Open enrollment is the period each year when you’re allowed to start, stop or change your health insurance plan. Normally, you sign up around the end of one calendar year for coverage that lasts the full next year.
You’ll want to know when your open enrollment is so you have enough time to research and choose a health plan.
Open enrollment for 2017 health insurance
|Marketplace plans (Healthcare.gov and state exchanges) and individual health insurance plans||Nov. 1, 2016 - Jan. 31, 2017|
|Employer-sponsored health insurance||Dates depend on your employer, but typically in the fall|
|Medicare||Oct. 15 - Dec. 7, 2016|
|Medicaid||No date restrictions — you can apply at any time|
Open enrollment for marketplace and other individual health insurance plans
The open enrollment window for private, individual health plans will last three months for 2017 coverage: Nov. 1, 2016, to Jan. 31, 2017. This applies to all private, individual health plans.
You can shop for private plans in four ways:
- On Healthcare.gov or a state exchange.
- On the phone, by calling the marketplace call center at 1-800-318-2596.
- Directly on an insurer’s website.
- Via a local health insurance broker.
Note that tax credits to lower monthly premium payments are available only on Healthcare.gov or your state’s exchange. If you qualify for those subsidies, shopping on the exchange or phoning the marketplace call center is likely your best financial choice.
Most people who shop on state or federal exchanges qualify for premium help. In 2015, 84% of consumers who shopped on the exchange had subsidized premiums, according to the Centers for Medicare and Medicaid Services.
If your income is too high to qualify for tax credits, there may be some good reasons to shop elsewhere. The main reasons to not use the Affordable Care Act marketplace exchanges for health insurance are:
- The provider network doesn’t work for you. Your preferred doctors are not in the provider networks of the plans on the exchange.
- You want more plan options. Insurers can offer the same plans on the exchange and off, at the same price, and many do. They also may offer additional plans through their website or brokers that aren’t available on the marketplace. You can compare all of an insurer’s available plans by going directly to the source.
- You have a chronic condition and the marketplace plans don’t cover your needs. Plans purchased directly from an insurer or through a broker might have better benefits. For example, if your drug is not on a plan’s drug formulary or medical equipment you need isn’t covered, you should look at non-marketplace plans.
You won’t sacrifice plan quality by avoiding the health insurance exchanges. All health insurance policies are required to cover the same essential benefits and meet minimum standards.
Many plans automatically discontinue after the plan year, but not all. If you have a plan from an exchange and want to discontinue it, make sure you do so as of Dec. 31.
The only way to get an individual health plan outside of open enrollment is to qualify for a special enrollment period.
Open enrollment for employer-sponsored insurance (group health insurance)
If your health insurance comes from an employer, your open enrollment may not be at the same time each year. Your employer and health insurer will decide the open enrollment dates, and the timing may depend on a lot of factors, including when new plan information is available from the insurer. But selection is generally during the fall.
In general, employer open enrollment periods for health insurance are shorter than for other plans because there are fewer plan options and workers often can use business hours to choose one. Most companies offering health insurance have one to three plans for employees, says Sally Poblete, CEO of Wellthie, a health benefits consultant and software provider for employers and brokers.
Fifty percent of workers are “extremely” or “very” satisfied with their employer’s plans, according to the Employee Benefit Research Institute, and an additional 41% are “somewhat satisfied.” Employer-provided insurance is often much less expensive than similar plans you’d find on public exchanges, because employers often cover a portion of workers’ premiums.
However, you might prefer to buy a plan other than your employer’s group health insurance, either because the networks don’t include your doctor or because you’d like specific benefits your workplace isn’t offering.
If that’s the case, take note of these rules:
- You must decline your employer’s insurance during your workplace open enrollment period.
- When you decline your employer’s insurance, you can’t get premium tax credits for a marketplace plan if your employer’s plan is “affordable” and meets a minimum value standard. An employer plan is “affordable” if your portion of premiums for the lowest-cost self-only plan is less than 9.66% of your household income, and the plan must pay at least 60% of medical bills to meet minimum value.
- You can sign up for private health insurance only during the national open enrollment period, whether through a broker or online.
Medicare open enrollment
Medicare open enrollment is Oct. 15 to Dec. 7, 2016. Medicare beneficiaries also have other time periods throughout the year when they can change benefits. And unlike other types of insurance, Medicare has additional “disenrollment” periods.
Here are the dates to be aware of each year if you have Medicare or are approaching age 65:
- Oct. 15 to Dec. 7: open enrollment.
- Jan. 1 to Feb. 14: Medicare Advantage disenrollment. If you want to switch from Medicare Advantage to Original Medicare, you can do so during this time.
- Jan. 1 to March 31: Medicare Part B general enrollment. If you wish to enroll in Part B, you can do so during this time as long as you already have Part A.
Other health plans
There are some short-term health plans you can purchase outside of open enrollment without a special enrollment period. Those plans usually don’t count as minimum coverage under the Affordable Care Act, so buying one doesn’t protect you from paying the penalty for not having health insurance. Additionally, they tend to have high deductibles and poor coverage.
Lacie Glover is a staff writer at NerdWallet, a personal finance website. Email: firstname.lastname@example.org. Twitter: @LacieWrites.