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Healthcare shopping and navigation is likely (and understandably) one of Americans' least favorite items on the to-do list. But with some preparation, you can make the process as efficient and painless as possible. Let's start by marking the calendar for open enrollment, the time of year when you can freshen up your coverage and re-prioritize your plans.
Open Enrollment 101
Open enrollment is a designated period when you can apply for, purchase, or change a health insurance policy for the coming year. And while open enrollment isn't necessarily the only time you can update or make changes to your insurance, it's likely your best bet to make changes without meeting additional requirements.
We'll cover what it looks like to shop or make changes to your health insurance outside of open enrollment later in this article. However, let's look at what you can expect from shopping during an annual open enrollment period.
Open enrollment periods are standard and in place for plans available through Medicare, employers, and the ACA Marketplace.
When is Open Enrollment?
Open enrollment periods may vary based on whether your employer offers your plan or if you shop the ACA marketplace or private market.
Open Enrollment Through an Employer
Suppose your health insurance is provided through your employer. In that case, you should begin to receive notifications from them (most likely your Human Resources Department) to prepare for the upcoming open enrollment period. Once open enrollment has started, you can likely meet with a benefits coordinator or HR representative to discuss your insurance needs and make new selections for the upcoming year.
When you have job-based health insurance, your employer sets the open enrollment periods that can occur at any time of the year. Typically, however, the enrollment period is set in the fall, so the coverage you select can begin on January 1 of the following calendar year.
Generally, you're only allowed to make healthcare policy and other changes to your benefits plan during open enrollment, so don't procrastinate on this one: make your appointment to speak to a benefits rep and review your existing plans against your anticipated healthcare needs for the coming year.
Open Enrollment on the ACA Marketplace
If you shop for your individual insurance plan through the ACA Marketplace (healthcare.gov), open enrollment dates will be the same in most U.S. states. Enrollment to make plan changes beginning January 1 of the following year will run from November 1 to December 15. If you're already enrolled in a plan through the Marketplace, you'll likely receive reminder notices to prepare to update your coverage for next year.
Even if it's been a quiet year for your healthcare needs, it's still a good idea to sit down with your current plan and think ahead about any changes you may need in the near future, whether it's an upcoming surgery, a possible pregnancy, or a change to your prescriptions.
Open Enrollment for Medicare
Medicare open enrollment (for Medicare Advantage and Part D plans) runs from October 15 to December 7 each year, and there is a separate open enrollment period from January 1 to March 31 for people who already have Medicare Advantage. Note that the Medicare open enrollment periods do NOT apply to Medigap plans, which don't have an annual open enrollment period.
Medigap plans are only available without medical underwriting during your initial enrollment period or during one of the limited special enrollment periods that apply to those plans. However, a few states have implemented rules that allow Medigap enrollees to make changes to their plans on an annual basis.
Open Enrollment: What Else You Should Know
The changes you make to your plan—whether you're upgrading or streamlining your coverage—won't be effective immediately. Updates to your coverage will take effect in the following plan year (typically beginning January 1).
If you don't sign up for health insurance during the open enrollment period, you probably can't sign up for health insurance until the next open enrollment period unless you experience an extenuating circumstance, also known as a qualifying event.
In addition to purchasing a new plan or updating a current one, you can use the open enrollment period to end coverage you don't need for the following year.
More Enrollment Opportunities
So what happens when life happens, and you need to change your plan outside that short, month-long open enrollment window? Suppose you changed or lost your job, had a baby you weren't planning for or had to move to another state to care for a relative. That's where qualifying events and special enrollment periods come in.
The government and insurance carriers recognize that certain life changes or unexpected events shouldn't prohibit consumers from accessing the necessary healthcare coverage. Whether an employer provides your coverage or you purchase it through the ACA Marketplace, you have options beyond open enrollment when life sends changes your way.
Several qualifying life events may allow you to make changes to your healthcare coverage outside of a designated open enrollment period; here are some of the most common examples:
Family growth or other changes to household size
Marriage or divorce
Changes to employment
Relocation
Loss of existing healthcare coverage
Becoming a U.S. citizen
Planning for Open Enrollment and Beyond
Planning is the key to making the most of your next open enrollment period. Spending a little time reviewing your policy or consulting a qualified advisor ahead of time can significantly cut down on the possibility of midyear regret that can come from inadequate coverage.
And if the process feels intimidating, we get it… and we've been there. That's why we've made it our mission to connect consumers with licensed agents who have the experience and expertise to guide you through life's most important decisions.
Get started with Trusted Referral Network today to take the headache out of your healthcare planning.
Want to be a part of the #TRN Team? We are looking for guest writers to contribute to our blog. Reach out to jo@trustedreferral.org to learn more.