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HEALTH Insurance
HEALTH INSURANCE INSIGHTS

Open enrollment for plans through the Affordable Care Act runs between Nov. 1 and Jan. 15 in most states. During that time, you can choose a new health plan or make changes to your current one.

Open enrollment is a time to make changes to your health insurance plan or to buy a different one.

When open enrollment is for you depends on how you get insurance. Most people get their insurance through an employer, and open enrollment for businesses varies. The company makes that decision. Check with your human resources department to find out when your company holds open enrollment.

If you don’t get health insurance through an employer, there are a few dates to know:

  • Medicare recipients can make changes between Oct. 15 and Dec. 7 or during a more limited open enrollment from Jan. 1 to March 31.
  • Most people who get individual insurance through the Affordable Care Act (ACA) exchanges have between Nov. 1 and Jan. 15 to enroll. A handful of states have their own open enrollment period.

Read on to learn everything you need to know to enroll in a 2023 health insurance plan.

KEY TAKEAWAYS
  • Open enrollment is a specified period of time during which you can sign up for health insurance or change your plan.
  • A special enrollment period is when people can sign up for health insurance or make changes if they have a qualifying life event.
  • If you don’t get health insurance through an employer, you can buy through the ACA marketplace or directly from an insurer.
  • If you are healthy and don’t use a lot of medical services, you might want a plan with a lower premium, such as a bronze or silver plan.

What is open enrollment?

Open enrollment is the time of year – in the fall and winter – when people can enroll in a health insurance plan for the next calendar year, or make any necessary changes to their plan.

Often, when people mention “open enrollment health insurance,” they think of the health plans through the online, state-based health insurance exchanges that came about when the Patient Protection and Affordable Care Act was passed in 2010.

Open enrollment for these health plans can be found at Healthcare.gov. Open enrollment for 2023 health insurance takes place in the fall of 2022 for health plans on the private market.

However, if you get health insurance at work, you may have a separate open enrollment period designated by your employer.

When is 2022 open enrollment for health insurance?

Open enrollment for plans through the Affordable Care Act starts on Nov. 1 and goes through Jan. 15, 2023. To get coverage starting on Jan. 1, 2023, you'll need to select a plan by Dec. 15.

Some states have longer open enrollment periods, though this can change, so you should confirm dates with your state’s website. Currently, these states have longer enrollment periods, and you may notice that Rhode Island’s open enrollment period is extremely long:

  • California: Nov. 1 to Jan. 31
  • District of Columbia: Nov. 1 to Jan. 31
  • Idaho: Nov. 1 to Dec. 15
  • Maryland: Nov. 1 to Dec. 15
  • Massachusetts: Nov. 1 to Jan. 23
  • New Jersey: Nov. 1 to Jan. 31
  • New York: Nov. 1 to Jan. 31
  • Rhode Island: Oct. 15 to Dec. 31, 2023
  • Washington, D.C.: Nov. 1 to Jan. 31

Open enrollment for health insurance in Rhode Island runs from October 15 throughout all of 2023. That’s the longest of any state.

For other states, open enrollment starts on November 1, 2022.

A few states have shorter enrollment periods, and while things can change, you’ll want to be watching the calendar if you live in these two states:

  • Idaho: Nov. 1 to Dec. 31, 2022
  • Minnesota: Nov. 1 to Dec. 22, 2022

How long is open enrollment for health insurance?

Open enrollment for healthcare generally lasts about two and a half months – but some states give their residents a little less time, and some states a little more. Rhode Island gives its residents the longest open enrollment period for health insurance – over a year.

Do you have to apply for health insurance every year?

No. If you like your current healthcare plan, you don’t have to reapply. Do nothing (just keep paying your premiums), and you’ll keep your health insurance.

Special enrollment: How to get health insurance after open enrollment

A special enrollment period is usually only available to people with qualifying life events, such as losing their coverage, having a child, getting married or moving. You can go to healthcare.gov to get started during this special enrollment period. If your state has its own marketplace, the federal site will connect you to the state website.

While on the federal or state site, you enter information, such as where you live, your household income and the number of people in the household. The site provides you with plan choices and cost estimates for the plans. Those cost estimates will include any potential cost-reducing subsidies that can reduce the cost of your coverage.

People with income up to 150% of the federal poverty level ($20,385 for a single person, $34,545 for a family of three) can sign up for marketplace coverage every month. The Centers for Medicare and Medicaid Services estimates that about one-third of marketplace plan members will qualify for this monthly special enrollment period.

Your employer will also grant you a special enrollment period with a qualifying life event. Check with your HR department for details.

What information will I need to enroll in a health plan?

So what is there to know before open enrollment? That you’ll be doing some paperwork – possibly a lot of it.

Applying for health insurance will go more smoothly if you have everything on hand before applying. Fortunately, if you don’t have everything, you can always return to your online application; the website will save your work.

Healthcare.gov will list everything you need, but generally, the documents you will need include:

Proof of income. You'll need a 1040 federal or state tax return, along with wages and tax statement (such as a W-2 or 1099), a pay stub (if you have one) or self-employment ledger documentation (such as a Schedule C). If you have Social Security Administration statements or an unemployment benefits letter, that may suffice.

Immigration information. If you are an immigrant, you’ll need a permanent resident card (also known as a green card), a re-entry permit, a refugee travel document or an employment authorization card – and there are about a dozen other documents that you may use. Again, Healthcare.gov has a lengthy list.

Citizenship. If you’re a citizen of the United States, you’ll need to provide proof, like a U.S. passport, a state-issued enhanced driver’s license or a birth certificate. The list of documents you can submit is long, but you’ll only need one or two to prove you are who you are. For instance, a birth certificate and driver's license would work.

Documents pertaining to adoption. If you have adopted or have a foster child and want them on your health plan, you’ll need to show proof that you’re the parent or legal guardian. You’ll need to provide an adoption letter, record or foster care papers (signed by a government or court official).

What is the purpose of open enrollment for health insurance?

Although it can be frustrating to have a limited window to enroll in health insurance, there are reasons for the open enrollment period.

Insurers are trying to keep healthcare costs down and limit what is known in the industry as “adverse selection,” which is when healthy people resist signing up for health insurance while sick people do.

If you know that you can get health insurance whenever you want to, you might opt not to get it or get the cheapest plan available. Then, if your health changes, you could switch to a plan with better coverage.

Health insurance exists to help people pay for health care costs. There’s nothing wrong with using it. But the health insurance industry would go broke if people only paid for coverage if they suddenly needed it. Just like the car insurance industry would go out of business if people could just buy car insurance after having an accident.

Open enrollment for health insurance is an incentive for people to buy health insurance and get it in place before it’s needed.

Why is a longer open enrollment period better?

It’s easier for consumers to have a longer open enrollment period. It’s complicated to choose a health plan, and if you’re a procrastinator, you don’t want to be in a position where you only have a few days to make up your mind about a new health plan.

As healthcare plans become more expensive, many people – particularly those who are paying for their own insurance and not receiving health insurance from a company as an employee benefit — need time to find the plan that suits their budget.

What are your health insurance options?

Depending on your situation, you have the following options during open enrollment:

Renew your current policy:

You can keep your current health insurance as long as it's still offered. You may not have to do anything if you want to keep what you have. But your current plan may be changing. Watch the mail for a letter about any changes your plan intends to make in 2023.

Changes might not be acceptable to you. For instance, your doctor leaving the provider network or your medications not being covered any longer. You want to look for a plan that better suits your needs. If you need to switch, open enrollment is the time.

Buy an individual policy through a marketplace or directly from an insurance provider:

You can buy an individual health plan through the ACA marketplace or directly from an insurance provider.

ACA plans are eligible for tax subsidies – plans bought directly from an insurance provider outside of the ACA marketplace aren't eligible for those subsidies. Find out more about ACA subsidies.

Another option for people with low incomes is Medicaid. More than three dozen states expanded Medicaid eligibility, allowing people with incomes 138% of the federal poverty level to get Medicaid.

Make changes to your employer-based group health insurance:

If you get your health insurance through your employer, the open enrollment period for the government-run marketplaces and Affordable Care Act plans won't affect you.

You must sign up for coverage during your employer's open enrollment period.

Employers often change health insurance providers, so make sure you review your offerings. It likely changed since last year. Ask your employer its rules, so you know what you have to do.

Change your Medicare plan:

If you are enrolled in Medicare and want to change your plan – such as switching to Medicare Advantage (Part C) or adding prescription drug coverage (Part D) – you must sign up during its open enrollment period.

Medicare open enrollment is from Oct. 15 to Dec. 7, 2022, and coverage starts on Jan. 1, 2023.

There is a more limited open enrollment from Jan. 1 to March 31, 2023, when you can either switch Medicare Advantage plans or move from Medicare Advantage to Original Medicare.

Again, open enrollment for the government-run marketplaces doesn't affect you.

Buy a short-term health plan:

Short-term health insurance plans are a low-cost option. They aren't nearly as generous as ACA plans and don't have to cover basic services, such as maternity, prescriptions and mental health. So, you need to consider a plan's specific coverage before going with a short-term one.

A benefit of short-term insurance plans is that they're much cheaper than other plans. However, they don't offer as much coverage, so you may get stuck paying with more or all of healthcare costs for some services.

How to select a health plan

If you're buying a health plan through the ACA marketplace, you have a choice of four metal levels and a fifth, limited option:

  • Bronze
  • Silver
  • Gold
  • Platinum
  • Catastrophic (available to people younger than 30 or older than 30 if you're eligible for a hardship or affordability exemption)

The metal tiers each have different premiums and out-of-pocket costs. Bronze plans have the highest deductibles and copays, while Platinum plans have the lowest. However, the premiums for the Bronze plans are the lowest, while Platinum plans cost the most each month.

The most popular plans in the individual market are Silver and Bronze. According to a report by eHealth, the percentage of people who choose each level is:

  • Bronze: 36%
  • Silver: 39%
  • Gold: 17%
  • Platinum: 1%

When deciding what plan is best for you, think about your health and your family's health – and financial situation.

Do you see a doctor or other health care provider regularly to help you manage a chronic disease or condition? Do you take costly medications? You may want a health plan that has lower copays and deductibles if you're a frequent user of services.

If you're young and healthy and use few medical services, you may want a plan with lower premiums, such as a Bronze plan. Of course, you never know what can happen. And you can't change your plan outside open enrollment just because something happened to you.

Look at the out-of-pocket maximums for the plans you're considering.

  • Can you afford the premiums?
  • Can you pay the out-of-pocket costs and deductibles if you need care?
  • Are your doctors and hospitals in the plan's network?
  • Do you mind getting a referral to see a specialist?
  • Do you want the flexibility to see providers outside of your network?

Once you answer these questions, you can compare plans and see what's best for you.

You will also have to decide what type of plan you want in terms of provider access.

The three most common types of health insurance plans are health maintenance organization (HMO), exclusive provider organization (EPO) and preferred provider organization (PPO) plans.

PPOs are usually more expensive and don't require doctor referrals to see specialists. PPOs also allow you to get care outside of your provider network -- though at a higher price than in-network. HMOs and EPOs don't pay for care outside of provider networks.

How much are ACA plan premiums?

ACA plan average premiums decreased for the fifth year in a row.

In 2022, the average monthly ACA premium is $438, according to the Kaiser Family Foundation, a nonprofit that focuses on national health issues. Subsidies may lower that considerably. In 2022, thanks to the American Rescue Act, it was possible to find healthcare plans for under $10 a month. It remains to be seen if that will happen in 2023.

Let's take a look at the average premiums for individual coverage in 2022, according to the Kaiser Family Foundation:

  • Bronze: $329
  • Silver: $428
  • Gold: $462

The Kaiser Family Foundation doesn’t list the average price of a Platinum plan.

Platinum plans require the insurer to pay 90% of the costs and the policyholder to pay 10%. This high level of coverage usually means the highest premiums as well.

What does a health insurance plan cover?

Under the Affordable Care Act, plans must provide at least these essential benefits:

  • Outpatient care, including chronic disease management
  • Emergency care
  • Hospitalization
  • Pregnancy and newborn care
  • Mental health and substance abuse services
  • Prescription drugs
  • Rehabilitation services and devices
  • Lab tests
  • Preventive and wellness services
  • Dental and vision care for children

Insurance plans can offer benefits in addition to the required benefits. The best way to find out what benefits each plan covers is to go to its website and compare.

What if you don't want health insurance?

If you don't want to sign up for health insurance during the open enrollment period, you will have to wait an entire year if you change your mind. The exception is if you have a qualifying life event that would spark a special enrollment period.

Something important to remember: You no longer get penalized at tax time for not having health insurance. Congress eliminated that mandate's tax penalty.

However, a handful of states have mandates:

  • California
  • District of Columbia
  • Massachusetts
  • New Jersey
  • Rhode Island
  • Vermont

You may be fined at tax time if you don't have health insurance in those states.

Special enrollment periods for health insurance

You need to sign up for health insurance during open enrollment, but there are a limited number of ways that you can get health care during other parts of the year. If you don't enroll during open enrollment, you're eligible for a special enrollment period if:

  • You get married
  • You get divorced and were getting your health insurance through your spouse's employer
  • You have a baby, adopt a baby or place a child for adoption or foster care
  • Your spouse or partner dies and that leaves you without health insurance
  • Your spouse or partner loses a job and you had coverage through their employer
  • You lose your job and had coverage through your work
  • You are no longer a full-time employee eligible for workplace coverage
  • You are in an HMO and move outside its coverage area
  • You leave jail or gain citizenship

If you voluntarily drop your coverage, you won't qualify for a special enrollment period. The only time you can re-enroll is during open enrollment.

If you apply for a special exception and are rejected, you can appeal the decision to the Health Insurance Marketplace.

Frequently asked questions: Open enrollment

Is open enrollment the same for all companies?

No. If you’re getting your health insurance from an employer, there is likely going to be a short window of time for your open enrollment, but it can be at any time of the year and for any length of time. That’s up to your employer. Typically, an employer’s open enrollment period lasts two to four weeks.

What happens if I miss the open enrollment deadlines?

If you have an employer, talk to your human resources department. Unfortunately, you will probably have to go without insurance until the next open enrollment period or buy your own plan from an insurance broker.

Can I get a subsidy to help cover the cost of my health plan?

Congress has yet to decide how the subsidy program will work in 2023. If something isn’t done, it’s expected that 13 million Americans who get insurance through the Affordable Care Act marketplace will see their insurance rates rise significantly – and 1 million Americans could see their health insurance costs double. But this is a worst-case scenario.

When will my health insurance plan take effect?

In most states, if you buy a health insurance plan in November or the first half of December, your health care coverage will start on January 1. If you buy the plan after December 15, it’ll probably start on February 1.

Who can help me enroll in a health plan?

You have a number of options. If you are insured through an employer, contact your human resources department. If you’re buying health insurance on your own, you probably should turn to an insurance agent or broker. You can also go to Healthcare.gov if you’re going to buy insurance through the Marketplace, and you can call a 24-hour customer service line (1-800-318-2596).

What are off-exchange health plans?

That simply means that you’re not purchasing a health care plan from the health insurance exchange but directly from the insurance company itself.

What can you do if your 2022 coverage is not available in 2023?

If your 2022 coverage will no longer be offered in 2023, you will need to find a new health plan. Your insurance company may have a similar plan to replace the one that’s no longer available, or you can compare other plans.

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