Annual checkups are key in maintaining health and wellness, but they aren’t just for your body. Reassessing your health insurance plan needs on a yearly basis—especially following new diagnoses or big life events—can go a long way toward optimizing your coverage. Each year, Americans get a chance to do just that during their annual open enrollment period in the marketplace and/or with their employer.
What is the open enrollment period?
The annual open enrollment period is the time of year during which Americans can make changes to their elected health insurance coverage (such as the group health plan they receive through their employer) or purchase new insurance through the Health Insurance Marketplace (also known as Obamacare). (People with Medicare or Medicaid will have different stipulations and times for enrollment.)
Open enrollment is also a good time for beneficiaries to add a spouse or dependents, or otherwise change their household composition, to their plan if they haven’t done so already.
Even if you plan to renew your current plan, it’s a good idea to check the fine print for the coming year—what is and is not included (such as prescription medications and copays) changes year to year, so you’ll want to make sure you have the right coverage for you and your family.
If you miss the open enrollment period for the federal marketplace, you may still be able to elect new coverage or make changes to your plan during a special enrollment period. However, you must have one of the following qualifying life events to participate in special enrollment:
- Changes in your household: If you get married, divorced (with a loss of coverage), or have or adopt a baby, you may qualify for special enrollment. You may also qualify if someone in your household dies and you lose coverage because of it. You must apply for coverage within 60 days of one of these events.
- Changes in your residence: If you move to a new zip code or county, or move to the U.S. from another country, you may qualify for special enrollment. The same goes for students moving to or from where they were attending school. One caveat: Unless you moved from another country, you’ll have to prove you had health insurance coverage for at least one day during the 60 days before you relocated in order to qualify.
- Loss of your health insurance coverage: If you lose your health insurance because of an involuntary job loss, a family member losing coverage, or because you become ineligible for the Medicare or Medicaid services you were receiving, you may qualify for a Special Enrollment Period.
- Other qualifying events: If you recently became a U.S. citizen or left incarceration, you may qualify for special enrollment.
When is open enrollment 2021?
While open enrollment for Affordable Care Act-compliant coverage in 2020 has already passed, the 2021 period is coming up. Open enrollment dates are Nov. 1 through Dec. 15, 2020 in most states, giving beneficiaries about six weeks to shop and compare plans before purchasing them through one of the health insurance exchanges (either the federally run healthcare.gov or their state-run marketplace).
If your state operates its own health insurance marketplace, those dates may vary slightly (for instance, California, Colorado, and Washington D.C. have permanently extended their dates into January). Additionally, due to the COVID-19 pandemic, many states have extended their open enrollment deadlines, so check your state’s marketplace to be sure. In 2021, 16 states (including New York, Massachusetts, and Washington) will run their own exchanges.
If you sign up for coverage during the open enrollment period, your insurance will take effect Jan. 1.
The Medicare open enrollment period differs from ACA open enrollment period. Medicare open enrollment for 2021 is Oct. 15 through Dec. 7, 2020, with plans going into effect on Jan. 1. Medicare also offers a number of other unique enrollment periods for varying purposes. You can visit medicare.gov to learn more.
What happens if you miss open enrollment?
If you miss the 2021 open enrollment period, you run the risk of not having health insurance coverage for an entire year (unless you qualify for a special enrollment period). This means you may have to pay for medical costs, such as doctors visits, prescription medications, and emergency services, out of pocket.
While the ACA used to require those who did not have health coverage (and were not exempt) to pay a fine (otherwise known as a Shared Responsibility Payment) on their federal tax return, the Tax Cuts and Jobs Act did away with that payment for tax year 2019 and beyond. However, there are a handful of states that still charge a financial penalty, so you’ll want to check with your state’s law.
There are other coverage options worth investigating if you’ve missed the open enrollment period. First off, check to see if you can be added to your spouse or partner’s plan, or if you’re under the age of 26, your parent’s plan.
If you have little to no income, you may qualify for Medicaid or CHIP (Children’s Health Insurance Program), which is affordable health coverage provided by the government. You can find out if you qualify through either the Health Insurance Marketplace or by contacting your state’s Medicaid agency.
Short-term plans are another stopgap for coverage. A short-term insurance plan provides coverage for at least 364 days, with the potential to extend up to 36 months. This coverage is much less extensive than the type of plan you would get through an employer or the Marketplace—short-term insurance is not required to cover prescriptions or maternity costs, for instance—but it can help defray medical bills while you await the open enrollment period next year.
Another coverage option is gap insurance (also known as supplemental insurance). Gap insurance is meant to work in conjunction with your primary insurance (it’s often called insurance for your insurance) to help fill coverage holes. For instance, some ACA plans do not include dental or vision, so a beneficiary might add a supplemental insurance plan so they can get their teeth cleaned or buy a new pair of glasses. Gap insurance is not meant to replace primary coverage, but might come in handy in case of an emergency.
To help offset prescription medical costs without insurance, there’s also the SingleCare discount card. Free to download and use, the SingleCard card isn’t a form of insurance—but a discount program that reduces the cash price of prescriptions at U.S. pharmacies. Search for your meds and see how much you can save today!