Open Enrollment – The Basics

July 10, 2013

When is the new open enrollment period? – The first-ever open enrollment period for individual and family health insurance plans under the Affordable Care Act (ACA) begins October 1, 2013 and ends March 31, 2014. Open enrollment periods in following years will be shorter than this one-time six-month period.

What is an open enrollment period? – The Affordable Care Act’s open enrollment period is when consumers (and small businesses) can purchase health insurance plans that include new health reform provisions and required benefits. Coverage under these new plans will begin no sooner than January 1, 2014. These new provisions allow you to purchase health insurance with 10 new essential health benefits, obtain government subsidies, and enroll without fear of being denied for pre-existing medical conditions.

Who needs to apply for coverage during open enrollment? – The new open enrollment period applies to individuals and families who are not subject to an exemption or who do not have qualifying coverage, such as employer-sponsored health insurance. So, if you have employee health benefits, you do not necessarily need to enroll in a new plan during the Affordable Care Act’s open enrollment period, but rather through your employer’s open enrollment period for their group plans. If your share of your employer-sponsored health insurance monthly premium is too costly, you may choose to opt out of that plan and purchase a qualified health plan with subsidy assistance, depending on your income level.

Will I be required to purchase a health insurance plan during this period? – If you wish to enroll in a health reform-compliant plan, you will need to enroll during this open enrollment period unless you qualify for a “qualifying event”. If you don’t purchase a health reform-compliant plan, you may be subject to a tax penalty.

What happens if I don’t purchase during the open enrollment period? – Outside of open enrollment, your ability to apply for health insurance may vary from state to state. It may be limited to the occurrence of a qualifying event, such as the loss of a job, a marriage or divorce, a move, or the birth of a child.

What if I miss open enrollment and don’t have a qualifying event? – You may be able to purchase a non-compliant plan or a short-term health insurance plan, but these won’t meet the standards of the Affordable Care Act and their benefits will likely not be as comprehensive.

Where do I shop for health insurance during open enrollment? – During the open enrollment period, individuals and families can shop for health reform-compliant plans, including those with subsidies, at state health insurance marketplaces or private-sector online health insurance marketplaces designated by the state – if the state decides to appoint such a marketplace.

Get more detailed information on how to prepare for open enrollment.