Unlike shopping for a car or switching your gym membership, there’s only a limited period every year when you can sign up for new health insurance or change to a different plan. This window is called the Open Enrollment Period (OEP).
With some exceptions, if you don’t act during the annual OEP, you’ll have to wait until it rolls around again the following year to sign up for health insurance.
What Types of Insurance Have an Open Enrollment Period?
Most health insurance plans have an Open Enrollment Period. This includes many workplace-based plans, including those offered by employers with more than 50 employees, individual policies you buy on your own for yourself or your family, and Medicare.
Since the passage of the Affordable Care Act in 2010, millions of people have been able to buy an individual plan through the state or federal Health Insurance Marketplace (also called an “Exchange”) for what’s often called Obamacare health insurance.
Plans sold on the exchange must cover preexisting conditions and 10 “essential health benefits,”1 including preventive and wellness services, hospitalization and outpatient care, prescription drugs, and pregnancy, maternity and newborn care.
And only policies sold on the exchange offer Obamacare subsidies for those who qualify based on income. These are discounts on your monthly health insurance payments and are also known as “premium tax credits.” You could also be eligible for cost-sharing reductions, which lowers the amount you pay for deductibles, copayments and coinsurance and also reduces your out-of-pocket maximum.
Open Enrollment Periods also apply to individual or family plans you can buy directly from an insurance company outside the exchange.
What You Need to Know
The Open Enrollment Period is the time every year when you can sign up for health insurance, renew your current plan or change to a different plan.
Once the Open Enrollment Period is over, you’ll only be able to choose a new health insurance plan if you experience a major life change known as a “qualifying event.”
The Open Enrollment Period is the time to review whether you have the best plan for you or your family, both for cost and coverage. This especially applies the coverage offered by your current plan has changed or your healthcare needs or budget differ from a year ago.
When Is the 2021 Open Enrollment Period?
In general, open enrollment for individual plans, whether they’re purchased on or off the exchange, runs for the six-week period from November 1 to December 15. Some states have longer open-enrollment schedules.
- Change from Medicare Part A and Part B (also known as Original Medicare) to a Medicare Advantage (also called Medicare Part C) plan.
- Change from Medicare Advantage plan back to Original Medicare.
- Switch from one Medicare Advantage plan to another.
- Make changes to your existing Medicare drug plan, including adding or dropping drug coverage.
- Join a Medicare prescription drug plan, switch from one Medicare drug plan to another, or drop your drug coverage completely.
If you’re already in a Medicare Advantage plan, there’s an additional OEP that runs from January 1 to March 31. During these three months you can decide to switch to a different Medicare Advantage plan or to Original Medicare. You’ll also be able to join a Medicare prescription drug plan.
If you get your health insurance through your job, your employer sets the OEP. It often takes place in the fall, with new coverage starting at the beginning of the year. But your company may choose a different period. While there’s no requirement on how long the enrollment period has to last, it’s generally at least two to four weeks.
How Does the Open Enrollment Period Work?
If you get your insurance through your workplace: Your employer will usually let you know the Open Enrollment Period is coming soon.
If you buy your healthcare through the Health Insurance Marketplace (exchange): You’ll receive two notices by email or regular mail.3 One will be from your insurance company and the other from the exchange.
The letter from the exchange will tell you what to do to receive a tax credit as well as cost-sharing discounts for 2021, such as providing documents like your income tax returns to determine if you qualify for the subsidies. The letter will outline how to update your application to be sure you’re getting the best savings for the year ahead.
The letter from your insurance company will tell you whether your 2020 plan is available for 2021 and what coverage changes may have been made. (Plans do change, so be sure to read this letter closely.) If your 2020 coverage has been discontinued, the letter will suggest alternative plans that offer similar coverage.
If you get coverage through the Health Insurance Marketplace, you’ll get two notices: one from your insurance company and the other from the exchange.
Beginning on November 1, you’ll be able to log into your account, update your application and see what plans are available. During the OEP, you can renew your existing plan or enroll in any other policy that’s available in your area. Your 2021 health insurance will begin on January 1 if you make your choice or stick with your current plan by the December 15 deadline.
If you try to choose a new plan for 2021 after December 15, the exchange may automatically enroll you in your existing plan. If that policy is no longer available, you may be automatically enrolled in a plan with similar coverage and cost. As healthcare.gov notes, “Automatic enrollment is a good fallback. But the best way to make sure you have a 2021 plan that works for you, with the savings you qualify for, is to log in, update your application, and view all your plan options for 2021.”
If you purchase your health plan outside the exchange: You’ll likely receive a similar letter from your insurance company spelling out the changes to your current plan and offering details about alternative coverage you might want to consider.
What Can You Sign Up for During the Open Enrollment Period?
During the OEP, you can renew your current plan or choose a new one. If you get health insurance through the exchange, you may want to consider a plan off the exchange (in other words, one sold directly through an insurance company). And vice versa: If you’ve been buying health insurance for yourself or your family directly through an insurance company, the OEP is the best time to evaluate whether the exchange offers better options in terms of coverage and price.
During the OEP, you’ll also be able to purchase a policy for dental coverage if dental benefits aren’t included in your current plan. If this coverage is included and you no longer want it, you can change to a plan that doesn’t include these benefits, too. (Keep in mind that if you purchase your health insurance through the exchange, it includes dental coverage for children under 18 as an essential benefit.)
Likewise, all plans on the exchange provide vision care for children up to age 18, including eye exams and glasses. Most don’t include vision benefits for adults, and you can’t buy stand alone vision coverage for adults through the exchange. You can shop for the vision care off the exchange or with the help of a licensed insurance broker.
If you have health insurance through your or your spouse’s job, open enrollment also provides you the chance to switch or add other benefits that are offered. These may include benefits like life insurance, health savings accounts and coverage for alternative health services such as acupuncture and massage. For more information, reach out to your company’s human resources department or health plan administrator.
What Happens if You Miss the Open Enrollment Period?
In general, if you miss the OEP or don’t do anything, you won’t be able to change your health insurance plan for the rest of the year.
However, if you experience significant changes in your life during the year, you automatically become eligible to sign up for health insurance during a 60-day Special Enrollment Period. These changes are known as “qualifying events,” and include:
- You married, or, in some states, enter into a domestic partnership.
- You have a baby or adopt a child.
- You divorced or legally separated from your spouse and lose health insurance as a result.
- You turn 26 and aged off of your parent’s health insurance plan.
- You move and need to choose a new plan based on your new geographic area.
- You lose your health insurance coverage because you lose or quit your job or have a reduction in hours, or your spouse’s losses a job leaving you uninsured.
However you purchase your health insurance, open enrollment is your yearly opportunity to ask yourself a few questions about whether your plan meets your current needs. For example:
- Are your preferred doctors and other healthcare providers still participants in the plan?
- Are the medications you and family members now take covered under the prescription plan?
- If your budget or health needs have changed, would it make sense to switch to a plan with lower-cost premiums? Or should you opt for a more expensive plan due to health concerns that offers broader coverage and a wider network of providers?
Since the Open Enrollment Period only comes around once a year, you’ll want to consider your options carefully. A licensed health insurance agent can guide you in deciding whether to stick with your current plan, move to a different one or add or drop coverage for benefits like eye and dental care.