Health Insurance Blog

Open Enrollment and Special Enrollment Periods

Posted by:
Martha Murray
March 20, 2023
Find out more about Open Enrollment and Special Enrollment Periods and how they can best serve you and your loved ones.

What is open enrollment?

Open enrollment is the time period at the end of each year, where anyone can sign up for health insurance. During this time,

  • You cannot be denied health insurance because of health status because of the regulations in the ACA (Affordable Care Act). 
  • You can make changes to your plan, your household information, renew your policy, or cancel it altogether. 
  • You are also able to look at all of your plan options and choose the one that best fits your needs. 

Why does open enrollment happen?

Open enrollment was implemented to decrease and discourage adverse selection. 

  • Adverse selection happens when sick people sign up for health insurance, but healthy people do not. It skews the amount of risk a health provider takes on when insuring someone, so the entire health insurance industry tries to prevent it. 

A health insurance company can only exist if it takes in more money in premiums each year than it pays out in claims. For this to happen, it needs more healthy members than sick members. 

What is my responsibility during open enrollment as a consumer? 

You as a consumer should know enough about your health insurance to make a decision about what you want to do for the upcoming year. In order to be prepared, review your policy each year and what coverage you may need for the upcoming year. 

You may also contact your health insurance agent and let them know of any changes to income, household size, or if you would like to change policies. Your health insurance agent can help you navigate the health insurance world during open enrollment. 

What if I miss open enrollment? 

Luckily if you miss open enrollment, you have a few options. 

  • There are some kinds of health insurance that you can sign up for anytime, year round. This includes dental, vision, short term, and accident plans. 
  • Short term and accident plans are similar in coverage to Marketplace plans, however you will not receive a tax credit with these plans and they don’t cover preventative care, ongoing prescriptions, or pre-existing conditions. 

There is one more option though if you miss open enrollment, it is called a special enrollment period.

Special enrollment period

What is a special enrollment period?

A special enrollment period is when an individual qualifies to sign up for a health insurance plan, outside of the open enrollment window. In order to qualify for a special enrollment period, you have to have a qualifying life event. These include, but aren’t necessarily limited to:

  • Loss of coverage
  • Change in household
  • Moving
  • Change in income
  • Release from incarceration
  • AmeriCorps member who’s beginning or finishing service
  • Becoming a member of a federally recognized tribe
  • Becoming a US citizen

What do I do if I qualify for a special enrollment period?

There is a time frame in which you are qualified to sign up on the premise that you have a qualifying life event. You have 60 days before or after your qualifying life event to sign up for health insurance. During this time you can contact your health insurance agent and they will be able to help you with everything. 

Why does any of this matter to me?

Health insurance can seem like a heavy topic. There’s a ton of information, which is why it is helpful to have a health insurance agent guide you through this process. However, as an individual, knowing the basics of health insurance and the enrollment periods will help you significantly in getting the best health insurance policy for you and your family. 

Health insurance policies change yearly, along with prices and benefits. They also change depending on your situation, like household size, income, and zip code. 

It is very important to review your options during open enrollment, and understand your options to optimize your benefits from your health insurance. 

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