Your most important open enrollment questions answered
Autumn in the U.S. often means changing leaves, darker nights and dipping temperatures. But autumn is more than just a precursor to winter. For health insurers and qualifying individuals, autumn also means open enrollment for employer-sponsored health insurance programs. The open enrollment period—also known as "annual enrollment"—is the time of year when people can enroll in a health insurance plan for the next year.
It's always best to go into a new year confident about your health plan, so we put together a brief list of the most common questions people ask about open enrollment. Our goal is to make sure everyone has the most up-to-date information they need to make the health care decisions that make sense for them.
When is open enrollment?
The open enrollment period starts on Nov. 1. But that's not the only important date you need to remember. For coverage that is scheduled to begin on January 1, health care decisions need to be made mid-December. And, if you qualify for a Special Enrollment Period (SEP) exception, you can make health care decisions any time you'd like.
What is the Special Enrollment Period (SEP)?
The SEP refers to certain life events including losing previous coverage, moving to a new place, getting married, having a baby or adopting a child. The idea with SEP is that uncontrollable events often require new or extended health coverage. The government doesn't think individuals should be penalized for needing health care during times of transition. Depending on your employer's benefits enrollment policy, you may have 60 days prior to or 60 days following the life event to enroll in a new plan. Employer-sponsored health plans must provide a SEP of at least 30 days.
Medicaid and Children's Health Insurance Program (CHIP) coverage are other ways people can be eligible for coverage. Medicaid and CHIP are free or low-cost health programs that cover services like hospital and doctor visits and prescription drugs.
Who is eligible for Medicaid?
People with low income, including individuals, families and children, pregnant women, older adults and people with disabilities are eligible for Medicaid. Many states have expanded Medicaid programs to cover all people below certain income levels.
It's easy to find out if you're eligible for Medicaid. You just need to create an account and fill out a Marketplace application. If you earn too much money to qualify for Medicaid, don't worry. You might qualify for additional savings on out-of-pocket costs or be eligible for tax credits.
What is CHIP and who qualifies for it?
The Children's Health Insurance Program (commonly referred to as CHIP) is a program designed to keep kids safe. It provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid, but not enough to buy private insurance. In some states, CHIP also covers pregnant women. Every state offers some form of CHIP coverage, which works closely with that state's Medicaid program. That means you'll always have the coverage you and your children need. Again, filling out a Marketplace application is the best way to find out which CHIP benefits you qualify for.
How does the Marketplace work?
The health insurance Marketplace exists in each state. It allows people to compare health insurance coverage plans. It can also tell people if they're eligible for tax credits or private insurance or health programs like Medicaid or CHIP. Once you create a Marketplace application, your information will be forwarded to your state agency. If there is a chance anyone in your household qualifies for Medicaid or CHIP, your state agency will contact you about enrollment.
If you change plans in the Marketplace or add a new household member, any out-of-pocket costs you've already paid won't transfer to your new plan. This is true even if you stay with the same insurance company. Be sure to call your current insurance company before changing plans to make sure you know what to expect.
The bottom line
November is when things outside tend to get a bit blustery. But it's also time to make decisions about your health care for next year, so don't get left out in the cold! If you're worried you make too much money to get help with health coverage, think again. Your circumstances will determine your options, so don't hesitate to fill out a Marketplace application as soon as you can.