Open Enrollment, What Does it Mean?

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Open enrollment marks a specific time of year in several types of coverage including group health insurance, Medicare, and most recently the Health Insurance Marketplace, when eligible applicants can choose or change plans. Unlike signing up for coverage on the traditional individual market, which could be done at any time of year before Obamacare, those enrolling in certain health plans only have a several month long window to select a plan and get coverage.

Open enrollment periods typically change each year, and may overlap among multiple coverage types, as Medicare and individual health insurance did in 2013. If you’re already enrolled in a health plan with an open enrollment period and are happy with your coverage, you are not required to make any changes during this time, and can keep the benefits you have.

Employer-Sponsored Insurance

Employees who have coverage through the workplace can make certain adjustments to their plan, such as opting for a lower or higher deductible than the previous year, that they couldn’t at other times.

Qualifying life events such as marriage, giving birth to or adopting a child, or a death in the family can be recorded at any time of year, but specific changes in your policy can only take place during open enrollment.

This is a time when, if your employer offers a variety of plans, you can decide perhaps this is the year to open an HSA or conversely that you would rather have fewer out-of-pocket charges on covered services.

Open enrollment season for group insurance plans is often the same for many health plans nationwide. Some smaller insurance companies may have their own open enrollment period, which should be indicated by your employer.

During this time, all members of a group health plan have the ability to apply for certain benefit programs, and insurers are required to accept each applicant without medical underwriting or asking proof of insurability. For this reason, the model of group coverage had a major influence on the health reform law.

If you miss open enrollment season for your group, you will continue to be insured under the same plan as the previous year, but you will have lost the opportunity to make any major changes. As mentioned with certain life events, exceptions do apply in some cases, and newly hired workers can also get insured outside of open enrollment.

Employers offer various types of coverage, and it can be easier to keep your old plan rather than taking the time to learn the differences between HMO, PPO, POS and indemnity plans, but it can be more valuable in the long run to know your options. It only takes a few moments to check the plan documents for each policy offered, where you can find out which providers are in-network and view the amounts that insurers will pay for covered services.

Also, check to see if spouses or dependent children are covered — group plans are not required to offer coverage to employee’s family members, but some may do so. If you use any particular doctors, make sure they are in-network if you want to keep them, and if you take prescription drugs remember to check the plan’s form to see if yours are covered.

For more details on your group health insurance options, contact your company’s human resource department or your health plan.


Medicare open enrollment happens once a year, often through the late fall. Seniors enrolled in this government health plan have the option of changing their major medical policy or prescription benefits for the following year at this time. As plans typically change to some degree each year, it’s important to review the details of your plan and others offered, as the various letters of Medicare can get complex.

New rules and exclusions can be introduced and have a large impact on your health care. While all Medicare enrollees receive a Plan Annual Notice of Change each September, it is essential to review the notice to see if you prefer to change your plan during open enrollment.

Even if you’re satisfied with your coverage and don’t want to bother finding a new plan, policies can vary in cost and benefits from year to year. After reading through the Annual Notice of Change, you can better determine how much you’d like to continue the same plan. If you switch plans, consider more than the premium cost. Make sure your specific health needs, including medications, are still included in your coverage.

According to a Kaiser Foundation survey, only 6 out of 10 Medicare members actually look at their plan options each year, or have someone else read the choices on their behalf. One-fourth claim they rarely or never check for alternatives during open enrollment.

If you find your plan doesn’t cover what you need anymore or see that it’s received a low rating, there are many others to choose from that offer quality coverage. Find a plan with a higher rating by using the Medicare Plan Finder tool.

Also, if you fall into the doughnut hole (Medicare Part D’s coverage gap), keep in mind that the Affordable Care Act helps fill the gap with discounts averaging about 53 percent on covered brand name medications and 28 percent on generic drugs.

Throwing so many changes at the Medicare population each year is somewhat absurd, but it’s worthwhile to keep up with these changes. If you’re enrolled in Medicare and have questions, you can contact the Medicare program at 800-633-4227, visit, or call a licensed agent at the number above.

Individual Health Insurance: On and Off Exchange

The health insurance marketplace for individuals and small businesses holds its open enrollment period for several months beginning in the fall. In the first year the exchanges were introduced, open enrollment lasted from October 1, 2013 until March 31, 2014 to ensure people were able to sign up successfully and find out how well the new program and new rules for the traditional market would fare.

For the second year of open enrollment, consumers have between November 15, 2014 and January 15, 2015 to enroll. The open enrollment period for the marketplaces applies to federally-facilitated and state-run exchanges as well as non-exchange health plans.

For individual policyholders, this period is an essential time not only to switch plans or gain coverage, but also to make sure you won’t be penalized for going without coverage. Those who miss the open enrollment period can apply for insurance plans off the exchange, but likely won’t meet the deadline to avoid the individual mandate tax.

Open enrollment on the marketplace will last from November 15 until January 15 each year, marking the safe zone for gaining individual health insurance and not having to pay a penalty.

State exchanges provide a variety of plans from each insurer participating in your region, covering a large population of Americans with lower income. Many of those applying for coverage on the exchange will also apply for tax credits during open enrollment, which will be applied to plans in order for them to receive reduced premiums and medical costs.

You cannot apply for subsidies or marketplace health plans at any other time of year. Your plan may change from year to year in some respects, but the core elements of essential health benefits and minimum essential coverage (plans paying at least 60 percent of total covered costs) will always be included in such plans under federal law.

Like other coverage, certain life events such as changes in family status or income, or relocation to another state can also qualify a person for special enrollment periods apart from open enrollment in the marketplace.

If you have questions about the marketplace in your state or want to apply during open enrollment, call us at 888 803 5917. Our agents are certified to sell exchange plans in every state and can help you determine eligibility for subsidies and choose the right plan.

You can find out more about the health insurance marketplace on our Obamacare site.

If you miss the enrollment period, you can apply for a short-term medical plan to cover you until the next open enrollment window in November. This ensures you’re safe during this time.


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