Health insurance is essential no matter what stage of your life. There are some exceptions to this rule, but most insurance policies require that you stay with the plan for an entire year. You can change your coverage and enroll in a new program during the annual open enrollment period. This is everything you need about open enrollment for your health insurance.
What is Open Enrollment?
Open enrollment is when you have the opportunity to change or select your health insurance plan. The timing of registration will vary depending on which method you are enrolling in,” said Anand Shukla (senior vice president, individual markets, Aetna), a CVS Health company.
The Medicare annual enrollment period, for instance, runs from October 15 to December 7. The Affordable Care Act (ACA), Marketplace/Exchange open enrollment period starts on November 1.
“If your employer offers health insurance, you may be eligible for an annual enrollment period. During this time, you can sign up or modify your coverage. Shukla says that it is essential to verify these dates with your employer.
How to Maximize Open Entry Periods
Open enrollment can be accessed in many ways. First, find out when you are eligible. Koleen Cavanaugh (Vice President of Marketing at Independence Blue Cross in Philadelphia) says that your open enrollment period will depend on where and how you buy insurance.
Next, assess your lifestyle and Health. Kyu Rhee M.D. is Aetna’s senior vice president, chief medical officer, and chief medical officer. To help you do this, Kyu Rhee recommends asking the following questions:
- Are you currently seeing a primary care doctor, or do you see any other medical specialists?
- Which medications are you taking?
- What diagnostic tests such as imaging or blood tests do you require?
- Are you due to receive critical preventive screenings such as vaccinations or cancer screenings?
- Do you have multiple chronic conditions?
- Are you planning any procedures or surgeries?
After you have narrowed down what you want, you can start looking at coverage options. Dylan H. Roby, Associate Professor of Health, Society and Behavior, University of California, Irvine’s Program in Public Health, suggests that you look for a plan that suits your needs for the next year, both in terms of monthly premiums in terms of your health needs.
You can also talk to a trusted broker or licensed advisor in your locality to learn more about the available plans. Shukla says that many insurers offer seminars in their local communities, which provide information on programs and allow you to ask questions.
When choosing a plan, consider the four Ds: doctors, drugs, diagnostics, and deductibles. Dr. Rhee says that you should ensure your doctors are connected, that your medications are covered, and that critical diagnostic tests such as blood tests and imaging can be accessed. Also, make sure your deductible is affordable.
He also suggests that you consider hearing, vision, and dental coverage. It is ideal to have telehealth visits or virtual care included in your health plan. He says that your health plan is your ticket for staying and getting well.
Featured Health Insurance Partners
Open Enrollment Management for Different Types of Health Insurance
Roby recommends that you consider more than just the premiums when viewing the details of any health insurance plan. He says that deductibles and copayments are significant, including coinsurance, coinsurance, and out-of-pocket limits.
These are additional tips for maximizing your open enrollment period based on your insurance plan.
ACA
The Advance Premium Tax Credit (APTC) is available to anyone who decides on an ACA Marketplace plan. Open enrollment starts on November 1. Shukla says that APTC can be a significant reduction in the premium you pay for insurance coverage, depending on your household income.
Roby adds that reviewing your options at each open enrollment period is wise as the tax credits or subsidies you have may be affected by changes in your local health insurance plans and policies.
Nearly 90% of the consumers who used HealthCare.gov to get their health insurance received the APTC during the 2024 open enrollment period. The average APTC amount for eligible recipients was 85% of their premiums during the 2020 and 2024 available enrollment periods.
Medicare
According to Carrie Jardine (a revenue cycle manager at Heading Health in Austin), Medicare health insurance’s initial open enrollment period covers seven months. Heading Health is a mental health clinic. It starts three months before your eligibility for Medicare, generally when you turn 65. It continues until your birthday month and ends three months later.
However, the Medicare annual enrollment period runs from October 15 to December 7. Jardine says that you can either stay on the standard Medicare plan or choose to enroll in a Medicare Advantage plan through one of many commercial payers.
Employer-sponsored insurance
Jardine explains that if you get health insurance through your employer, the initial open enrollment period is when you are eligible to enroll with the employer’s insurance carrier. This is usually determined at the discretion of the employer.
An annual open enrollment period may be offered by your employer, in which employees can choose another plan. However, this is not an obligation for all companies.
Roby says it might be good to join a low-cost, high-deductible plan, significantly if your employer contributes money to your health savings account.
What if I want to make changes outside of open enrollment?
You can’t make any changes to your coverage options after the open enrollment period. This is only possible if you are eligible for a particular enrollment period due to a qualifying life event such as a birth, marriage or adoption, loss of coverage or change of residence, income change, or becoming a U.S citizen. You may be able to enroll in a new plan within 60 days or 60 days, depending on your circumstances.
