When Is Open Enrollment For Health Insurance? (2024)

Open enrollment is the time of year when you can sign up for health insurance or make changes to your coverage.

That’s the only time you can change your health insurance unless you have a qualifying life event that triggers a special enrollment period for health insurance. Here’s what you need to know about open enrollment for health insurance.

When Is Open Enrollment for 2024 Health Plans?

Open enrollment for the Affordable Care Act marketplace, sometimes called Obamacare, is from Nov. 1 2023, to Jan. 15, 2024, in most states. A handful of states with their own health insurance exchanges have slightly different open enrollment periods.

Here are the open enrollment periods by state:

Open Enrollment By State

What Is Open Enrollment?

The open enrollment period is when you can get health insurance or change your health plan—for specific types of health plans. During that time, people can review their health insurance options and choose the plan that works best for them.

The specific open enrollment varies by type of health insurance:

• ACA marketplace open enrollment is from Nov. 1 to Jan. 15 in most states.
• Medicare annual enrollment period is usually Oct. 15 to Dec. 7
• Medicare Advantage annual enrollment goes from Jan. 1 to March 31.
• Employers have their own open enrollment periods for health insurance.

Why Is There an Open Enrollment Period?

Health insurance has an open enrollment period to avoid people buying health coverage only when they’re sick.

If people only got health insurance when they needed care and then dropped it when their health improved, there wouldn’t be enough healthy people paying premiums to offset the costs for sicker members.

Insurers need healthy members to pay premiums while not requiring much care. That helps offset the cost of covering the sickest members.

You can get coverage at other times of the year if you have a qualifying life event, such as getting married, having a baby, losing other health insurance or moving to a new state.

How to Maximize Open Enrollment Periods

Use open enrollment to dig into the health insurance plan options available to you.

The ACA requires that health plans cover essential health benefits, including emergency care, outpatient care, hospitalization, pregnancy and newborn care, mental health and substance abuse services, prescription drugs, rehabilitation services, lab tests, preventive and wellness services and dental and vision care for children.

The ACA requires that baseline of coverage, but health insurance plans still differ by:

• Plan design
• Premium costs
• Copays for doctor, urgent care and emergency room visits and prescription drugs
• Deductibles
• Coinsurance
• Provider networks
• Prescription drug benefits

Here is what to think about when choosing health insurance during open enrollment.

Consider Possible Health Care Needs for the Next Year

You can’t always predict your future health care needs, but you may know that you need knee surgery in the next year. Maybe you’re starting a family or you’re on medication that costs hundreds of dollars each month. Those may all affect your health insurance costs.

How much health care you may need in the next year may influence the plan you choose. If you’re expecting a healthy year with limited health care issues, a high-deductible health plan (HDHP) may work for you. But if you’re expecting a child or have health care needs, a plan with higher premiums and a low deductible might make more sense.

In the ACA health insurance marketplace, bronze and silver plans have lower premiums and higher deductibles, while gold and platinum plans have lower deductibles but higher premiums. Make sure you understand the cost differences between bronze, silver, gold and platinum health insurance.

Compare Health Insurance Costs

Premiums are a key part of a health insurance costs,but there are also out-of-pocket costs like deductibles, coinsurance and copays.

You want to weigh the costs of premiums along with out-of-pocket costs to find the right plan for you. Some people prefer lower premiums and higher deductibles, so they don’t pay as much for having health insurance but pay more when they need health care services.

Others may rather pay higher premiums with lower deductibles. That way, they have a better idea of knowing what they’ll pay for health insurance coverage and may not get hit by a big medical bill if they need care.

Figure out whether a high deductible/lower premium plan works for you or if you’d rather a low deductible and higher premium.

Explore Plan Design Differences

The type of health insurance plan you choose influences your health insurance costs and flexibility in getting care.

Health maintenance organization (HMO) and exclusive provider organization (EPO) plans are usually cheaper than a preferred provider organization (PPO) plan. But you generally won’t get coverage for out-of-network care in an HMO or EPO. An HMO also usually requires members to get a primary care referral to see a specialist.

PPOs cover out-of-network care—typically at a higher cost than in-network care—and don’t require a referral to see a specialist. That freedom usually comes at a higher cost than HMOs.

Our research on Obamacare costs found that a 30-year-old pays $427 monthly on average for an unsubsidized HMO in the ACA marketplace compared to $466 for an EPO and $512 for a PPO.

Check Out the Health Plan’s Provider Network

Look at the plan’s provider network to make sure your providers are considered in the network. Also, check to ensure that the provider market has many specialists and other providers in your area, so you won’t have to travel long distances if you need to see other health care professionals.

If a provider isn’t in your plan’s network, you may pay more for that care or have to pick up the whole tab, depending on your health plan.

Ask Yourself These Questions When Choosing a Health Insurance Plan

• Do I have a chronic illness that requires regular doctor visits?
• Do I want the flexibility to get out-of-network care?
• Do I want to avoid needing a primary care referral to see a specialist?
• Do I take expensive prescription drugs?
• Do I have a family or do I plan on starting one over the next year?
• Are lower premiums or lower out-of-pocket costs more important to me?
• Can I afford hefty out-of-pocket costs if there’s an emergency?
• Do I want a plan that offers virtual care?

“When choosing a plan, take the 4 Ds—doctors, drugs, diagnostics and deductibles—into account. Ensure your doctors are in network, your drugs are covered, key diagnostic tests like blood tests and imaging are accessible and your deductible meets your financial needs,” says Dr. Kyu Rhee, CEO at National Association of Community Health Centers.

If you still need help, you can speak to a broker or licensed insurance advisor who can help guide you through the different plan offerings in your area.

“Many insurers also offer local seminars that offer insight on plans and allow for questions,” says Anand Shukla, senior vice president of individual markets at Aetna, a CVS Health company.

Managing Open Enrollment for Different Types of Health Insurance

Here are some additional tips to maximize your open enrollment period based on your health insurance plan.

ACA Health Plans

The ACA marketplace at Healthcare.gov helps Americans get health insurance who may not otherwise obtain coverage because they can’t afford it or don’t have access to workplace health insurance. Those with incomes between 100% and 400% of the federal poverty level are eligible for premium tax credits and subsidies that lower health care costs.

ACA plans are the only ones eligible for these tax credits and subsidies, so take advantage of these cost-saving measures if you qualify.

“It’s wise to check out your options during each open enrollment period because the tax credits and subsidies available to you may change due to changes in the health insurance policies and plans being offered in your area,” says Dylan H. Roby, interim chair and associate professor of health, society and behavior at the University of California, Irvine’s Program in Public Health.

Medicare

Medicare has three different enrollment periods. The initial enrollment period is when you become eligible. That is seven months long, beginning three months before your initial eligibility with Medicare (generally when you turn 65) and continues during your birthday month and terminates three months afterward.

There are also two enrollment periods each year. The Medicare annual enrollment period is from Oct. 15 to Dec. 7, when you can make changes to your coverage. The other enrollment period, called the Medicare Advantage open enrollment period, is from Jan. 1 and March 31 and allows members only to switch Medicare Advantage plans or change from Medicare Advantage to Original Medicare.

Employer-Sponsored Health Insurance

Companies decide on when you can become eligible for health insurance. Some employers may let you get coverage when you start, while others may not allow coverage until you’ve been there for a few months.

Employers with group health insurance may also limit who can have health insurance coverage, such as requiring a certain number of work hours before giving a part-timer health insurance and not allowing spouses on plans.

Businesses additionally decide on their open enrollment period. Ask your employer for its specific open enrollment period dates.

If you’re comparing employer-sponsored health insurance, check to see if your company donates money for your care, such as in a health savings account or flexible savings account. Those savings accounts are a way to save for your health care tax-free.

Medicaid

Medicaid, the federal/state health insurance program for low-income Americans, doesn’t have an open enrollment period. Anyone eligible for Medicaid can sign up during any time of the year.

Can I Make Changes Outside Open Enrollment?

You can change your health insurance outside open enrollment if you have a qualifying life event. These are examples of qualifying life events that create a special enrollment period when you can make changes and sign up for health insurance:

• Adopting a child
• Becoming a U.S. citizen
• Changing income
• Getting married
• Having a baby
• Losing health insurance
• Moving to a new state

Special enrollment periods last 60 days after the qualifying event.

Health Insurance Open Enrollment FAQs