As the temperatures cool and the summer fades, Americans begin to face decisions about enrollment options. And no, we aren’t talking about new students heading off to college or transferring to new schools. Enrollment season isn’t just for higher education—it’s also for healthcare decisions, as US citizens usually only have one opportunity to renew, adjust, or purchase new health insurance coverage during the year. With the Healthcare.gov enrollment coming November 1st, here’s everything you need to know about open enrollment for 2022.
Most health insurance plans in the United States provide coverage for a calendar year, regardless of when the plan was created or opened. And once per year, citizens using employer-sponsored, government-sponsored, or self-sponsored plans can alter or change the type of health insurance plan they wish to use. This is called ‘Open Enrollment’, and it’s often the only time you can switch health insurance plans. If you miss the enrollment window, you’re stuck with the type of plan you currently have (unless it’s healthcare without an enrollment period such as Medicaid, CHIP, or certain forms of short-term health insurance).
Open Enrollment season doesn’t start at the same time every year like football or baseball season. Your enrollment time frame depends on the type of health insurance you seek to purchase. The three main types of health insurance coverage are:
- Employer-sponsored health plans
- Individual marketplace health plans
Medicare is a federally funded health insurance program for seniors (65 and up) and those with certain disabilities. For most people, Medicare will consist of three parts:
- Medicare Part A for hospital insurance
- Medicare Part B for medical insurance
- Medicare Part D for prescription drug coverage
Yes, we skipped Part C, which is known as Medicare Advantage, and this is a special type of coverage provided by private insurers.
The open enrollment period for Medicare begins October 15 and ends on December 7 each year. For Medicare Advantage, the enrollment period begins January 1 and ends on February 14. And finally, there’s an additional enrollment period for those interested in only Medicare Parts A and B. The additional period begins January 1 and extends all the way to March 31.
The passage of the Affordable Care Act created a government-sponsored health insurance marketplace where Americans could shop for health insurance coverage that fits their specific needs. Unlike Medicare or employer-sponsored plans, health insurance purchased on the marketplace are self-funded, which means you’ll have a lot of decisions to make about the level of care you wish to receive.
Regardless of the type of plan you choose, enrollment must be completed between November 1 and December 15 each year. All 50 states have this enrollment schedule for federal healthcare exchanges, although certain states with their own exchanges have different enrollment periods. For example, the ACA exchange in Pennsylvania allows enrollment from November 1 to January 31 for the 2022 season.
Unlike government-sponsored plans, the enrollment period for employer-sponsored plans is up to the discretion of the company. The most common practice for employer-sponsored plans is for insurance coverage to run from January 1 until December 31 of a calendar year, meaning new coverage begins with the turning of the annual calendar.
If your employer-sponsored coverage covers this time frame, your enrollment period is likely to begin in the fall around October or November, but you’ll need to check with your specific employer for more details. Note that you don’t NEED to accept the health plan offered by your employer, but turning it down likely means more money spent out of pocket on health needs.
In some situations, you may be granted a waiver on these enrollment rules. In order to receive special enrollment privileges, you must prove a ‘qualifying life event’ has taken place. Qualifying life events require immediate health insurance coverage, which is why special enrollment is granted if you meet the criteria.
What counts as a qualifying life event? Any of the following:
- Moving to a new state or area where your previous health insurance will no longer be valid
- Having a baby or adopting a child
- Losing your healthcare involuntarily (i.e., getting laid off or fired from your job)
- Getting married
Special enrollment periods are offered by any type of plan that also offers an open enrollment period. If you’re unsure which type of health insurance is best for you and your family, contact your financial advisor and discuss your options.
Speak With an Advisor
If you need assistance with your finances, work with a professional financial advisor from Good Life Financial Advisors of Mt. Pleasant. You can also opt to self enroll so you can find the best plan for you. We’re ready to help create a personalized plan for your specific needs.
The opinions voiced are for general information only and are not intended to provide specific advice or recommendations for any individual.