Open enrollment is in effect due to the Affordable Care Act, also known as Obamacare, and takes place every year to provide consumers with the chance to find a health insurance plan that fits their medical needs. There are different enrollment periods for health insurance plans available through an employer, Medicare, Medicaid, Medigap, and CHIP. Learn when you should expect to enroll depending on the type of policy you qualify for and find out other situations where you may qualify to apply outside of this period.
Why Is There an Open Enrollment Period?
An open enrollment period is designed to protect consumers and maintain reasonable prices across the market. Limiting insurance enrollment to a single period during the year prevents people from rushing to buy health insurance once they become sick or injured. As a result, an annual enrollment period helps ensure that people who are paying into insurance are the ones who receive the benefits, keeping prices low.
When Is the Affordable Care Act Open Enrollment Period?
Obamacare refers to subsidized health insurance plans available on the Health Insurance Marketplace, which is designed to increase the availability and affordability of coverage for all Americans. The official Health Insurance Marketplace is found on HealthCare.gov, where people in most states should enroll for healthcare or get cost assistance if they qualify. However, states have been given the option to run a state-run exchange, federal-run exchange, or partnership exchange, so where you apply for medical insurance can vary depending on where you reside.
For the majority of states, the window for ACA Open Enrollment is scheduled from November 1 to January 15. This is decided each year, and the federal government can all issue a nationwide extension when using the federal marketplace. Several state legislators have passed permanent extended open enrollment periods in their states, including California, Colorado, and Washington, D.C.
Medical Insurance Open Enrollment Dates By State
When Is Open Enrollment for Private Insurance?
There are still many private insurance policies that are not available through the Marketplace, and you can often find a wider range of options and higher coverage options by shopping on the provider’s site directly. While these plans may be as affordable as or cheaper than policies available under the ACA, you will not qualify for tax credits or income-based assistance. Private insurance providers follow the same schedule as HealthCare.gov open enrollment. There are very few private health plans that are available outside this time period. While many of these policies may not be considered qualifying health coverage, insurance companies can inform you if your plan meets minimum essential coverage criteria.
If you’ve missed open enrollment and you need access to cheap health insurance options there are still plans available:
What Is a Special Enrollment Period?
If you are unable to sign up for an insurance policy through the Marketplace or a private insurance company by the 2023 open enrollment period, you must meet the criteria for the special enrollment period. Meeting these criteria allows you to sign up or make changes to your policy later in the year. The criteria for qualifying for a special enrollment period include the following.
Household Change
If there is a change in your household size due to a major life change, you have 60 days following the event to make a change to your policy. It is likely you will need to provide proof with documentation before 2023 coverage can be provided. These events can qualify:
- Getting married
- Having a baby, which includes birth, adoption, and foster care
- Gained or became a dependent
- Loss of coverage due to divorce or legal separation
- Death of a dependent under your plan
Residence Change
Most of the time, moving to a new home qualifies you for a special health insurance enrollment period. This can include moving to a new zip code or county, arriving from a foreign country, living somewhere or coming back home from working or going to school in a different location or transitioning to or from transitional housing. However, you will not qualify if you moved for medical treatment or you did not have coverage for at least one day during the 60 days prior to moving.
Coverage Loss
If you or a person in your household has lost health insurance in the last 60 days or expects to lose coverage during some point in the next 60 days, the Special Enrollment Period allows you to enroll in a new plan. These are reasons you may lose coverage:
- Becoming ineligible for federal plans such as Medicaid, Medicare, or CHIP
- Losing coverage through a family member
- Dropping individual plan due to discontinuation or other cause
- Experiencing a loss in employer-provided health coverage
Eligibility Change
There are several other life events that can allow you to apply for a plan outside of the normal open enrollment window if you were not eligible before. Examples include becoming an American citizen or gaining membership to a federally recognized tribe, being released from incarceration, or ending service as a VISTA, NCCC, or America Corps member.
New HRA or QSHERA Coverage
If a person’s employer offers coverage for by an HRA, Qualified Small Employer Health Arrangement, or similar plan, you can make a change. However, you will need to enroll via telephone instead of using the HealthCare.gov website.
When Is Medicare Open Enrollment
Medicare is a type of federal health insurance that is available for seniors who are 65 or older, some individuals with disabilities, and people diagnosed with end-stage renal disease. Medicare is split into four parts that include different 2023 coverage options:
- Medicare Part A: Hospital coverage for hospice, hospital stays, skilled nursing, and sometimes home care
- Medicare Part B: Medical coverage for doctor visits, preventative treatment, and other types of outpatient care
- Medicare Part D: Prescription drug coverage
- Medicare Advantage (Part C): Bundled Medicare provided by a private insurer that is an alternative to traditional Medicare coverage
People have many options when choosing this type of health plan, so it is important to know all Medicare open enrollment 2023 dates.
Initial Enrollment Period
While some people are automatically enrolled in Medicare, others have the option to enroll when they become eligible. If receiving either disability or retirement benefits from Social Security or the Railroad Retirement Board, then the individual is automatically enrolled in both Medicare Part A and Part B. A person can choose to opt out of Part B if they want to remain covered by another insurance policy; however, the premium is higher if enrolling in Plan B later on unless singing up during a Special Medical Insurance Enrollment Period.
Otherwise, there is a seven-month period for signing up for Medicare that starts three months before a person turns 65 and ends three months after the month of his or her birthday. It is important to note that waiting to enroll until your 65th birthday will delay coverage. If a person misses signing up during this time period and is not eligible for a special enrollment period, there are annual open enrollment dates from January 1st to March 31st with an effective date of July 1st.
Special Enrollment Period for Medicare
There are some situations that make a person eligible for a special enrollment period for Medicare, excluding people who have ESRD. If you meet these criteria, there is no penalty for enrolling in Part B. You can apply at any time if you or your spouse is still working and you are covered by an employer-provided health plan. You also have eight months to enroll without a higher premium after stopping employment or losing coverage. If you miss this eight-month time window, you will need to wait for the next open enrollment period and can expect a late penalty.
Medicare Advantage and Part D Enrollment
Unlike Obamacare open enrollment, it is not necessary to enroll in Medicare every year to maintain coverage. However, there are separate periods for Medical Advantage and Medicare Part D open enrollment. This time is reserved for making changes or starting a plan after the Initial Enrollment Period has passed, and the open enrollment dates are different than those for Part A and B.
During this special period, there are several ways you can make changes to your plan.
- Switch to Medicare Advantage from Original Medicare or vice versa
- Join a Part D plan in addition to Original Medicare
- Choose a Medicare Advantage plan that includes prescription drug coverage
- Transition to a Medicare Advantage Plan that does not include drugs
- Remove Part D completely
If you already have a Medicare Advantage plan, you can switch to another Medicare Advantage Plan or return to Original Medicare between January 1 and March 3, 2023.
Medigap Enrollment
A type of supplemental policy to Medicare sold by private providers, Medigap is designed to provide additional coverage for costs that Original Medicare often does not cover. This includes costs remaining because of copayments or deductibles. However, it does not cover many common costs seniors are often faced with, such as private nursing, glasses, housing at a long-term facility, and hearing aids.
Medigap is only available for people with both Part A and Part B Medicare. Medicare D can be purchased in addition to Medigap to cover prescription drugs, but it is illegal for someone to have this supplemental coverage in addition to an Advantage Plan. Patients have several choices when choosing Medigap plans, which are labeled using a letter system. As of 2020, people who became eligible for Medicare by January 1, 2020, are no longer eligible for Supplement Plan F or Plan C.
There is a one-time open enrollment period for people applying for Medigap, which starts the first day of the month a person turns 65 and extends for six months after this. As long as a person is at least 65 years old and enrolled in Medicare Part B, policy providers cannot refuse to provide insurance. While people who are eligible can apply for Medigap at any time, it is possible they will be denied by providers or charged extra for applying outside the Medigap Open Enrollment Period. Federal law requires that Medigap is sold at the lowest price during the MOEP, and some states have additional regulations in place that require medical-coverage for people under the age of 65 who request it, but possibly at an extra cost.
Which Insurance Plans Do Not Require Open Enrollment?
Medicaid is a free or very low-cost health plan for low-income families, which is determined based on Modified Adjusted Gross Income. CHIP is a program in place for families with uninsured children who make too much income to qualify for Medicaid but are unable to afford a private care provider. People can enroll in Medicaid or CHIP by contacting the Medicaid agency or applicable CHIP program in the state where they reside, or an application can be submitted through the Marketplace.
While health plans provided by an employer are not tied to the same open enrollment-period as Marketplace and private plans, there is still a period to make a selection. Most often, this takes place at some point during the fall, but the timing can vary each year. It is up to the employer to ensure employees are aware when this period is and who is eligible for healthcare enrollment. Often, this route allows a very small selection in policy options or there is only a single healthcare option.
If you’ve missed the 2023 open enrollment period and you’re still in need of health coverage, short-term health insurance is a viable option to help you find the coverage that you need until you’re able to apply for a policy through the ACA or another channel. You can sign up for short-term health insurance at any point during the year depending on the state you live in.
Prepare for Open Enrollment
Whether you are shopping for a marketplace plan during open enrollment or plan to explore temporary plans outside of the enrollment period, it is crucial that you take the time and effort to compare plans and find one that works for you. Fortunately, FirstQuote Health can help. No matter when you are searching for health insurance, we can provide you with personalized quotes based on the information you provide. Start comparing plans so you can find one that best fits your needs.