An open enrollment period is where you can enroll in or make changes to your employee benefit selections. Every year, employees have the option to change their medical coverage during open enrollment. If employers have 50 or more employees and offer health benefits, they must offer an “open enrollment” period. The enrollment window is usually kept open for approximately 30–60 days before the renewed plan takes effect. What if you miss open enrollment for health insurance at work?
For example, open enrollment for 2022 runs from November 1, 2021, through January 15, 2022. You should enroll by Dec. 15 for coverage that starts on Jan. 1. Open enrollment is also available to individuals or families who buy their own insurance through ACA (Affordable Care Act) exchanges or directly from health insurance companies.
Open enrollment is an important period for health insurance.
Through open enrollment, you can take advantage of benefits like health, vision, dental, life insurance, and HSA. During the open enrollment period, the rates are reassessed and the health plan prices are also altered for the coming benefit year.
The changes that you could make to a health insurance plan include:
- adding or dropping coverage
- adding or removing dependents
- enrolling for benefits for the first time
If you miss the open enrollment window, you could end up losing coverage for yourself and your dependents. Also, you might be subject to a fine by the ACA. You might not be able to make changes until the next open enrollment period begins.
While this might sound like a scary fallout for missing one deadline, there are ways and circumstances in which you could still get some coverage or try to minimize the financial risk.
What's the eligibility under the special enrollment plan?
The first thing to do would be to check if you qualify for a SEP (special enrollment period). It's a period of time during which you could buy coverage even outside the normal open enrollment period. There are some events that make you eligible for SEP and are known as qualifying life events. Some examples of the events include:
- getting married/divorced
- having a baby/adopting a child
- losing coverage due to the death of a spouse, parent, or guardian
- losing eligibility for Medicare, Medicaid, or CHIP due to a change in income or household circumstances
Changes related to residence changes like moving to a different ZIP code or country, a seasonal worker moving to/returning from work, a student moving to/returning from school/university, or becoming a U.S. citizen also make you eligible for SEP.
Other options are available for health coverage.
There are other options for obtaining health coverage including:
- Enroll in coverage through your spouse’s plan if he/she has one and their enrollment period is still open.
- If you're younger than 26 years, you might be able to get added to your parent’s plan as a dependent.
- You could consider buying health insurance from the Health Insurance Exchange Marketplace.
- You could check your eligibility for Medicaid, which provides health coverage to low-income adults. Pregnant women, the elderly, and people with disabilities could also get coverage through Medicaid.
- If you're out of all the above options, you could buy a short-term health insurance plan, which is a temporary plan that offers an affordable way to pay for healthcare for a brief period of time.