The Open Enrollment Period refers to the period when Americans are allowed to purchase or make existing changes to their health insurance plan for the upcoming year. This has been a yearly occurrence since President Barack Obama passed the Affordable Care Act in 2010, which is commonly referred to as Obamacare.
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What Is Obamacare?
Obamacare, also referred to as the Affordable Care Act was a healthcare reform conceived and enacted by President Barack Obama in 2010.
The major overhaul of the U.S. health-care system was enacted to provide all Americans with the opportunity to access affordable health care. Additionally, under Obamacare, insurance companies are required to offer healthcare to all Americans – making it illegal to reject individuals based on pre-existing conditions or current health status.
Before Obamacare was introduced, health insurance in most North American states was expensive and complicated. It was also denied in certain scenarios to patients with certain medical conditions, leaving them without any financial support.
Since President Donald Trump assumed power in 2017, he has repeatedly threatened to dismantle Obamacare, leading many to ask, “Has Obamacare been repealed?” Numerous attempts in Congress failed to fully repeal and replace the bill, meaning Obamacare shall continue for the foreseeable future.
What is the Affordable Care Act?
The Affordable Care Act (ACA) is a health care reform that went into law in 2010. The official name is The Patient Protection and Affordable Care Act, but, most often, it is referred to as the ACA or Obamacare.
The ACA created a nationwide Open Enrollment Period from which individuals and families could purchase health insurance plans. Open enrollment is the only time of year when most individuals can enroll in a health insurance plan without coverage being declined.
The act helps provide affordable health insurance coverage for all Americans and makes it more accessible and fairer for consumers. Since 2010, the ACA has helped millions of Americans receive coverage that they otherwise wouldn’t have had access to.
What is the Open Enrollment Period for 2025?
The open enrollment period begins November 1, and ends January 15, in most states.
That gives you a 45-day window to enroll in individual market coverage or make changes to existing coverage. It’s recommended for all individuals to look over their health insurance options every year, as policy offerings continuously change.
Key Facts About Open Enrollment 2024
- Open enrollment is the only time of year one can shop for individual and family health plans, without qualifying for special enrollment.
- Special enrollment periods are available for those who have a Qualifying Life Event such as marriage, the birth of a child, or losing employer-based coverage.
- Enrollment, re-enrollment, and switching plans must be done during the designated open enrollment period.
- Should you miss the open enrollment period, the only alternative options are employer-based coverage, Medicare, Medicaid, the children’s health insurance program, and short term health insurance.
Individual Market Coverage
The standard November 1 through December 15 open enrollment period only concerns individual market coverage. The individual market includes individual and family coverage purchased through the ACA’s exchanges (Marketplaces) and off-exchange.
The individual market acts as a safety net for the millions of Americans between jobs, in early retirement, or underinsured. During the 2024, around 21.4million consumers in all 50 states and the District of Columbia enrolled or reenrolled in Marketplace plans.
Those who have grandfathered health coverage (a health insurance policy purchased on or before March 23, 2010), are not affected by any changes related to open enrollment. Because the plan is no longer available for purchase it doesn’t have applicable open enrollment windows.
That being said, it is in the best interest of those on grandfathered health plans to see how their current coverage compares with 2025 ACA-compliant plans. You might be eligible for premium or cost-sharing subsidies!
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Medicare and Employer-Sponsored Health Insurance
The open enrollment period only applies to the individual health insurance market, so it does not affect those who receive health insurance coverage from their employers.
Instead, employer-sponsored health insurance and Medicare has open enrollment windows that are separate from enrollment periods within the individual market.
- Most employer-sponsored health plans hold open enrollment periods in the fall to ensure coverage changes are effective on January 1, but that isn’t always the case.
- After the initial enrollment period of seven months, Medicare’s annual open enrollment begins on October 15 and ends December 7.
When is Open Enrollment for Health Insurance 2025
The Open Enrollment Period for purchasing health insurance for will be November 1st through December 15th.
States with state-run exchanges can extend the open enrollment period and can permanently change their open enrollment period dates.
If your state does have an extended enrollment period, check when your health insurance policy comes into effect; in some cases, it may be later than January 1st.
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What Are Important Dates Of The 2025 Open Enrollment Period?
- Thursday, November 1. Open Enrollment starts – this is the earliest date you can enroll, re-enroll, or modify a 2023 insurance plan within Marketplace.
- Saturday, December 15: Open Enrollment ends – this is the last day to enroll in or change plans for coverage, unless you are qualified for the Special Enrollment Period.
- Wednesday, January 1: The earliest date that plans purchased during the open enrollment period can begin.
Open Enrollment Dates by States
Generally speaking, open enrollment starts every year on November 1st and ends on December 15th. However, open enrollment may be extended in the federal marketplace and there are certain states with permanent extensions in place.
It’s best to double-check your official state-based websites to find out the exact enrollment dates for your state and find out about any possible extensions.
What Are States with Special Dates?
States with state-based exchanges may issue extensions each year, and some of these states have permanent extensions to their dates.
When Does Open Enrollment End?
In the majority of states, open enrollment ends on December 15, if you want to have coverage start on Jan 1st. After this date, it is only possible for persons to enroll or change plans if they qualify for a special enrollment period or live in a state with an extended enrollment period (listed above).
Why Is There A Shorter Enrollment Period?
The newer shorter enrollment period gives enrollees less time to research plans and submit applications but does have its benefits. Ensuring sign-up by Dec 15 means the new coverage can begin on Jan 1, ensuring no coverage gap is suffered.
Previously, many people enrolled in late January and had a March 1st activation date. As a result, many Americans were paying premiums for just 10 months as opposed to 12.
The change also allows insurers to use a full year’s data claims, which gives for more accurate plan pricing.
What If I Have Coverage Through My Employer?
The open enrollment changes do not affect those who have employee health insurance coverage.
Many employee health plans have their open enrollment periods in the fall so that any coverage changes will come into effect on Jan 1. Though this is not always the case, as some plans do not follow the calendar year.
Be sure to find out the key dates that apply to your employer-shared plan as well as any questions answered before the window closes.
How Much Is the Penalty for Not Having Health Insurance?
Unlike years gone by, Americans are no longer fined for not having ACA-compliant health insurance coverage. Prior to 2019, the tax penalty for not having health insurance was $695 for adults and $347.50 for children, or 2% of your yearly income – whichever figure was greater.
How to Get Health Insurance After Open Enrollment
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Can I Sign up for Health Insurance After Open Enrollment?
If you fail to purchase health insurance during the 2024 Open Enrollment period, don’t panic – it may still be possible to qualify for health insurance at other times throughout the year.
The government is fully aware that a lot can happen in the space of 12-months and has put measures in place to help individuals and families get healthcare coverage anytime after the deadline. Individuals who have a Qualifying Life Event are able to buy health insurance at different times during the year.
A Qualifying Life Event is something that happens to an individual/family that causes them to either lose healthcare coverage or need to make a plan change, such as getting married/divorced, changing residence, or a job loss.
Additionally, short-term health insurance is available, as is employer-based coverage, Medicaid, and CHIP. Likewise, first nations, Alaska Natives, and individuals who qualify for Medicaid can purchase health insurance at any time throughout the year.
What Is a Qualifying Life Event (QLE)?
A Qualifying Life Event refers to a major life change, which can make you eligible to purchase a health insurance plan beyond the 2024 Open Enrollment Period.
If you or your family has had any of the following qualifying life events occur, you could be eligible during the Special Enrollment Period (SEP) to sign up for coverage:
- You have gotten married
- You have had a baby or are adopting.
- You no longer receive health care under your parents.
- Your insurance company cancels your plan.
- You have just become a US citizen.
- You no longer qualify for Medicaid
- You have just been released from incarceration.
- You are a college student returning from college.
- Your spouse has died, and you have lost coverage.
- You are a seasonal worker.
- You have gained membership in a federally recognized tribe.
Once you receive approval, you can then shop around for a plan in the state-based exchange or the federal Marketplace.
Is Turning 26 A Qualifying Life Event?
When an individual turns 26, they lose access to their parent’s coverage. So yes, this means that turning 26 is, in fact, a Qualifying Life Event.
Because it is one of the few QLEs you can anticipate, you are able to enroll in health insurance 60 days before and after your birthday. Missing that deadline will mean that you’ll have to wait for up to 10 months for the next available Open Enrollment Period.
Special Enrollment Periods
If you have a Qualifying Life Event, you must sign up for the Special Enrollment Period within 60 days of that change.
It is important to remember that not all life events are eligible for enrollment during the Special Enrollment Period. Here are a few of the most searched life events that ultimately will not be eligible as a QLE:
- Voluntarily dropping your health care coverage.
- Learning that your primary physician is not in your network.
- Missing the open enrollment period due to being on vacation.
- Your most current healthcare insurance policy was canceled due to nonpayment of premium.
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Alternative Health Insurance Outside Obamacare
1) Short-term Health Insurance Plans
Short-term health insurance plans (also known as temporary health insurance) typically provide coverage for a limited period of time – usually between 30 days and 6 months. The plans often won’t cover pre-existing conditions or preventive medical care but can limit financial liability for medical bills in case of unexpected emergencies or accidents.
The plans are ideal for those transitioning between jobs or who are temporary without medical insurance. The short term medical insurance plan can act as a brief filler to ensure an individual comes out of this period unscathed.
2) Accident Insurance
Accident insurance plans provide a cash payout on specific unexpected injuries, helping you cover medical and out-of-pocket costs. Most accident insurance is sold as supplementary coverage to an existing health insurance plan but can be purchased in a standalone manner.
3) Critical Illness Insurance
Similar to accident insurance, critical illness insurance plans provide a cash payout when an individual is diagnosed with a serious illness, such as cancer, stroke and heart disease.
4) Dental or Vision Insurance
Vision and dental are often excluded from traditional health insurance. As such, dental or vision insurance plans provide coverage or discounts for dental or vision services. Examinations, treatments, prescriptions, cleanings, fillings, and crowns are examples of some of the services that might be fully or partly covered.
Obamacare Enrollment Advice
During the open enrollment period, you need to create an account on HealthCare.gov or on your state’s own marketplace, choose a plan, and enroll before the deadline. The process, in its entirety, can take time, and that’s without factoring in the time needed to make sure you are enrolling in the right plan for you.
Give yourself time to solve problems that may arise and don’t leave it until the last minute!
Health insurance agents provide knowledge of the market and law that is helpful in you finding the best healthcare plan. Our licensed agents are impartial to which health insurance plan you choose and our only endeavor is to find the best plan for you.
Get Assistance With Health Insurance
If you are looking for assistance in picking a health insurance plan for 2024, get in touch with the licensed health insurance agents at Coverage Haven today.
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