Open Enrollment for Health Insurance is Here

The weather is changing, leaves are falling and it is that time of year again- open enrollment in the United States! Whether you have private or public health insurance coverage there are specific times during the year where you can make changes to your coverage, typically these occur around the fall. There are two main types of insurance: private and public. Private health insurance is typically available through an employer-sponsored program, membership through a group association or purchased individually from an insurance company. Public health insurance is sponsored by the government (either at the federal or state level) this includes Medicare, Medicaid, Children’s Health Insurance Program (CHIP), Veterans Health Administration (VHA), TRICARE and Indian Health Services.

Each year health and drug plans can make changes this includes changes such as cost, coverage, what pharmacies and providers/systems are in their networks.

What is open enrollment?

Open enrollment is the term that is used to describe the period of time each year when you are able to sign up for health insurance. Depending on where you are getting your insurance from commercial, health exchange, Medicare or Medicaid these periods will be different.

If you purchase your insurance on the Health Insurance Marketplace or if you have Medicare, we are entering the time when you can make changes to your 2018 health plan. During this open enrollment period, you have an opportunity to review your plan options and determine if your health plan is meeting your current needs or not. This allows time for you to review and consider if you have the coverage you need for both health care services including your appointments and your lab work as well as your coverage for prescriptions. During open enrollment, you do not have to make any changes to your plan if you are satisfied with the coverage you are currently receiving.

Typically, if you don’t sign up for health insurance during the open enrollment period you will need to wait until the next open enrollment period, this is unless you experience what is called a qualifying event. If you live in a state that has its own marketplace, you may have a longer enrollment period.

A qualifying event or special enrollment period allows you to sign up for health insurance outside of open enrollment under certain circumstances, frequently these are called life events. Examples of life events that will allow you to sign up for health insurance during the special enrollment period are because you:

  • have a new baby
  • aged off of a parent’s health insurance plan
  • got married or divorced
  • lost your job
  • lost a spouse/partner and became a widower or widow
  • no longer are covered by COBRA insurance as it expired

If you did not pay your monthly insurance premiums and lost your insurance or if you voluntarily canceled your coverage these are not considered life events and would not qualify you for the special enrollment period.

What are the dates for open enrollment?

  • Open Enrollment for Medicare is October 15th to December 7th, 2017 for coverage that begins on January 1st, 2018.
  • Open Enrollment for the Health Insurance Marketplaces/Exchanges is November 1st to December 15th, 2017 for coverage that begins on January 1st, 2018.

Where can I go for plan information or compare plans?

Health Insurance Exchanges or Marketplaces

On HealthCare.gov you can learn about open enrollment and either apply for the first time or login to renew or change your plan. You are able to preview plans and see estimated prices before you log in as well. You will be asked to put in your zip code and answer a couple questions in order for the preview to give you an estimate of the cost.

Medicare

You can call 1-800-MEDICARE or go to Medicare.gov.

What types of insurance don’t use open enrollment?

Medicaid

Medicaid is a state and federal program that provides health insurance for individuals and families who qualify based on their income. Medicaid eligibility rules vary from state to state. Medicaid doesn’t limit enrollment to an open enrollment period. If you meet the qualifications for Medicaid you may enroll at any time.

CHIP

The Children’s Health Insurance Program does not limit enrollment to an open enrollment period either. CHIP provides low-cost health insurance to children in families that are above the income requirements for Medicaid, but still, require assistance. In some states, CHIP will also cover pregnant women.

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