When can you enroll in health insurance? A simple guide

People can sign up for health insurance during the open enrollment period or when they first become eligible for coverage, such as starting a new job. You can also sign up and make changes to your health coverage if you have a qualifying event, such as losing other coverage, a spouse’s death, getting married or having a child.

When can I enroll in a health insurance plan?

During the open enrollment period, which typically occurs once a year, you can enroll in a health insurance plan or make changes to your plan.

If you miss this period, you may still be able to enroll or make changes through a special enrollment period if you experience a qualifying life event, such as marriage, the birth of a child or job loss. Additionally, you can apply for Medicaid or CHIP anytime if you meet the eligibility requirements.

What are the different types of health insurance enrollment periods?

Health insurance enrollment periods determine when you can sign up for, change, or update your health insurance coverage. Understanding the different types of enrollment periods is important to ensure that you don’t miss an opportunity to enroll in a plan. 

Open enrollment period

The open enrollment period is a set period each year during which you can enroll in or change your health insurance plan. If you’re enrolling through the health insurance marketplace or your employer’s health plan, this is the time to apply for coverage.

If you’re getting a plan from the marketplace, the open enrollment period for the health insurance marketplace begins on November 1st. It ends on January 15th in most states, but the date may vary for some states.

Special enrollment period

The special enrollment period allows you to enroll in or change your health insurance plan outside of the open enrollment period if you experience certain life events. These events trigger a change in your circumstances, which makes you eligible for a special enrollment period.

What is a qualifying event for health insurance?

There are two types of triggers for SEPs:

• Loss of eligibility for health coverage
• Certain life events

Life events that create a special enrollment period include:

• Marriage
• Birth or adoption
• Death of a spouse or dependent
• Job loss
• Job change
• Retirement
• Reduction in work hours
• Relocation

Employer-sponsored insurance enrollment

If you receive health insurance through your employer, they typically have an enrollment period. This is often aligned with open enrollment but is specifically for employees and their families who want to sign up for or modify their employer’s plan. If you are a new hire, your employer will offer you an enrollment period during which you can sign up for health insurance coverage. This is typically available within 30 to 60 days of your start date.

Medicaid enrollment period

Medicaid and the Children’s Health Insurance Program (CHIP) provide coverage to low-income individuals and families, and enrollment in these programs is not limited to a specific period. You can apply for Medicaid or CHIP at any time of the year as long as you meet eligibility requirements.

Medicare enrollment period

Medicare is a federal program for people over the age of 65 or those with specific disabilities. This period occurs around your 65th birthday, starting three months before the month you turn 65 and lasting three months after. 

Medicare has three periods for enrollment:

• When you become eligible for Medicare, you can join a Medicare plan no matter the month or day.
• After your initial eligibility, you can join Medicare during the open enrollment period from October 15th to December 7th. 
• If you’re switching from one Medicare Advantage Plan to another, you can enroll in your new plan from January 1st to March 31st.

What happens if you miss enrollment deadlines?

Missing health insurance enrollment deadlines can lead to a gap in coverage, which may leave you unprotected in the event of illness, accidents, or medical emergencies. The good news is that some options are available depending on your situation, but understanding the consequences and alternatives is important to avoid a coverage gap. 

• Special-enrollment period options: If you miss open enrollment, you might still qualify for a special enrollment period if you experience a qualifying life event, such as job loss or change, birth or adoption of a child, marriage, divorce or moving to a new state.
• Applying for Medicaid or CHIP: If you miss open enrollment and don’t qualify for a special enrollment, another option is to apply for Medicaid or the Children’s Health Insurance Program (CHIP). These programs provide coverage for low-income individuals and families; enrollment is available year-round. You can apply for these programs anytime if your income or family size changes.
• Short-Term Health Insurance: If you miss the enrollment deadlines and don’t qualify for Medicaid or a special enrollment period, you might consider applying for short-term health insurance. These plans offer temporary coverage for those who need health insurance coverage between longer-term plans or who cannot get coverage through the usual channels.

If you miss an enrollment period, staying informed about the next opportunity to enroll is important. Mark the calendar for open enrollment dates and monitor any updates or changes to enrollment periods that may apply to you.

How to prepare for health insurance enrollment

Preparing for health insurance enrollment is important to ensure you choose the right plan for your needs and avoid any last-minute stress. Whether you’re enrolling in a marketplace plan, employer-sponsored insurance, or another type of health plan, following these steps can help you make an informed decision and ensure a smooth enrollment process.

• Gather necessary documents: Before enrolling, gather documents such as proof of identity, income statements, current health insurance details and family information.
• Understand your health insurance needs:  Take the time to think about what type of coverage you and your family need. Consider your current health conditions, lifestyle and any upcoming medical needs.
• Research health insurance plans: Before enrollment begins, do some research to compare the available health insurance plans. There are various options, and make sure you choose a plan that fits your budget and healthcare needs.
• Stay organized and mark important dates: Make sure you are aware of the enrollment deadlines. Missing deadlines could mean waiting another year or qualifying for a special enrollment period to make changes.
• Ask for help: If you have questions about finding the right plan for your needs, you may benefit from finding a reputable, licensed insurance broker or working with one of your state marketplace’s navigators, whose job is to point people toward workable plans.

Selecting the right health insurance plan can be challenging. Each year, millions of Americans have the opportunity to choose a new plan or to tweak their existing coverage. But with so many options available, how can you know if you are making the right choice?

“Get educated,” says Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute. “There are potential options out there for you.”

Fronstin adds that such alternatives may or may not be better than the plan you already have. “But that is something you have to figure out,” he says.

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