more for medical care. Platinum plans are the opposite: You pay the highest premiums but the lowest doctor bills.

Finally, you’ll want to buy a plan that provides the flexibility you need to continue whatever care you’re currently getting. Some plans only provide access to a limited network of health care providers, or they may require you to get a referral from your primary care doctor before seeing a specialist. You’ll want to know that beforehand.

“It’s always best to see what health insurance policy will cover your doctor, hospital and medication,” says Gross. “That’s the important stuff you need to figure out before signing any papers.”

Need a health plan for you or your family? Explore your insurance options now, or contact a licensed insurance agent at 1-844-211-7730.

This article contains information that is not compiled by UnitedHealthcare or any of its subsidiaries. UnitedHealthcare does not represent all the information provided are statements of fact.

Sources:

CMS.gov “Marketplace plan year 2024 Open Enrollment fact sheet.” October 25, 2023. Retrieved from https://www.cms.gov/newsroom/fact-sheets/marketplace-plan-year-2024-open-enrollment-fact-sheet

CMS.gov. “Medicare and the Health Insurance Marketplace.” October 2023. Retrieved from https://www.cms.gov/marketplace/outreach-and-education/medicare-and-the-health-insurance-marketplace.pdf

CMS.gov. “More than 4.5 million select affordable health coverage in ACA Marketplace coverage since start of Open Enrollment Period.” November 21, 2023. Retrieved from https://www.cms.gov/newsroom/press-releases/more-45-million-select-affordable-health-coverage-aca-marketplace-coverage-start-open-enrollment

Healthcare.gov. “3 things to know before you pick a health insurance plan.” Retrieved from https://www.healthcare.gov/choose-a-plan/comparing-plans/ Accessed January 8, 2024

Healthcare.gov. “The Children’s Health Insurance Program (CHIP).” Retrieved from https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/ Accessed January 8, 2024

Healthcare.gov. “Health coverage for retirees.” Retrieved from https://www.healthcare.gov/retirees/ Accessed January 8, 2024

Healthcare.gov. “Health coverage options if you’re unemployed.” Retrieved from https://www.healthcare.gov/unemployed/ Accessed January 8, 2024

Healthcare.gov. “The Marketplace in your state.” Retrieved from https://www.healthcare.gov/marketplace-in-your-state/ Accessed January 8, 2024

Healthcare.gov. “When can you get health insurance?” Retrieved from https://www.healthcare.gov/quick-guide/dates-and-deadlines/ Accessed January 8, 2024

Healthcare.gov. “Why health insurance is important.” Retrieved from https://www.healthcare.gov/why-coverage-is-important/protection-from-high-medical-costs/ Accessed January 8, 2024

Mass.gov. “Request an Open Enrollment waiver.” Retrieved from https://www.mass.gov/request-an-open-enrollment-waiver Accessed January 8, 2024

U.S. Department of Health and Human Services. “HealthCare.gov enrollment exceeds 15 million, surpassing previous years’ milestones.” December 20, 2023. Retrieved from https://www.hhs.gov/about/news/2023/12/20/healthcaregov-enrollment-exceeds-15-million-surpassing-previous-years-milestones.html

Compliance code:

50676-X-0524