The short version
- Open Enrollment is the yearly window when anyone can buy or change an individual health plan.
- Outside it, you need a qualifying life event, which usually opens a 60-day Special Enrollment Period.
- Miss both and you may wait months for coverage, so the dates matter.
Why there are windows at all
Individual and family health plans, the kind you buy yourself rather than through an employer, can't be bought on any day of the year. If they could, many people would wait until they were ill to sign up, and prices would rise for everyone. So coverage is sold in set windows instead.
There are two: Open Enrollment, which comes around once a year for everybody, and Special Enrollment, which opens for you personally when your life changes in certain ways.
Open Enrollment: once a year, for everyone
In states that use HealthCare.gov, Open Enrollment runs from November 1 to January 15. During that time anyone can buy a plan, switch plans or drop one, with no questions asked about why.
When you enroll decides when your coverage starts:
- Pick a plan by December 15 and coverage usually starts January 1.
- Pick one between December 16 and January 15 and it usually starts February 1.
Some states run their own marketplace instead of HealthCare.gov and can set slightly different dates. Georgia, Kentucky, Nevada and Virginia are among the states I'm licensed in that do this, so check your state's dates each fall, or ask me.
Open Enrollment is also your chance to look again at a plan you already have. Premiums, doctor networks and drug lists can all change from one year to the next, and being renewed automatically into last year's plan isn't always the best deal.
Special Enrollment: when life changes
Outside Open Enrollment, you can only enroll if something has happened that qualifies you for a Special Enrollment Period. The most common are:
- Losing other coverage. Leaving a job with health benefits, aging off a parent's plan at 26, losing Medicaid, or COBRA running out.
- Moving. To a new state, or to an area with different plans. You'll generally need to have had coverage before the move.
- Changes in your household. Getting married, having a baby, adopting a child or placing a child in foster care.
- Other changes. Such as becoming a U.S. citizen or being released from incarceration.
In most cases you have 60 days from the event to choose a plan. When you're losing coverage, you can usually start up to 60 days before it ends, which is the best way to avoid a gap.
Coverage from a Special Enrollment Period usually starts on the first day of the month after you pick a plan. A new baby is the exception: coverage can go back to the day of birth.
Worth knowing
Choosing to drop your coverage, or losing it because premiums weren't paid, doesn't count as a qualifying event. Neither does simply deciding you want insurance now.
What if you've missed both?
If you're outside Open Enrollment and nothing has changed, you'll generally have to wait for the next Open Enrollment to buy an individual plan.
Check before you assume that, though. Some qualifying events are easy to overlook, and depending on your income and your state you may qualify for Medicaid or CHIP, which you can apply for at any time of year.
How I can help
If you think you've had a qualifying event, or Open Enrollment is coming up and you're wondering whether to stay put, tell me what's changed. I'll check which windows are open to you and which plans are available where you live.
See the states where I'm licensed
This article is general information, not advice about your own situation. Enrollment rules, dates, plans and prices vary by state and can change from year to year.
