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OPEN ENROLLMENT AND SPECIAL ENROLLMENT

FAQs

If you’ve ever selected an insurance plan for you or your family, you’ve probably heard the terms “open enrollment” and “special enrollment.” But what do they mean? Here are some answers to your frequently asked questions.

#1. WHAT IS OPEN ENROLLMENT?

Open enrollment is a yearly opportunity to change or update your insurance plan. The open enrollment period usually lasts for several weeks to give you and your family plenty of time to make the right decision about your health insurance.

#2. IS OPEN ENROLLMENT THE SAME FOR EVERYBODY?

No. If you get health insurance through your job, your company can decide when open enrollment is each year. Medicare, individual/family plans, and Marketplace plans have open enrollment in the late fall. Medicaid or the Children’s Health Insurance Program (CHIP) open enrollment runs mid-May to mid-June each year.

Employer-Sponsored Plan
  • Description – This is an insurance plan you get through work.
  • Open Enrollment Period – Your employer chooses its open enrollment period each year.
Medicare
  • Description – Medicare is federal health insurance available for eligible individuals age 65 and over (or) individuals under 65 with certain disabilities or medical conditions
  • Open Enrollment Period – Medicare has several defined enrollment periods for beneficiaries. Your initial enrollment period is when you first become eligible for Medicare. This is a seven-month window in which you can enroll in Original Medicare. The Medicare annual enrollment period (AEP) happens each year from October 15 – December 7. You may change your coverage choices (for example you can switch from Original Medicare to a Medicare Advantage plan or vice versa) during this time. Medicare also provides special enrollment periods for qualifying life events.
Medicare Advantage
  • Description – Medicare Advantage is an “all in one” alternative to Original Medicare and may include additional benefits beyond Original Medicare, like prescription drug coverage, dental, hearing, and vision care. Medicare Advantage plans are offered by Medicare-approved private companies. You must have Medicare Parts A and B to enroll in a Medicare Advantage plan.
  • Open Enrollment Period – The annual enrollment period is October 15 – December 7. You can change your Medicare coverage during this time. This includes changing to Original Medicare or joining or changing a Medicare Advantage Plan. If you’re in a Medicare Advantage plan, you can change to a different Medicare Advantage plan or switch to Original Medicare once during January 1 – March 31..
Medicaid and CHIP
  • Description – A federal and state insurance plan for individuals and families with limited income.
  • Open Enrollment Period – Open enrollment runs mid-May to mid-June each year with the plan change effective July 1st. Members may qualify for a change in plans outside of open enrollment but would need to contact an HPR (866-608-9422) to see if they are eligible.
Individual/Family Plans and Marketplace
  • Description – Insurance plans available through healthcare.gov or your state for individuals, families, and small businesses. You can also purchase an individual or family plan directly from a health insurance company.
  • Open Enrollment Period – November 1 - December 15.

#3. WHAT HAPPENS IF I MISS OPEN ENROLLMENT?

If you miss open enrollment, you’ll have to wait until next year to change your insurance plan. That’s why it’s so important to review your plan each year and mark your calendar for open enrollment.

#4. CAN I MAKE CHANGES TO MY INSURANCE PLAN OUTSIDE OF THE OPEN ENROLLMENT PERIOD?

It depends. Except when applying for Medicaid or CHIP, you cannot make any changes to your insurance plan outside of open enrollment unless you experience a qualifying life event.

#5. WHAT IS A QUALIFYING LIFE EVENT?

A qualifying life event is a big life change, like having a baby or changing jobs. These life changes allow you to stop, start, or make adjustments to your insurance plan no matter what time of year. Some common life changes include:

  • Getting married or divorced
  • Death of a family member in your plan
  • Losing your current insurance coverage
  • Having a baby, adopting a child, or becoming a foster parent
  • Getting a new job
  • Other employment changes like getting laid off or retiring
  • Becoming a U.S. citizen
  • A change in your income that affects what plans you are eligible for
  • Permanently moving to a place where different health insurance plans are available

 

#6. WHERE CAN I GET HELP?

If you plan on getting insurance through your job, the human resources (HR) department can help you with open and special enrollment. For other plans, like Medicaid, CHIP, individual/family, or Marketplace, there may be someone in your city that can help you. To find local helpers, go to takecareutah.org or localhelp.healthcare.gov.