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How does Open Enrollment work?

With most health insurance policies, you can only buy, cancel or adjust your coverage during this specified period each year.

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While you can apply for most types of insurance at any time, health insurance is a little more complicated. For most health insurance policies, you can only sign up during open enrollment — a short time frame that comes around once a year. But there are exceptions for major life changes.

What is Open Enrollment?

The Open Enrollment period is the window of time you have each year to sign up for health insurance or make changes to your current coverage. The dates vary between states, but open enrollment typically lasts a few weeks.

Technically, Open Enrollment applies to anyone who doesn’t have health insurance through their work — such as self-employed individuals and those who want to purchase a marketplace plan.

It’s slightly different to Annual Enrollment, which is the designated period where you can make changes to your employer-sponsored coverage.

However, the terms are used interchangeably, so we’ll be talking about both in this article.

What types of insurance can I get during Open Enrollment?

Most types of health insurance plans use open enrollment periods. These include:

  • Health insurance marketplace plans. Under the Affordable Care Act (ACA), you can apply for a subsidized policy through HealthCare.gov. The site will guide you to a state or federal marketplace, where you can shop for a policy that suits your needs and budget.
  • Medicare. Primarily for those 65 years old and older, Medicare is a low-cost government program. You can apply for Original Medicare and Medicare Advantage during open enrollment.
  • Employer-sponsored health insurance. If you have access to insurance as part of your employee benefits, you’ll be eligible to enroll in, adjust or disenroll from your coverage once a year. Your employer may offer health, dental, vision, disability and life insurance, as well as ancillary benefits such as legal services. They’ll typically subsidize your premiums, and any contributions you make will come out of your paycheck.
  • Private health insurance. This refers to policies you buy on your own, as opposed to getting coverage through an employer or marketplace. You can go directly through an insurer, or enlist an agent or broker to help you get quotes.

If you apply for health insurance during open enrollment, your insurance company must issue a policy. They can’t ask you to go through medical underwriting or provide evidence of insurability — both of which can make it tricker to get coverage.

Why am I hearing about the ACA and pre-existing conditions in the news?

Before 2014, you could buy individual marketplace plans all year round — but in most states, insurers looked at your medical history to determine eligibility. This means that people with pre-existing conditions could be denied coverage.
Thanks to the ACA, that’s no longer the case. Open enrollment is limited to a few weeks a year, and your insurer can’t ask any questions about your health or medical history if you apply for a policy during that period.

What types of insurance don’t use Open Enrollment?

There are no date restrictions for these insurance plans:

  • Medicaid and Children’s Health Insurance Program (CHIP). If you qualify for these programs, you can enroll at any time.
  • Medigap. Designed to supplement Original Medicare, Medigap policies are available to purchase all year. But if you want to skip medical underwriting, you’ll need to enroll in the initial six-month window.
  • Short-term health insurance. Since this coverage isn’t regulated by the ACA, plans are available year-round. However, not all states offer short-term health insurance, and many states impose limitations, according to HealthInsurance.org.
  • Travel insurance. You may need to purchase a policy shortly after you book your trip, though — so check with your insurer.
  • Supplemental insurance, in some cases. You can buy an individual policy year-round. But if your employer offers supplemental coverage — like additional life insurance — you’ll have to sign up during its enrollment period.

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When is Open Enrollment for 2021?

The time frames vary depending on the type of plan you need.

Type of plan Open Enrollment period
Marketplace and private policies

November 1 to December 15, 2020.

Nine states and DC offer longer open enrollment periods, according to HealthInsurance.org:

  • California — November 1, 2020 to January 15, 2021
  • Colorado — November 1, 2020 to January 15, 2021
  • District of Columbia — November 1, 2020 to January 31, 2021
  • Massachusetts — November 1, 2020 to January 23, 2021
  • Minnesota — November 1, 2020 to December 22, 2020
  • Nevada — November 1, 2020 to January 15, 2021
  • New Jersey — November 1, 2020 to January 31, 2021
  • New York — November 1, 2020 to January 31, 2021
  • Pennsylvania — November 1, 2020 to January 15, 2021
  • Rhode Island — November 1, 2020 to January 23, 2021

Note: Under the ACA, Native Americans and Alaskan Natives are welcome to enroll in individual plans on the marketplace year-round.

Medicare

October 15 to December 7, 2020.

This applies to Medicare Advantage and Part D plans.

Medigap plans don’t have an annual enrollment period.

Employer-sponsored coverage

Employers set their own timeframes, so it depends.

Most employers open up enrollment for a two- to four-week period in the fall, between October and December.

If you’re unsure, speak to your company’s HR or benefits department.

Can I get health insurance coverage outside Open Enrollment?

Yes — you’re eligible for a special enrollment period if you have a major life change that is considered a “qualifying event.”

These are major life changes, according to Healthcare.gov:

Qualifying event Examples
Loss of health coverage
  • You changed jobs
  • You’re longer eligible for Medicare, Medicaid or CHIP
  • You turned 26 and can’t stay on a parent’s plan
Changes in household
  • You got married or divorced
  • You had a baby
  • You adopted a child
  • You lost coverage due to a death in the family
Changes in residence
  • You moved to a different ZIP code or country
  • You’re a student moving to or from the area you attend school
  • You’re a seasonal worker moving to or from the place you live and work
  • You moved to or from a shelter or other transitional housing
Other
  • You became a US citizen
  • Your income changed, affecting the coverage you qualify for
  • You became a member of a federally recognized tribe
  • You gained status as an Alaska Native Claims Settlement Act (ANCSA) corporation shareholder
  • You were released from prison
  • You started or ended service as a AmeriCorps member

How to prepare for Open Enrollment

There are a few decisions to make to ensure you get the coverage you need. In the leadup to open enrollment or annual enrollment, follow these steps:

  • Figure out how you’re going to get health insurance. If you’re buying coverage on your own, you can go to insurers directly or shop via the health insurance marketplace. And if your employer offers subsidized coverage, ask about the enrollment dates and types of policies offered. You may also be able to opt into your spouse’s health plan.
  • Compare plans and coverage. Firstly, assess the premiums to make sure they’re affordable. Then, weigh up the features of each policy — including deductibles, copays, out-of-pocket limits and out-of-network coverage. The amount of coverage you need comes down to how often you visit a doctor, if you take prescription medications and whether you have new dependents to cover, like a baby.
  • Look into dental and vision benefits. Once you’ve selected a health insurance plan, check out your options for dental and vision coverage. While these policies aren’t legally required, dental insurance may be a good idea if you’re due for a checkup or cleaning, or anticipate needing a root canal, oral surgery or orthodontics in the next year. Similarly, if you need new glasses or contacts, a vision insurance plan can cover some of those costs.
  • Assess life and disability insurance. Your employer might offer these policies at a low or no cost to you. Life insurance pays out to your beneficiaries if you die during the term, while disability insurance replaces part of your salary if you become sick or injured and can’t work for a period of time.
  • Decide if you want to open a HSA or FSA. Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) allow you to use pretax money to pay for eligible health expenses, like premiums, deductibles and over-the-counter medications. There are maximum contributions you can make to each. The key differences are that your employer owns your FSA, and if you don’t use all the funds by the end of the year, you may lose them. By contrast, you own your HSA — so you can roll over the funds if necessary.

Is there an Open Enrollment period for HSAs and FSAs?

If you want to set up a FSA, you’ll need to wait for your employer’s annual enrollment period. You can usually only change your FSA contributions during that time — but the IRS has relaxed the rules in response to the COVID-19 pandemic.

You can enroll in a HSA at any time, as long as you have a high-deductible health plan. You can also update your contributions throughout the year.

Bottom line

For most health insurance plans, you can only buy coverage during a short window of time each year. This is known as open enrollment, and it differs slightly from annual enrollment — which is when you can opt into any job-based benefits, like health, vision and dental insurance.
To make sure you’re ready to make your elections for open enrollment 2021, compare health insurance policies.

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