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A TRUSTED INDEPENDENT HEALTH INSURANCE GUIDE SINCE 1994.
An open enrollment period is a window during which individuals and employees may enroll in health insurance or make changes to their coverage.
For employer-sponsored coverage, the open enrollment period is generally the only time that employees can drop their coverage, whereas, in the individual market, people can drop coverage at any time during the year. But in both cases, open enrollment is the only time that people can sign up for a plan, or switch to a different plan, unless a special enrollment period is triggered by a qualifying event.
General open enrollment in the individual market (both on-exchange and off-exchange) runs from November 1 to January 15 in most states, although states that run their own exchanges have flexibility with this and some have different enrollment schedules.
You can learn more in our comprehensive guide to individual market open enrollment.
Employers can set their own open enrollment windows, so although it’s common for them to occur in the fall, they vary from one employer to another.
Medicare also has an annual open enrollment period in the fall for Medicare Part D and Medicare Advantage, as well as an open enrollment period at the start of the year for people who are already enrolled in Medicare Advantage.
You can learn more in our comprehensive guide to Medicare open enrollment.
In the individual market, most plans will take effect on January 1. But in most states, enrollments completed between December 15 and January 15 will have coverage effective on February 1, and March 1 is a possible effective date in some states that have longer enrollment windows.
If you enroll in an individual market plan due to a qualifying event, your coverage will generally take effect the first of the month after you enroll. But some states that run their own exchanges still have a 15th of the month deadline for this, meaning that your coverage might take effect the first of the second following month if you enroll after the 15th (in most states, there is no longer a 15th of the month deadline). And if the qualifying event is a newborn or newly adopted child, coverage can be backdated to the date of birth or adoption.
When Medicare beneficiaries make changes to their coverage during the fall open enrollment period, the new plan will take effect January 1. But if Medicare Advantage enrollees make changes to their coverage during the Medicare Advantage open enrollment period (January – March each year), the new plan will take effect the first of the month after the change is made.
If you enroll, disenroll, or make changes to your coverage during your employer’s open enrollment period, they will take effect on the first day of your employer’s plan year. In most cases, this is set up to correspond with the calendar year, meaning that the plan year starts on January 1. But some employers have plan years that do not follow the calendar year, so you’ll want to carefully read the information that your employer gives you during the open enrollment period.
Sticking with your current health insurance plan – without exploring your options – can be a huge enrollment blunder. Here are the top mistakes to avoid.