When is open enrollment for health insurance? – Forbes Advisor

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Health insurance is essential, no matter your age or stage of life. While there are some exceptions, most health insurance plans require you to stay with them for a full year. If you want to change your coverage or enroll in a new plan, you can do so during the annual open enrollment period. Here’s everything you need to know about open enrollment for health insurance.

What is open enrollment?

“Open Enrollment is a select time each year when you can choose or change your health insurance plan option. However, timing varies depending on the plan you sign up for,” says Anand Shukla, senior vice president of individual markets at Aetna, a CVS Health company.

For example, the annual enrollment period for Medicare runs from October 15 to December 7 of each year. Meanwhile, the Affordable Care Act (ACA) marketplace/exchange open enrollment period begins on November 1.

“If you get health insurance from your employer, the company likely has an annual enrollment period during which you can sign up or change your coverage. Be sure to confirm these dates with them,” says Shukla.

How to maximize open enrollment periods

There are several ways to make the most of open enrollment. First of all, know when you are eligible. “Your open enrollment period depends on how and where you buy insurance,” says Koleen Cavanaugh, vice president of marketing for Independence Blue Cross in Philadelphia.

Then take the time to assess your health and lifestyle needs. To do so, Kyu Rhee, MD, senior vice president and chief medical officer at Aetna, recommends answering the following questions:

  • Do you have a primary care doctor or do you use a specialist doctor?
  • What medications do you take?
  • What diagnostic tests, such as blood tests or imaging, do you need?
  • Are you planning to undergo key preventive exams, such as vaccinations and cancer screenings?
  • Are you managing one or multiple chronic conditions?
  • Do you anticipate any surgery or procedure?

Once you find what you’re looking for, look for coverage. Dylan H. Roby, Associate Professor of Health, Society and Behavior at the University of California Irvine Public Health Program, recommends looking for a plan that meets your needs for the coming year, in terms of monthly premium prices and in terms of health needs.

“You can also talk to a trusted local broker or licensed insurance advisor to help you learn about the different plans available in your area. Many insurers also offer local seminars that provide information about the plans and allow questions to be asked,” says Shukla.

“When choosing a plan, keep in mind the 4 Ds: doctors, drugs, diagnoses and deductibles. Make sure your doctors are in network, your medications are covered, key diagnostic tests like blood work and imaging are affordable, and your deductible meets your financial needs,” says Dr. Rhee.

He adds that you should also consider vision, dental and hearing coverage. It’s ideal if your plan also covers telehealth visits and virtual care. “Your health plan is your ticket to getting and staying healthy,” he says.

Manage open enrollment for different types of health insurance

No matter what health insurance plan you have, Roby suggests considering more than just premiums when weighing the details of a given plan. “Deductibles, copays, coinsurance, out-of-pocket maximum and provider network are also very important things,” he says.

Here are some additional tips to maximize your open enrollment period based on your health plan.

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If you decide on an ACA Marketplace plan, for which open enrollment begins November 1, you should consider the Advance Premium Tax Credit (APTC). “Depending on your household income, you may qualify for the APTC which can significantly reduce the amount of premium you pay for insurance coverage,” says Shukla.

“It’s a good idea to check your options during each open enrollment period because the tax credits and subsidies available to you may change due to changes in health insurance policies and plans offered in your area,” adds Roby.

Nearly 90% of consumers in states that use HealthCare.gov for health insurance received the APTC in the 2021 open enrollment period. Among those who received the APTC, the average APTC amount covered 85% of their premium total during the 2020 and 2021 open enrollment period.

state health insurance

If you get your health insurance through Medicare, the initial open enrollment period spans seven months, according to Carrie Jardine, revenue cycle manager at Heading Health, a mental health clinic in Austin, Texas. It begins three months before your initial Medicare eligibility (usually when you turn 65), continues through your birthday month, and ends three months afterward.

However, the annual enrollment period for Medicare runs from October 15 to December 7 of each year. “During this time, you can choose to stay with the traditional Medicare plan or opt for a Medicare Advantage plan through a variety of commercial payers,” says Jardine.

employer sponsored insurance

“If you obtain health insurance through an employer, initial open enrollment is the period of time in which you are first eligible to enroll with your employer’s health insurance carrier and is generally determined at the discretion of the employer. individual,” says Jardine.

Your employer may have an annual open enrollment period where employees have the opportunity to choose a different plan, but this period is not required for all companies.

“Joining a lower-premium, high-deductible plan might make sense, especially if your employer is contributing money to a health savings account on your behalf,” says Roby.

Can I make changes outside of open enrollment?

After the open enrollment period ends, you can only make changes to your coverage options if you qualify for a special enrollment period due to a qualifying life event: birth, marriage, adoption or foster care, loss of coverage, change of residence, change in income, or becoming a US citizen. Depending on your situation, you may have 60 days before or 60 days after the event to enroll in a new plan.

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