Benefits 101: What Is Open Enrollment? | VA Employee Benefits Group

For millions of Americans, the end of the year is open enrollment season – a yearly opportunity to take stock of your health care needs and select the health insurance plan that works best for you.  It is a window of time – typically in the fall – when you can sign up for health insurance, review, assess, and modify your existing benefits.

There are more choices than ever to help you find a plan that will best suit your health needs.  Think of it like planning a trip: you don’t pack a surfboard if you are planning to hike in the mountains.  Likewise, there is a lot to think about when selecting a health plan for the next year.  What does it cost?  Does it include your prescription or preferred doctors?  Understanding health insurance basics and how open enrollment works is essential for making informed choices about your benefits and insurance coverage.

Here’s How Open Enrollment Typically Works:

  • Eligibility: Anyone eligible for health insurance can participate in Open Enrollment. This includes you, your dependents, and individuals looking to buy insurance through the individual marketplace (e.g., through the ACA exchanges)
  • Review Options: During the Open Enrollment period, you have the opportunity to review your current insurance coverage and assess their healthcare needs for the upcoming year. You should consider factors like changes in your health, anticipated medical expenses, and any new coverage options that might be available.
  • Enrollment or Changes: You can use the Open Enrollment period to either enroll in a new insurance plan, make changes to your existing plan, or renew your current coverage. This might involve switching plans, adding or removing dependents, changing coverage levels, or adjusting other plan details.
  • Deadline: Open Enrollment is time sensitive. Once the designated period ends, you generally cannot make changes to your insurance coverage until the next Open Enrollment period unless you experience a qualifying life event (such as marriage, birth of a child, job loss, or relocation), which triggers a Special Enrollment Period.
  • Coverage Start: The new coverage usually begins at the start of the upcoming calendar year, though this can vary depending on the specific insurance plan and enrollment date.

Which Plans Don’t Use Open Enrollment?

  • CHIP (Children’s Health Insurance Program) – CHIP offers low-cost health coverage for children from birth through age 18. CHIP permits enrollment at any time so you can ensure your children have coverage year-round.
  • Medicaid – Medicaid is a joint federal and state program that helps cover medical costs for some people with limited income and resources. Medicaid allows enrollment in health insurance during any time of year, provided you qualify.
  • Short-Term Health Insurance – health insurance plan with a limited duration, typically several months to a year.  These plans are geared toward people who need temporary medical insurance to bridge the gap between longer-term plans.   These plans don’t have enrollment periods because the need for this type of insurance is difficult to predict.

It’s important to note that missing the Open Enrollment period without a qualifying life event can result in being without health insurance coverage until the next Open Enrollment period. To ensure you have the coverage you need, carefully review your options and make any necessary changes during the designated Open Enrollment timeframe.

Health insurance providers are committed to helping all Americans make informed health coverage choices for themselves and their families.  Open Enrollment is a great time to explore the benefits already available to you in your current plan, including discounts and wellness opportunities that can save you money and keep you healthy.