Open enrollment is the time of year when you can sign up for health insurance or make changes to your coverage.
That’s the only time you can change your health insurance, unless you have a qualifying life event that triggers a special enrollment period for health insurance. Here’s what you need to know about open enrollment for health insurance.
when is enrollment open for 2023 health plans?
Open enrollment for the Affordable Care Act Marketplace is November 1. 1, 2022, to Jan. 15, 2023, in most states. a handful of states with their own health insurance exchanges have slightly different open enrollment periods.
here are the open enrollment periods by state:
open enrollment by state
what is open enrollment?
The open enrollment period is when you can get health insurance or change your health plan, for specific types of health plans. during that time, people can review their health insurance options and choose the plan that best suits their needs.
Specific open enrollment varies by type of health insurance:
- aca market open enrollment is from nov. 1 to Jan 15 in most states.
- medicare‘s annual enrollment period is usually October 1. Dec 15 7
- medicare advantage annual enrollment starts in January. March 1 to 31.
- Employers have their own open enrollment periods for health insurance.
- plan design
- premium costs
- copayments for doctor visits, urgent care and emergency room care, and prescription drugs
- provider networks
- prescription drug benefits
- Do I have a chronic condition that requires regular doctor visits?
- Do I want the flexibility to get care outside the network?
- Do I want to avoid the need for a primary care referral to see a specialist?
- Do I take expensive prescription drugs?
- Do I have a family or do I plan to start one in the next year?
- Are lower premiums or lower out-of-pocket costs more important to me?
- Can I pay high expenses out of pocket if there is an emergency?
- Do I want a plan that offers virtual care?
- adopt a child
- become a US citizen
- changing income
- get married
- having a baby
- loss of health insurance
- move to a new state
why is there an open enrollment period?
health insurance has an open enrollment period to prevent people from buying health coverage only when they are sick.
If people only got health insurance when they needed care and then dropped it when their health improved, there wouldn’t be enough healthy people paying premiums to offset the costs of sicker members.
insurers need healthy members who pay premiums without requiring a lot of care. which helps offset the cost of covering the sickest members.
You may be able to get coverage at other times of the year if you have a qualifying life event, like getting married, having a baby, losing other health insurance, or moving to a new state.
how to maximize open enrollment periods
Use open enrollment to dive deeper into the health insurance plan options available to you.
The ACA requires health plans to cover essential health benefits, including emergency care, outpatient care, hospitalization, pregnancy and newborn care, mental health and substance abuse services, prescription drugs, rehabilitation services, lab tests, preventive and wellness services, and dental services. and vision care for children.
the aca requires that basis of coverage, but health insurance plans still differ by:
Here’s what to consider when choosing health insurance during open enrollment.
consider potential health care needs for the coming year
You can’t always predict your future health care needs, but you may know you need knee surgery in the next year. maybe you’re starting a family or taking medications that cost hundreds of dollars each month. all of these can affect your health insurance costs.
The amount of health care you may need in the next year may influence which plan you choose. If you’re looking forward to a healthy year with limited health care problems, a high deductible health plan (HDHP) may work for you. But if you’re expecting a child or have health care needs, a plan with higher premiums and a low deductible might make more sense.
In the market here, bronze and silver plans have lower premiums and higher deductibles, while gold and platinum plans have lower deductibles but higher premiums.
related: bronze, silver, gold or platinum medical insurance
compare health insurance costs
Premiums are a key part of a health plan’s costs, but there are also out-of-pocket costs like deductibles, coinsurance, and copays.
You want to weigh your premium costs along with your out-of-pocket costs to find the plan that’s right for you. Some people prefer lower premiums and higher deductibles, so they don’t pay as much for health insurance, but pay more when they need health care services.
Others may prefer to pay higher premiums with lower deductibles. That way, they have a better idea of what they’ll pay for health insurance coverage and may not be saddled with a large medical bill if they need care.
Find out if a high deductible/lower premium plan works for you or if you prefer a low deductible and higher premium.
explore plan design differences
The type of health insurance plan you choose influences your health insurance costs and flexibility in receiving care.
Health maintenance organization (hmo) and exclusive provider organization (epo) plans are often less expensive than a preferred provider organization (ppo) plan. But you generally won’t get coverage for out-of-network care at an HMO or EPO. An hmo also typically requires members to get a referral from primary care to see a specialist.
PPOS cover out-of-network care, usually at a higher cost than in-network care, and do not require a referral to see a specialist. that liberty generally comes at a higher cost than hmos.
Our research found that a 30-year-old pays an average of $390 per month for an hmo on the market here compared to $436 for an epo and $458 for a ppo.
check the health plan’s provider network
Check the plan’s provider network to make sure your providers are included in the network. Also, make sure the provider marketplace has plenty of specialists and other providers in your area, so you don’t have to travel long distances to see other health care professionals.
If a provider isn’t in your plan’s network, you may pay more for that care or have to pay the entire bill, depending on your health plan.
ask yourself these questions when choosing a health insurance plan
“when choosing a plan, keep in mind the 4 ds (doctors, medications, diagnoses and deductibles). make sure your doctors are in network, your medications are covered, key diagnostic tests like blood work and imaging are affordable, and your deductible meets your financial needs,” says dr. kyu rhee, senior vice president and chief medical officer, aetna.
If you still need help, you can talk to a licensed insurance broker or advisor who can guide you through the different plan offerings in your area.
“Many insurers also offer local seminars that provide information about plans and allow questions to be asked,” says Anand Shukla, senior vice president of individual markets at Aetna, a CVS health company.
manage open enrollment for different types of health insurance
Here are some additional tips to maximize your open enrollment period based on your health insurance plan.
health plans here
the marketplace here at healthcare.gov helps Americans get health insurance who might not otherwise get coverage because they can’t afford it or don’t have access to workplace health insurance. Those with incomes between 100% and 400% of the federal poverty level are eligible for premium tax credits and subsidies that lower health care costs.
Plans here are the only ones eligible for these tax credits and subsidies, so take advantage of these cost-saving measures if you qualify.
“It’s a good idea to check your options during each open enrollment period because the tax credits and subsidies available to you may change due to changes in health insurance policies and plans offered in your area,” says dylan h. Roby, Interim Chair and Associate Professor of Health, Society, and Behavior at the University of California, Irvine Public Health Program.
Medicare has three different enrollment periods. the initial enrollment period is when you become eligible. which lasts seven months, beginning three months before his initial Medicare eligibility (usually when he turns 65) and continuing through the month of his birthday and ending three months after.
There are also two enrollment periods each year. Medicare’s Annual Enrollment Period is Oct. Dec 15 7, when you can make changes to your coverage. the other enrollment period, called the medicare advantage open enrollment period, is in January. on March 1 and March 31 and allows members to only switch Medicare Advantage plans or switch from Medicare Advantage to Original Medicare.
employer-sponsored health insurance
Companies decide when you may be eligible for health insurance. Some employers may allow you to get coverage when you start, while others may not allow it until you’ve been there for a few months.
Employers can also limit who can have health insurance coverage, such as requiring a certain number of work hours before granting part-time health insurance and not allowing spouses to be on the plans.
Companies also decide their open enrollment period. ask your employer for the specific dates of the open enrollment period.
If you’re shopping for employer-sponsored health insurance, check to see if your company donates money for your care, such as in a health savings account or flexible savings account. those savings accounts are a tax-free way to save for your health care.
Medicaid, the federal/state health insurance program for low-income Americans, does not have an open enrollment period. anyone eligible for medicaid can sign up at any time of the year.
can I make changes outside of open enrollment?
You can change your health insurance outside of open enrollment if you have a qualifying life event. Here are examples of qualifying life events that create a special enrollment period where you can make changes and enroll in health insurance:
Special Enrollment Periods last 60 days after the qualifying event.