- In most states, open enrollment for 2020 coverage has ended.
- California, Colorado, and Washington, DC, have permanently extended open enrollment (Colorado’s has ended, but enrollment continues until the end of January in DC and Connecticut).
- Massachusetts has extended open enrollment until January 23.
- New York has extended open enrollment until January 31.
- Idaho, Minnesota, Washington, Rhode Island, Connecticut, and Colorado extended open enrollment but it has since ended.
- The open enrollment schedule has changed several times
- State-run exchanges have flexibility to make OEP longer. For 2018, 2019, and 2020 coverage, 10 state-run exchanges extended open enrollment, although the details have varied each year.
- If your plan ended on December 31, you have a special enrollment period.
- Outside of open enrollment, you’ll need a qualifying event to enroll.
- Enrollment periods help prevent “gaming the system.”
- Limited enrollment windows have long been the norm for health plans.
- Consumer advocates worry that the shorter enrollment period makes it harder for people to enroll.
Q. What is the deadline to enroll in health insurance coverage in the individual market?
A. In most states, open enrollment for 2020 health plans has ended. HealthCare.gov allowed a brief (36-hour) extension after the official enrollment window ended on December 15, but that ended early in the day on December 18 (HealthCare.gov is used in 38 states). Enrollment ended in Idaho on December 16, in Minnesota on December 23, in Washington state on December 30, in Rhode Island on December 31, and in Connecticut and Colorado on January 15. Nevada residents who began the enrollment process by December 15 had until December 20 to finish the process.
In the remaining states, enrollment in 2020 coverage is still ongoing, with varying deadlines:
- Massachusetts: January 23
- California: January 31
- DC: January 31
- New York: January 31
Vermont and Maryland did not issue any sort of extensions for enrollment in 2020 plans.
Outside of open enrollment, plan changes and new enrollments are only possible for people who experience a qualifying event.
Native Americans and Alaska Natives can enroll year-round in plans offered in the exchange. Applicants who are eligible for Medicaid or CHIP can also enroll year-round.
California, Colorado, and DC: Open enrollment has been permanently extended
California enacted legislation in 2017 and again in 2019 that permanently establishes different enrollment dates within the state, both on and off-exchange. Open enrollment for 2020 health plans began October 15, 2019 for plans sold through Covered California, and November 1, 2019 for plans sold outside Covered California. But in both cases, enrollment continues through January 31, 2020. This same schedule will be followed in future years as well, so Covered California’s enrollment period is permanently scheduled to run from October 15 through January 31.
Colorado‘s Division of Insurance has also permanently extended open enrollment. State regulators published draft regulations in August 2018 calling for an annual special enrollment period, running from December 16 to January 15, that will be added to the end of open enrollment each year. The regulations were finalized in November 2018, adding the “annual market stabilization special enrollment period,” so open enrollment in Colorado will effectively last 2.5 months for all future enrollment periods (November 1 to January 15). Plans selected between December 16 and January 15 must take effect no later than February 1.
In DC, the exchange board voted unanimously to permanently implement an open enrollment window that runs from November 1 to January 31.
Massachusetts has extended open enrollment for 2020 coverage
In July 2019, the Massachusetts Division of Insurance announced that open enrollment for individual market coverage, both on- and off-exchange, would run from November 1, 2019 to January 23, 2020.
The 23rd of the month is the normal deadline in Massachusetts for a first-of-the-following month effective date (as opposed to the 15th in most states), so people who enroll by December 23 will have coverage effective January 1, and people who enroll by January 23 will have coverage effective February 1.
New York has extended open enrollment for 2020 coverage
As has been the case in prior years, New York State of Health’s open enrollment for 2020 plans will continue until January 31.
Enrollment was extended in Idaho, Minnesota, Washington, Connecticut, Colorado, and Rhode Island, but the deadlines have now passed
Idaho’s state-run exchange, Your Health Idaho, has consistently opted not to extend open enrollment over the last few years. But for enrollments in 2020 plans, they extended open enrollment by one day because December 15th was a Sunday this year, and Your Health Idaho’s call center is not open on Sundays.
As has been the case in prior years, people who applied by the end of open enrollment had a few extra days (until December 23) to finalize their plan selections for 2020 coverage.
MNsure announced that residents in Minnesota had until December 23, 2019 to select a health plan for 2020. Although MNsure normally requires applicants to enroll by the 15th of the month to have coverage the first of the following month, coverage was effective January 1, 2020 for any applicants who enrolled by December 23.
Washington Healthplanfinder issued a last-minute extension on December 16, giving Washington residents an extension through December 30.
As was the case last year, Rhode Island extended the enrollment deadline for 2020 health plans through the end of December. There was no press release or announcement on social media, but as of mid-October the exchange website had a notice saying “Mark your calendars! Open Enrollment for 2020 coverage starts November 1, 2019 and ends December 31, 2019.”
After enrollment ended on December 15, Access Health CT announced that enrollment would be extended until January 15, giving residents another full month to sign up. Enrollments completed between December 16 and January 15 will have coverage effective February 1. Connecticut’s exchange had already announced that.
As noted above, Colorado’s enrollment window has been permanently extended and will continue until January 15 each year. For 2020 coverage, enrollment has ended in Colorado.
Open enrollment schedules: A history
For 2014 coverage, when the bulk of the ACA’s provisions were first being implemented, open enrollment lasted six months (October 1, 2013 to March 31, 2014), in an effort to give everyone enough time to get used to the new system and enroll.
For 2015, 2016, and 2017 coverage, open enrollment lasted for three months. Open enrollment for 2018 coverage was scheduled to follow the same three-month time frame that the past two open enrollments used (November through January). But in April 2017, HHS finalized a market stabilization rule that included a variety of changes ostensibly aimed at protecting the stability of the individual health insurance market.
One of the changes made by the new rule was the open enrollment schedule for 2018 coverage. It was reduced to half of what was previously scheduled, although it’s worth noting that the November 1 — December 15 schedule was already slated to take effect in the fall of 2018 (for 2019 coverage). The market stabilization rule just moved it up a year. However, the Trump administration also drastically reduced funding for outreach, marketing, and enrollment assistance for HealthCare.gov, which is the exchange used by the majority of the states. This was certainly not what the previous administration had in mind when they scheduled the transition to a shorter open enrollment period. If anything, the shorter enrollment period requires more funding, not less.
The open enrollment window applies in the exchanges, and it also applies to plans purchased outside the exchange, although there are insurers in many states that allow people to enroll outside the exchange until December 31. [Prior to October 2019, Nevada law required health insurers to make their off-exchange plans (ie, purchased directly from the insurer) available for purchase year-round, albeit with a waiting period of up to 90 days. But the state enacted legislation in 2019 which eliminated that requirement.]
So nationwide, both on-exchange and off-exchange, health plans in the individual major medical market are only available during open enrollment or during a special enrollment period triggered by a qualifying event (with the exception noted above, regarding certain insurers that allow people to enroll off-exchange during the final two weeks of December).
State-run exchanges have some flexibility on open enrollment schedule
The 2017 market stabilization rule noted that the November 1 — December 15 open enrollment period would apply in every state in the fall of 2017. However, they also noted that some state-based exchanges — there are 13 of them as of 2020 — might experience logistical difficulties in getting their systems ready for the new schedule on a fairly tight timeframe.
As such, the market stabilization rule clarified that state-based exchanges could use their own flexibility to “supplement the open enrollment period with a special enrollment period, as a transitional measure, to account for those operational difficulties.” Ten of the 12 state-based exchanges that use their own enrollment platform ultimately opted to extend open enrollment for 2018 — only Idaho and Vermont kept the December 15, 2017 end date. And again the following year, 10 state-based exchanges extended open enrollment for 2019 coverage, although it was Idaho and Maryland that opted to stick with the December 15 end date.
For 2020 enrollments, Maryland, Vermont, and Nevada opted to keep the December 15 end date (and Idaho came very close to it; their reason for a one-day extension was that their call center isn’t open on Sundays, and the 15th fell on a Sunday. In general, Idaho residents should expect that the enrollment window will not be extended in the future, given how well they’ve adhered to that deadline for the last few years).
As we can see from the decisions in DC, California, and Colorado (to permanently extend open enrollment), states with their own enrollment platforms still have flexibility going forward. HHS has defined open enrollment as the window from November 1 to December 15, and that applies in every state. But state-run exchanges have the option to offer special enrollment periods before or after that window, in order to effectively extend open enrollment.
Pennsylvania, New Mexico, and New Jersey will have state-run exchange platforms by the fall of 2020; Maine might do so as well by the fall of 2021, and Oregon may join them in the future as well. Fully state-run exchanges are the only ones with the ability to extend open enrollment on their own (in the other states, the decision has to come from CMS, since the extension has to be issued via HealthCare.gov), and most of them have been choosing to do so each year.
Outside of the open enrollment window, enrollment is only available with a qualifying event
After open enrollment ends, people can only purchase coverage if they have a special enrollment period triggered by a qualifying event such as:
- Marriage (since 2017, this generally only applies if at least one spouse already had coverage before the wedding, although there are some exceptions),
- Becoming a U.S. citizen,
- Birth or adoption,
- Involuntary loss of other health coverage (this allows people to select a new plan in the first two months of the year if their insurer leaves the market at the end of the previous year; see details below).
- A permanent move to an area where new health plans are available (since July 2016, this only applies in most cases if you already had coverage prior to your move).
- Here’s a full list of qualifying events and their associated special enrollment periods.
Regardless of whether you purchase insurance through the exchange or off-exchange, the annual open enrollment window applies, and special enrollment periods are necessary in order to enroll at any other time of the year.
In 2016, HHS tightened up the rules regarding eligibility for special enrollment periods, and they further tightened the rules in 2017, as part of the market stabilization rule. As a result, the rules are being followed much more closely than they were in previous years, and in most states, anyone enrolling during a special enrollment period is required to provide proof of the qualifying event that they experienced
Special rule for loss of coverage
If your health plan was terminated on December 31 for reasons other than non-payment of premium or fraud, you are eligible for a special enrollment period, as loss of coverage is a qualifying event. In order to take advantage of this provision, you’ll need to check the box on the application that says you’re enrolling because you lost coverage.
People who had on-exchange coverage with an insurer that left the market were mapped to plans with different insurers if they didn’t return to the exchange to pick a new plan by December 15. But in most states, they’re still eligible for a special enrollment period (which continues for 60 days after the old plan ended) during which they can return to the exchange and pick a different plan.
People who had off-exchange coverage with an insurer that left the market are generally uninsured as of January 1 if they didn’t pick a new plan for themselves by December 31, as there’s no entity available to automatically select a new plan for them. But the same special enrollment period applies to off-exchange enrollees — they have 60 days after the old plan ends to sign up for a new plan (albeit with a gap in coverage if they didn’t sign up by December 31, as the earliest available effective date after that point is February 1).
In 2017 and 2018, numerous insurers exited the exchanges, leaving many people having to pick new plans. But for 2019, we saw the opposite trend, with insurers joining the exchanges in many states: Insurers joined the exchanges in Arizona, Florida, Illinois, Iowa, Maine, Massachusetts, Michigan, Missouri, New Mexico, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Utah, Virginia, and Wisconsin.
For 2020, the same thing happened, with widespread coverage area expansions, along with insurers joining (or rejoining) the exchanges in Alaska, Colorado, Florida, Georgia, Kansas, Louisiana, Mississippi, Missouri, Nebraska, Nevada, New Mexico, North Carolina, Oklahoma, Pennsylvania, South Carolina, Utah, Virginia, Washington, and Wisconsin.
But even when insurers remain in the exchange, they can change their coverage area from one year to the next. If an insurer exits a particular area of a state, people who had plans with that insurer in that area are eligible for a special enrollment period due to loss of coverage. The same is true if, for example, an insurer terminates all of the PPO plans they have and replaces them with HMOs. The people who had the plans that are terminated can opt to just accept the new HMO plan, but they also qualify for a special enrollment period during which they can pick a different plan.
Limited enrollment windows are normal and necessary when coverage doesn’t depend on your medical history
We frequently see people lamenting the fact that there’s a limited window in which to purchase coverage, but there are a couple of points to keep in mind:
- Limited open enrollment periods have long been the norm for employer-sponsored health insurance, which is where most non-elderly Americans get their coverage (you can’t just enroll in your employer’s plan anytime you like; you have to wait for open enrollment unless you have a qualifying event).
- Medicare also has limited annual open enrollment periods.
- The individual health insurance market used to allow people to purchase coverage anytime they wanted. But the insurance company would ask a long list of medical history questions and would decline applications from people with serious pre-existing conditions. That’s no longer the case, so the limited enrollment window is necessary to prevent people from waiting until they’re sick to enroll (which would be unsustainable, since insurance only works if there are enough healthy people paying premiums to offset the costs of the sick people).
Shorter open enrollment is controversial
The reason the Obama Administration had planned to shorten open enrollment (the Trump Administration moved this up a year, implementing it in the fall of 2017 instead of 2018) was to ensure that as many people as possible are enrolled in coverage for the full year. In the past, open enrollment continued throughout January — or even later, in the case of the initial open enrollment periods — which meant that people could sign up near the end of open enrollment and get a plan that took effect in March.
The idea behind the new schedule is that everyone has coverage that starts in January, making people more likely to pay for a full year of coverage. The new schedule also removes the ability for people to “game the system” by signing up in November for an expensive plan, utilizing it for a planned expense (a surgery, for example) in January, and then switching to a lower-cost plan with an effective date in February or March (note that this can be a counterproductive approach, as the out-of-pocket maximum would reset to zero when the new plan starts; if the person ends up needing medical care during the remainder of the year, they’d be starting from scratch on their deductible and out-of-pocket, without getting credit for the cost-sharing amount they paid under the more robust plan). It also eliminates the adverse selection that would otherwise occur when people don’t plan to enroll but then find out in late December or January that they’re in need of health care.
But on the other side of the coin, there has been considerable concern among consumer advocates, brokers, and other enrollment assisters who worry that six weeks just isn’t enough time to help everyone get enrolled. The new open enrollment period mostly overlaps with open enrollment for Medicare Advantage and Medicare Part D, and many of the brokers who help people enroll in individual market plans are also helping people enroll in Medicare during the same time, stretching their resources.
There have also been concerns that the shorter open enrollment period might mean that fewer young, healthy people will enroll in individual market coverage. Sick people tend to enroll as soon as open enrollment begins, so they’ll enroll regardless of the schedule. But young, healthy people — the people who are needed in order to keep the risk pools stable — are more likely to procrastinate and enroll at the last minute. The shorter open enrollment period might mean that they just don’t enroll at all, with total enrollment ending up lower than it would have been with the longer enrollment period.
But despite the shorter enrollment period and the funding cuts that the Trump administration made for marketing and enrollment assistance, enrollment in plans for 2018 was only slightly lower than it had been the year before. Almost 11.8 million people enrolled in exchange plans for 2018, versus about 12.2 million for 2017.
For 2019, enrollment ended only a little lower, at about 11.4 million, despite the fact that the individual mandate penalty has been eliminated. The Congressional Budget Office projected that 3 million fewer people would obtain coverage in the individual market (including on- and off-exchange plans) in 2019 as a result of the elimination of the mandate penalty. So while off-exchange enrollment has likely dropped precipitously, on-exchange enrollment only dropped by a few hundred thousand people.
Enrollment totals for 2020 aren’t yet available from all of the state-run exchanges, but enrollment via HealthCare.gov ended up just slightly lower in 2020 than it was in 2019 (about 8.3 million people versus 8.4 million in 2019), And that’s despite the fact that Nevada residents switched to Nevada Health Link for 2020 (instead of using HealthCare.gov) and tens of thousands of residents in Utah, Idaho, and Maine are eligible for Medicaid for 2020, instead of private plans in the exchange.
The Trump administration also finalized rules in 2018 that expand access to short-term health insurance plans. These plans are more likely to appeal to healthy people, which could have resulted in fewer people signing up for ACA-compliant health plans during open enrollment for 2019 and 2020 coverage. But again, many of those individuals may have previously uninsured or had coverage in the off-exchange market, so their enrollments and plan changes are not as closely tracked.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.