What you need to know about open enrollment

By Kate Rockwood

Every year brings the chance to make a major healthcare decision: choosing, or changing, an insurance plan. For many people, that happens during an open enrollment period, a specific time when you can opt in or change your insurance plan for any reason.

Even if you’re pretty satisfied with your insurance, it’s always worth looking over your options each year. That’s because things can change with insurance plans. Your deductible might go up sharply or your primary doctor might no longer be included in your plan’s network. 

Open enrollment windows vary depending on the kind of insurance you have such as from your work, through the Affordable Care Act (ACA) Marketplace, Medicaid, or, for people age 65 and older, Medicare. All four typically have different times of the year when you can enroll in a new insurance plan or make changes to a plan you already have. 

Meanwhile, if you qualify for coverage through Medicaid or the Children’s Health Insurance Program (CHIP), you can apply and enroll at any point during the year.

Open enrollment windows

If you get your health insurance from your job, your company will decide when the open enrollment window takes place. Ask your boss or someone in the HR department if you want to know the date. Many companies have enrollment periods that start in October.

Medicare and the ACA have set enrollment windows:

ACA open enrollment: Nov. 1 to Dec. 15, 2020, for 2021 coverage. Most states follow those dates, but several states—including California, Colorado, Pennsylvania, and Nevada—run their own healthcare exchanges and have enrollment windows that go as much as a month longer. You can check your state’s enrollment period here. You can also take a look at the different types of ACA plans here. 

Medicare open enrollment: Oct. 15 to Dec. 7, 2020, for 2021 coverage. Enrollment for Medicare Advantage is January through March. This is also the time when you can switch between plans or make changes to your plan.

If you sign up for an ACA or Medicare plan for 2021, your coverage would begin on Jan. 1, 2021. If you have existing coverage and are switching to a new plan, the new coverage would also start on Jan. 1, 2021. 

What happens if you already have insurance

If you already have ACA insurance and you don’t want to make any changes, you likely won’t have to do anything to renew your insurance as long as the plan still exists. However, if you get a subsidy for an ACA plan, it’s a good idea to manually renew your coverage to make sure you still get the subsidy. 

Medicare plans automatically renew, but because things frequently change with these plans, it’s a good idea to review your options each year. You might also decide to switch from traditional Medicare to Medicare Advantage. 

If you get insurance through your work, your company might allow you to automatically renew your healthcare plan or ask you to sign a few documents to renew your plan. Open enrollment periods are a chance to make any changes you want to your plan. 

What to think about when choosing a plan

A few important things to consider in an insurance plan are what it costs, what it covers, and the size of the insurance plan’s network (the hospitals, doctors, labs and more that the insurance company has negotiated with on coverage prices).

1. Cost. To understand how much you’ll really pay for your insurance, look at the premium (how much you pay to have insurance), deductible (how much you have to pay for medical care before insurance kicks in), copayments (flat fees for certain services), and out-of-pocket limits (a cap on how much of your own money you have to spend).

2. Network. Almost all insurance plans offer you big savings if you use a provider in their network. And HMOs won’t cover an out-of-network procedure unless it’s an emergency.  

3. Coverage. Most ACA and Medicare plans (if you have both Part A and B) include essential benefits like hospitalization, prescriptions, and wellness visits. Commercial healthcare plans or short-term insurance plans can vary. Some plans have low premiums, but don’t cover all the services you might need. Prescription drug coverage is also very important, especially if you regularly take medication.

If you need help enrolling in a plan or choosing a plan, there are free resources available. An HR rep at work should be able to help guide you through insurance options you get from your work. For help with an ACA plan, visit healthcare.gov. You can get free Medicare assistance through the State Health Insurance Assistance Programs (SHIP). 

It’s important to pay attention to enrollment windows because if you don’t qualify for a special enrollment period, you’ll likely have to wait an entire year before you can apply for insurance or make changes to your existing insurance.