Have you tried to sign up for health insurance or make a change to your current policy, only to be told you have to wait until open enrollment? That’s because most health insurance plans only allow you to enroll during a specific time of the year.
Open enrollment isn’t always ‘open’
Open enrollment is a specific period of time when you can buy individual health insurance. And if you don’t buy your health insurance or make changes to an existing policy during open enrollment, you’ll likely have to wait until the next year’s open enrollment for another opportunity.
Over the years, the period of open enrollment has continued to shrink. Initially, it was six months, and then three months long. But open enrollment in most states is now only about six weeks long.1
What types of health insurance have open enrollment periods?
Most types of health insurance have open enrollment periods, including:
Employer-based health insurance
Open enrollment for Medicare health insurance
Medicare is federal health insurance for people 65 and older, people under age 65 with specific disabilities, and people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
Medicare start dates are different for each beneficiary. If you qualify for Medicare because of a disability, there is no minimum age for receiving benefits. However, most beneficiaries become eligible for Medicare on the first day of the month they turn 65. So, if you turn 65 years old on May 14, you would become eligible for Medicare on May 1 of that year.
Every year, Medicare’s open enrollment period is October 15 – December 7. In addition, you can enroll in a Medicare plan three months before and three months after your 65th birthday.
Don’t forget, open enrollment isn’t just for enrolling in health insurance plans. It’s also the time to make changes to current plans or switch altogether. Plan benefits and costs can change from year-to-year. If you have a Medicare plan, check your Annual Notice of Changes (ANOC) to see what’s different for 2022.
Open enrollment for employer-sponsored health insurance
If you work for an employer that offers health insurance, you are given a certain number of days to enroll when you start your job. After that, you will have to wait for your plan’s open enrollment period to enroll or make changes.
Employers set their schedules for open enrollment, and open enrollment for employer-sponsored plans can be even shorter than the window for individual health insurance plans.
Open enrollment for individual health insurance
Open enrollment in the individual marketplace typically runs from November 1 to December 15 during a calendar year. However, the 2022 open enrollment period has been extended to January 15, 2022.
November 1, 2021: Open Enrollment started — the first day to enroll, re-enroll, or change a 2022 individual health insurance plan.
December 15, 2021: Last day to enroll in or change plans for 2022 coverage that starts January 1, 2022.
January 1, 2022: 2022 coverage starts if you’ve enrolled BY December 15, 2021, and paid your first premium.
January 15, 2022: Last day to enroll in or change plans for 2022 coverage that starts February 1, 2022.
February 1, 2022: 2022 coverage starts if you enrolled AFTER December 15, 2021, and paid your first premium.
Special enrollment period
Insurance plans that have open enrollment also have special enrollment periods. Special enrollment periods allow you to enroll in a health insurance plan outside of open enrollment, but only under special circumstances known as qualifying life events. There are four basic types of qualifying life events.
> Loss of health insurance coverage such as losing existing health coverage, including job-based, individual, and student plans or a dependent turning 26 years old and losing coverage through a parent’s plan.
> Changes in household such as getting married or divorced, having a baby or adopting a child.
> Changes in residence such as moving to a different zip code or a student moving to or from the place they attend school.
> Other qualifying events include changes in your income that affect the coverage you qualify for, becoming a U.S. citizen, leaving incarceration (jail or prison), or an AmeriCorps member starting or ending their service.
It’s important to mention that you won’t be eligible for a special enrollment period if you lost your other health insurance because you didn’t pay the monthly premiums or voluntarily canceled your prior coverage.
What types of health insurance don’t have an open enrollment period?
Most health insurers in the United States use some sort of open enrollment program that limits sign-ups to a particular time each year. Here are some exceptions:
> Medicaid, the state-based health insurance, doesn’t limit enrollments to an open enrollment period. If you qualify for Medicaid, you can enroll at any time.
> CHIP, the U.S. government’s Children’s Health Insurance Program, doesn’t limit enrollments to a particular time either.
> Travel insurance isn’t subject to open enrollment restrictions. Due to the short-term nature of travel insurance policies, they’re not usually subject to open enrollment. However, some travel insurance companies restrict your ability to purchase a travel insurance policy to the period of time immediately after you book your travel.
> Short-term health insurance doesn’t use open enrollment periods. Like travel insurance, short-term insurance isn’t regulated by the ACA, and plans are available year-round in states that allow them.
Essential health benefits
In 2010, President Obama signed the Affordable Care Act into law, formerly known as the Patient Protection and Affordable Care Act (ACA). The law outlined a list of ten “essential health benefits” that must be coverall by all new individual and small group plans.
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Pregnancy, maternity, and newborn care (both before and after birth)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
Public vs private health insurance marketplace
The Affordable Care Act also established health insurance marketplaces. A health insurance marketplace is a collection of health insurance plans that provide comprehensive information on each plan, such as enrollment eligibility, pricing, benefits, exclusions, and other important information.
When it comes to health insurance marketplaces, there are generally two types: public and private. A public health insurance marketplace is run and sponsored by the federal or state government, such as Healthcare.gov. In contrast, a private health insurance marketplace is run and sponsored by a private insurance company.
So, what is the difference?
Government-run marketplace
Health insurance plans available on a government-run marketplace are presented in 4 “metal” categories: Bronze, Silver, Gold, and Platinum.
Bronze
- Lowest monthly premium
- Highest costs when you need care
- Bronze plan deductibles — the amount of medical costs you pay yourself before your insurance plan starts to pay — can be thousands of dollars a year.
- Good choice if you want a low-cost way to protect yourself from worst-case medical scenarios, like serious sickness or injury. Your monthly premium will be low, but you’ll have to pay for most routine care yourself.
Silver
- Moderate monthly premium
- Moderate costs when you need care
- Silver deductibles — the costs you pay yourself before your plan pays anything — are usually lower than Bronze plans.
- Good choice if you qualify for “extra savings” — or if you’re willing to pay a slightly higher monthly premium than Bronze to have more of your routine care covered.
Gold
- High monthly premium
- Low costs when you need care
- Deductibles — the amount of medical costs you pay yourself before your plan pays — are usually low.
- Good choice if you’re willing to pay more each month to have more costs covered when you get medical treatment. If you use a lot of care, a Gold plan could be a good value.
Platinum
- Highest monthly premium
- Lowest costs when you get care
- Deductibles are very low, meaning your plan starts paying its share earlier than for other categories of plans.
- Good choice if you usually use a lot of care and are willing to pay a high monthly premium, knowing nearly all other costs will be covered.
Private health insurance marketplace
Private health insurance marketplaces tend to have more flexibility and provide a wide variety of health insurance plans. Instead of picking a plan from a “metal” category, you could pick a plan that has the part of each metal category that works best for you.
When you work with a private insurance company, they tailor their services to suit specific individuals instead of offering generic plans to work for a large audience. Not to mention, health insurance plans offered through a private health insurance marketplace are still required to meet the same ACA-compliant rules and offer the same essential benefits as health insurance plans on a government-run marketplace.
Tax credits for individual health insurance
If you purchase your health insurance through the Health Insurance Marketplace, you may be eligible for the premium tax credit – also known as PTC. The PTC is a refundable tax credit designed to help eligible individuals and families with low or moderate income afford health insurance.
How do I know if I am eligible for the premium tax credit?
You are eligible for the premium tax credit if you meet all of the following requirements:
> Have household income that falls within a certain range (individuals and families may be eligible for the premium tax credit if their household income for the year is at least 100 percent but no more than 400 percent of the federal poverty line for their family size)
> Do not file a Married Filing Separately tax return (unless you qualify for a special rule)
> Cannot be claimed as a dependent by another person
> Enroll in coverage through a Marketplace
> Are not able to get affordable coverage through an eligible employer-sponsored plan that provides minimum value
> Are not eligible for coverage through a government program, like Medicaid, Medicare, CHIP or TRICARE
> Pay the share of premiums not covered by advance credit payments
How much money can I get from the premium tax credit?
The size of your premium tax credit is based on a sliding scale. Those who have a lower income get a larger credit to help cover the cost of their insurance. When you enroll in Marketplace insurance, Woligo’s experts can help you figure if you are eligible for the premium tax credit, and if so, how much your estimated credit will be.
How does the premium tax credit work?
Once it is determined you are eligible for the premium tax credit, you then get to decide how it gets distributed. The first option is for the tax credit to be paid to your insurance company to lower what you pay for your monthly premiums (advance payments of the premium tax credit. Or, you can choose to get all of the benefit of the credit when you file your tax return for the year.
Why is the premium tax credit deemed ‘refundable’?
The credit is “refundable” because, if the amount of your premium tax credit exceeds the amount of taxes you owe, you will receive the difference as a refund. If you owe no taxes, you can get the full amount of your tax credit as a refund. Talk about a win win!
What happens if my circumstances, household income or family size change throughout the year?
If you have a change in circumstance, it is important to update your insurance provider as soon as possible so you know how much of a benefit you can depend on at the end of the year, or how much you might be expected to pay back. Remember, when you enroll in a health insurance plan on the Marketplace, your premium tax credit is estimated based on the current information you provide.
What are some examples of circumstances that could change whether or not I am eligible for the premium tax credit?
Changes in circumstances that could impact your eligibility or the amount of your actual premium tax credit include:
- Increases or decreases in your household income
- Lump sum payments of Social Security benefits, including Social Security Disability Insurance
- Lump sum taxable distributions from an individual retirement account or other retirement arrangement
- Debt forgiveness or cancellation, such as the cancellation of credit card debt
- Marriage or divorce
- Birth or adoption of a child
- Other changes to your household composition
- Gaining or losing eligibility for government sponsored or employer sponsored health care coverage
- Moving to another address
Need health insurance right now?
As we mentioned above, short term health insurance doesn’t use open enrollment periods and is often your best bet when you need health insurance right away.
Short term health insurance is a temporary solution to health insurance, so you never have to be without it. It was created to provide you with a safety net for unexpected times when you lose your traditional coverage or have a gap period while transferring jobs or switching plans.
Short term health insurance typically covers unexpected illness and injury, inpatient and outpatient hospital services, and emergency room visits. The exact benefits offered under short term health insurance depend on the specific policy you choose.
What if I already have health insurance?
Just because you already have health insurance doesn’t mean you should ignore open enrollment. Not only will your health needs change throughout your life, but the health insurance plans available to you could also change. At the very least, you should check in with an expert insurance agent through Woligo to make sure you are enrolled in the best possible coverage for your needs.
“45% of insured Americans are considering changes to their health insurance during the open enrollment, namely switching the plan provider or type.”2
ValuePenguin.com Survey
Best individual health insurance
The best individual health insurance is the one that provides you with the best coverage for your individual needs. And, the best part about health insurance through Woligo is that you won’t have to choose whether you want an insurance plan from a government or a private health insurance marketplace. You can compare plans from both!
Woligo’s team of experts is on standby, ready to help find the right plan for you.