What is open enrollment?
In the United States, there is only one period throughout the year when most people can sign up for health insurance or switch plans. This period is known as “open enrollment.”
But why can’t people choose health insurance whenever they please? For the most part, this system was put in place to discourage something called “adverse selection.” This is when only sick people sign up for health insurance, while healthy people do not. This disbalance makes health insurance a much riskier prospect for insurers, and it would make the entire industry less profitable. Of course, the ACA in its original form made health insurance mandatory, so this was something of a moot point until most states lifted health insurance mandates.
A crucial aspect of the open enrollment period is the adherence to ACA regulations. During this period, insurers are not allowed to turn down applicants due to their health status – including any pre-existing health conditions they may have. It is this factor that makes the open enrollment period necessary. If people were allowed to buy health insurance at any time, they would purchase plans only after certain conditions manifested. The open enrollment period ensures that everyone buys health insurance at the same time – whether they’re currently sick or healthy. Otherwise, healthy individuals would not be forced to pay the cost of unhealthy people – defeating the entire purpose of health insurance.
But the federal government still needed to provide individuals with a way to switch plans midway through the year to deal with unforeseeable changes in their healthcare needs. For example, someone might need to purchase an individual plan after losing their employment benefits. Or an individual might get married and receive new coverage under their spouse’s plan, making their own insurance obsolete. To account for these situations, the health insurance industry also has “special enrollment periods.” This allows people to change their insurance after a “qualifying life event.”
According to federal law, the open enrollment period for plans under the Affordable Care Act lasts for 45 days. Individual states may have their own unique system in place with varying lengths of time for open enrollment periods.
What qualifies as a life event?
The open enrollment period for Medicare is unique, as it begins three months before your 65th birthday – although this only applies to Medicare A and B. For all other aspects of Medicare, there is an open enrollment period every fall from October 15th to December 7th.
Medicaid and CHIP do not have open enrollment periods, as these programs are designed to be as easy as possible for low-income families to navigate. Finally, employer-sponsored health insurance coverage has its own enrollment periods, as your company decides when and how you become eligible.
Examples of qualifying life events include:
- Losing your job
- Losing your employee health insurance benefits
- Losing coverage under your parent’s plan after reaching a certain age
- Expired COBRA insurance
- Quitting your job
- Having your hours reduced so that you no longer qualify for your employment plan
- Getting divorced
- Getting married
- Moving to a different area where other plans are available
- Having a baby
- Adopting a child
- Changes in income
- Beginning or ending a service period with AmeriCorps
- Becoming a member of a federally recognized tribe
- Becoming a U.S. citizen for the first time
- Being released from incarceration
Examples of situations that are not considered qualifying life events include:
- Losing your insurance because you failed to pay your premiums
- Voluntarily canceling your health insurance
How do you know when enrollment is open?
If you’re searching for a “normal” insurance plan under the Affordable Care Act, the open enrollment period lasts from November 1, 2022, to January 15, 2023. This 45-day period changes slightly from year to year, so all subsequent open enrollment periods may not occur on these exact same dates.
In addition, the exact open enrollment period can vary from state to state. While most states are set to open their ACA marketplaces from November 1st to January 15th, you should check if your state has a slightly different system. Some states have their own health insurance exchanges and their own unique periods. For example, Idaho has an open enrollment period that occurs much sooner – lasting from October 15th to December 15th. California’s open enrollment period lasts longer than the federal period – starting on November 1st but lasting until January 31st. Maryland’s open enrollment period is shorter than average, lasting from November 1st to December 15th.
Should you switch health insurance if you enroll in an out-of-state school?
College students may need to change their health insurance for a number of reasons. Many of these individuals apply for health coverage under school health plans, which can be affordable and effective in some cases. However, school students also have the opportunity to enroll in a marketplace plan instead. In addition, school students under the age of 26 may be covered under a parent's insurance plan. If you lose your school student health plan, you may qualify for a special enrollment period – during which you can apply to be covered under your parent’s plan or your own individual marketplace ACA plan.
Many students who move to a new state for school may need to change their insurance coverage. For example, there may be more effective or more affordable insurance options in their new state, giving them the opportunity to switch insurance providers and save money. At this point, you can wait for the open enrollment period or determine whether your change in address constitutes a qualifying life event. In many cases, it’s possible to immediately switch insurance providers during a special enrollment period.
What happens if you miss open enrollment in 2023?
If you miss the open enrollment period in 2023, it’s not the end of the world. First, determine whether you have experienced any qualifying life events that trigger special enrollment periods. You might also determine whether you’re eligible for Medicaid, since there is no open enrollment period for this program. If these options are impossible, consider the many alternatives to a typical marketplace ACA plan.
Perhaps the most obvious option is to simply wait until the next open enrollment period. During this waiting period, you can shop around for deals and determine the most effective and affordable option for your unique needs. Don’t forget to set a reminder in your calendar so you remember to take action when the next open enrollment period rolls around.
Of course, you’re going to have a gap in your coverage while you wait for the next open enrollment period. The safest choice is to choose some kind of temporary, short-term insurance that covers you while you wait. This is much more reliable than simply having no insurance, as you never know what kind of medical situations you will encounter even a few months from now.
While many mainstream insurance companies offer temporary, short-term plans, you might also want to consider alternatives such as CrowdHealth. This crowdfunding platform is not the same as insurance coverage and should not be viewed as such. That being said, it does help you pay for your medical bills – providing the same basic end result as traditional health insurance coverage.
This could be a solid choice to cover gaps in coverage while you wait for the next open enrollment period, and it can also cover gaps while you wait for Medicaid or Medicare eligibility as a retiring adult. In addition, CrowdHealth can cover gaps for employees who have lost access to their employers’ health plans.
How does Crowdhealth work?
CrowdHealth can also serve as a permanent solution for those who need to pay their medical bills. The crowdfunding system is actually quite simple, and it involves posting your medical receipts to the platform after your bills have been paid. Next, CrowdHealth facilitates the crowdfunding process and your bills can be paid quickly and easily by other members. If your bills cost more than $500, you pay the first $500 while the remainder goes through the crowdfunding process.
CrowdHealth is affordable, with no deductibles and monthly fees that are a fraction of most health insurance premiums. In addition, there are no doctor networks – allowing you to freely choose the best providers for your unique needs. But perhaps one of the most important benefits is that CrowdHealth has no open enrollment periods, allowing you to sign up whenever it’s convenient.
Reach out to our team members to learn more about how CrowdHealth can help you achieve a more flexible, affordable healthcare plan.
Talk to a CrowdHealth Specialist
People Love CrowdHealth
Dr. Maryanna Barrett, MD
Owner of Thrive OBGYN
Dr. Tanya Stewart, MD, MBA
Former Chief Clinical Transformation Officer, United Health Group
Dr. Maryanna Barrett, MD
Owner of Thrive OBGYN
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