Typically, if you have coverage through an employer, your insurance will renew at the same time each year. This renewal period is called open enrollment. Unlike marketplace open enrollment, group plan open enrollment is based on the original enrollment date, instead of being based on a calendar year. You should be on the lookout for emails from your employer with “open enrollment” in the subject line. These are going to be emails you don’t want to send straight to the trash. You can also reach out to your HR department at any time to find out when your open enrollment period is.
Not everyone gets coverage through their employer. If your employer does not offer group health insurance, or if you are self employed, you would be eligible to enroll in individual health insurance through your state based exchange or marketplace.
What is individual health insurance and when can I apply?
Individual health insurance plans provide coverage through the end of the calendar year. Typically, these plans run from Jan. 1st to Dec. 31st of each year, and the annual open enrollment period for individual health insurance is Nov. 1 - Jan. 15. Enrolling in a plan by December 15th will ensure a January 1st start date. However, you have until the 15th of January to get coverage for the new year, and any applications submitted after 12/15 will have a February 1st effective date. Regardless of when your coverage begins, your plan will still expire on the last day of the calendar year.
The reason plans expire at the end of the year is because insurance carriers are allowed to change their rates and plans effective the 1st of each year. They typically have these new plans and rates available before the open enrollment period begins, to allow time for plan comparison. Since plans change from year to year, it is possible that the plan you enroll in for this year may not be available next year, or may be renamed and offer similar coverage. During open enrollment, it is important to look into your coverage options, even if you plan on sticking with your current plan, as rates can change.
What if I forget to enroll during the annual enrollment period?
If you miss the open enrollment window and are not enrolled in a plan by Jan. 15th, you will not be able to enroll in a new major medical plan, without a qualifying life event. We’ll talk more about this later on.
If you are already enrolled in a major medical plan and do nothing during open enrollment, you will be auto re-enrolled in your current plan, or something comparable to it if your plan no longer exists. You will however still be subject to any price changes.
Are there other opportunities to enroll throughout the year?
If you are not enrolled in a major medical plan and miss the open enrollment period, you are not completely out of luck. Short Term Medical (STM) plans may be an option for you, depending on your state. You can enroll in a STM plan at any time, even outside of open enrollment, but it is important to note that these plans do not offer the same benefits and coverage that major medical plans do. Short Term Medical plans are also not considered “qualified coverage”.
You may also be eligible to enroll in a major medical plan at other times of the year, if you experience what is called a “qualifying life event”. Qualifying events include moving, getting married or divorced, having a baby, adopting a child, or losing qualified coverage.
A loss of qualified coverage would include losing coverage that was provided through an employer (quitting or being laid off). This loss of coverage could also occur for individuals who turn 26 and have to be removed from their parent’s health insurance plan, or individuals who are recently divorced and are no longer on their spouse’s insurance plan.
Qualifying life events open what is called a Special Enrollment Period (SEP). This period is typically 60 days prior to or after the qualifying life event. During this period, you are eligible to enroll in a plan through your state based exchange or marketplace.
When will my coverage begin?
For major medical plans, coverage will be effective the 1st day of the month following your application, as long as the application is submitted prior to the 15th of the month. So, if you need coverage to begin on August 1st, you’ll need to have your application in by July 15th to ensure adequate processing time.
For most Short Term Medical plans, if you enroll in coverage today, your plan will go into effect tomorrow. It is important to note that Short Term Medical plans do not typically run for a full calendar year, but some can run for up to 360 days.
How do I enroll in individual health insurance?
SnapHealth is your resource for simplifying the process of shopping for health insurance. We provide a curated recommendation of plans that meet your unique needs and then submit an application on your behalf, once you have selected a plan. SnapHealth will support you from quote to enrollment, to ensure the process goes smoothly.
To get your free quote today, go to mysnaphealth.com and click on “Get a Quote”.