Prepare for Health Insurance Open Enrollment This Fall [2]

Open enrollment [4] for Affordable Care Act (ACA) coverage in the Marketplace [5] will run in most states from November 1 to January 15 for those under 65. The Marketplace is operated by the federal government through HealthCare.gov for most states, though some states [6] have their own Marketplaces. Open enrollment is a period of time in which individuals and families can add, drop, or make changes to their ACA health coverage.

What are my options outside of open enrollment?

In general, open enrollment is typically the only time during the year individuals can enroll in a health insurance plan or switch to a different plan.

Once open enrollment for ACA coverage in the Marketplace is over for the year [7], small businesses and their employees can get health insurance through:

  • Special enrollment periods. This period results from a qualifying life event such as marriage, a birth, loss of health insurance, moving, job change/loss etc. and allows people to change/add coverage outside of open enrollment.  Find if you qualify here [8]. (Some states [4], like California and New Jersey, still have 2021 special enrollment periods open due to COVID-19.)
  • Medicaid or the Children’s Health Insurance Program (CHIP). You can apply for these at any time. Find if you qualify here [9].
  • Short-term health plans. These plans were created to bridge gaps in coverage while awaiting the next open enrollment period. Short-term plans do not have to adhere to the ACA’s requirements for minimum coverage, do not generally cover pre-existing conditions, and provide limited benefits. Therefore, these plans are generally not a long-term solution for most people.
  • Group Health Reimbursement Arrangement (HRA). This option is when an employer offers a high-deductible health plan and reimburses employees for a predetermined amount of out-of-pocket health care expenses (often for deductibles and coinsurances covered under the plan). Businesses can start a Group HRA plan outside of open enrollment, thus creating their own open enrollment period to allow employees to get ACA coverage.
  • Traditional Group Health Insurance like SHOP. The Small Business Health Options Program (SHOP) offers health and dental insurance coverage for small businesses and their employees. To be eligible, small businesses generally have to employ between 1 and 50 employees. Small businesses can typically enroll year-round. There is no employer contribution requirement for SHOP plans. However, eligible employers that contribute at least 50 percent of the cost of premiums for all full-time employees are eligible for the Small Business Health Care Tax Credit. Find out more about SHOP here. [10]
  • Self-Funded Health Insurance. This option is when businesses assume the financial risk for providing health benefits. Instead of paying a fixed premium to an insurance company, a business pays for employees’ out-of-pocket claims. There are significant risks to self-funded health insurance plans. Employees’ claims are unpredictable, and small employers with limited financial resources risk being unable to pay for these claims as they arise.

When does open enrollment begin?

There are two open enrollment periods: one for Medicare (typically for people 65 and older) and one for people under 65.

  • Medicare [11]open enrollment for all 50 states runs from October 15 through December 7.
  • ACA coverage for people under 65 [12] runs from November 1 through January 15 in a majority of states. It is important to note that in order to have a health plan that takes effect January 1, 2022, enrollments must be completed by December 15, 2021. Enrollments completed after December 15 will be effective February 1, 2022. Some areas of the country, like California and the District of Columbia, have permanently extended their open enrollment periods to January 31. Other states may offer year-to-year extensions to open enrollment, but this is not guaranteed. Always check with your state’s website for updated 2022 dates.

Where can I find more information on Open Enrollment 2022?

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