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What Is Open Enrollment?

Open enrollment health insurance is a period of time every year when you can sign up for health insurance or change your plan (if an employer provides your plan, open enrollment is also a chance to disenroll if you no longer need the health care insurance plan). If you don’t sign up for health insurance during the open enrollment, you perhaps can’t sign up for health insurance until the next open enrollment period unless you experience a qualifying event.

If you’re qualified and apply for health insurance during the open enrollment, the health plan must insure you. The company is not permitted to use medical underwriting or need evidence of insurability, both of which could make it harder for you to get health insurance.

What Kinds of Health Insurance Use Open Enrollment Periods?

Open enrollment health insurance 2020 periods are common and in place for:

• Medicare
• Job-based health insurance
• Individual market health insurance, due to the Affordable Care Act (enrollment windows apply both in the health insurance exchanges and outside the exchanges)

Special Enrollment Is the Exemption to Open Enrollment

Health insurance plans that use an open enrollment system also have an exception that lets you enroll outside of open enrollment under extenuating situations, frequently called life events. This exception enables you to sign up for health insurance outside of open enrollment if you experience different qualifying life events, including:

• involuntarily losing other health insurance coverage (as a result of losing or quitting a job, aging off a parent’s health plan, getting divorced, etc.)
• moving out of your old plan’s service area or to an area where different health plans are present.
• getting married
• having a new baby or adopting a kid

You won’t be fit for a special enrollment period if you lost your other health insurance because you didn’t pay the monthly premiums, though, or if you voluntarily canceled your prior coverage.

Though qualifying events and special enrollment periods in the individual open enrollment health insurance marketplace are similar to those that have long existed for employer-sponsored programs, they are not identical. Healthinsplans.org has a guide that pertains specifically to special enrollment periods in the individual market, on and off-exchange. Also, the Society for Human Resource Management has the best summary of qualifying situations that trigger special enrollment periods for employer-sponsored health insurance.

Types of Health Insurance Do Not Use Open Enrollment

Many health insurers in the United States use some kind of open enrollment program that limits sign-ups to a specific time each year. Here are some exclusions:

• Medicaid, the state-based health insurance, doesn’t restrict enrollments to an open enrollment period. If you are eligible for Medicaid, you can enroll at any time.
• CHIP, America government’s Children’s Health Insurance Program, doesn’t restrict enrollments to a particular time either.
• Travel insurance isn’t subject to open enrollment limitations. Because of the short-term nature of travel insurance policies, they’re not usually subject to open enrollment. Nevertheless, some travel insurance companies restrict your ability to purchase a travel insurance policy to the time immediately after you book your travel.
• Short-term health insurance doesn’t utilize open enrollment periods. Like travel insurance, short-term insurance isn’t regulated by the Affordable Care Act, and plans are available year-round in states that accept them (medical underwriting is used to determine eligibility for coverage, and short-term plans generally don’t offer any coverage for pre-existing medical conditions). There are 11 states where short-term health plans aren’t available, and many states impose restrictions on short-term plans that go beyond what the federal government requires.
• In some instances, supplemental insurance products. Supplemental insurance plans sold to persons are available year-round. But if your employer provides supplemental insurance, your chance to enroll will likely be limited to your employer’s overall open enrollment period. Medigap plans, which are designed to supplement Original Medicare, are available for buying year-round. But after an individual’s initial six-month enrollment window ends, Medigap insurers in nearly every state are permitted to use medical underwriting to determine an applicant’s eligibility for coverage.

Resources and References:

• Open Enrollment Health Insurance Period
• Medicaid Eligibility and Benefits
• Factors to Consider Before Buying Short-term Health Insurance