ACA open enrollment is the annual window when you can sign up for, renew, or change a health insurance plan through the Affordable Care Act’s Health Insurance Marketplace. It typically runs from November 1 through January 15, and it’s the only time most people can get Marketplace coverage unless they qualify for a special exception.
When Open Enrollment Happens
On the federal Marketplace (HealthCare.gov), open enrollment follows this schedule each year:
- November 1: Open enrollment begins. You can enroll in a new plan, renew your existing one, or switch to a different plan.
- December 15: Deadline to enroll or make changes if you want coverage starting January 1.
- January 15: Open enrollment ends.
- February 1: Coverage starts for anyone who enrolled between December 16 and January 15.
That mid-December date matters. If you sign up by December 15 and pay your first premium, your coverage kicks in on January 1 with no gap. If you enroll after that but before the January 15 deadline, your coverage won’t begin until February 1.
Some States Have Different Deadlines
About 20 states and Washington, D.C. run their own insurance marketplaces instead of using HealthCare.gov, and several set their own enrollment windows. California, New Jersey, New York, and D.C. typically extend their deadlines through January 31, giving residents an extra two weeks. Idaho has historically moved in the opposite direction, closing enrollment in mid-December. Massachusetts, Kentucky, and Rhode Island also set slightly different end dates.
If you’re unsure whether your state runs its own marketplace, check your state’s health insurance website or start at HealthCare.gov, which will redirect you if needed.
Who Can Enroll
To buy a Marketplace plan, you need to live in the United States and be a U.S. citizen, U.S. national, or lawfully present non-citizen. People who are currently incarcerated are not eligible. Residents of U.S. territories can’t use the Marketplace unless they also qualify as residents of one of the 50 states or Washington, D.C.
There are no income maximums for purchasing a plan. You can buy Marketplace coverage whether you earn $25,000 or $250,000. Income only determines whether you qualify for financial help paying for it.
How the Plan Tiers Work
Marketplace plans are organized into four color-coded categories based on how costs are split between you and the insurer. The categories don’t reflect the quality of care or the size of the provider network. They reflect the percentage of typical medical costs the plan covers.
- Bronze: The plan covers about 60% of costs, you pay about 40%. Monthly premiums are the lowest, but you’ll pay more when you actually use care.
- Silver: The plan covers about 70%, you pay about 30%. A middle-ground option, and the only tier that qualifies for extra savings on out-of-pocket costs.
- Gold: The plan covers about 80%, you pay about 20%. Higher premiums, but less to pay at the doctor’s office or pharmacy.
- Platinum: The plan covers about 90%, you pay about 10%. The highest premiums, but the lowest costs when you need care.
If you’re generally healthy and mostly want protection against a major medical event, a Bronze plan keeps monthly costs low. If you use healthcare regularly, such as for prescriptions, specialist visits, or a planned surgery, a Gold or Platinum plan often saves money overall despite the higher premium.
Financial Help That Lowers Your Costs
The Marketplace offers two types of financial assistance, and both are based on your household income relative to the federal poverty level.
The first is a premium tax credit, which directly reduces your monthly premium. To qualify, your household income generally needs to fall between 100% and 400% of the federal poverty level. For 2021 and 2022, Congress temporarily removed the 400% upper cap, and subsequent legislation has extended enhanced subsidies. If your income exceeds 400% of the poverty level in a year without expanded subsidies, you’d need to repay any advance credit payments in full when you file your taxes.
The second type is cost-sharing reductions, which lower your deductibles, copays, and coinsurance. These are only available if you choose a Silver plan. When you qualify, the Silver plan essentially upgrades: instead of covering 70% of costs, it can cover anywhere from 73% to 94%, depending on your income. The lower your income within the eligible range, the more generous the savings. If you pick a Bronze, Gold, or Platinum plan, you can still use the premium tax credit, but you lose access to these extra out-of-pocket savings entirely.
This is why financial advisors often recommend Silver plans for people with lower incomes. A cost-sharing reduction can turn a Silver plan into something that performs like Gold or Platinum at a fraction of the price.
Enrolling Outside Open Enrollment
If you miss the annual window, you can still get Marketplace coverage through a Special Enrollment Period, but only if you experience a qualifying life event. You generally have 60 days from the event to apply. For people who recently lost Medicaid or CHIP coverage, that window extends to 90 days.
Qualifying events fall into a few broad categories:
- Loss of coverage: Losing job-based insurance, aging off a parent’s plan at 26, losing Medicaid eligibility, having a plan discontinued, or losing coverage through divorce.
- Household changes: Getting married, having or adopting a baby, placing a child in foster care, or the death of someone on your plan that causes you to lose coverage.
- Moving: Relocating to a new ZIP code or county, moving to the U.S. from another country, or moving for school or seasonal work.
- Other situations: Becoming a U.S. citizen, leaving incarceration, gaining membership in a federally recognized tribe, or being affected by a natural disaster.
Voluntarily dropping your insurance does not create a Special Enrollment Period. The coverage loss generally needs to be involuntary or due to a change in circumstances outside your control.
Is There a Penalty for Not Having Insurance?
The federal penalty for going uninsured was reduced to $0 starting in 2019, so there is no fee on your federal tax return if you don’t have coverage. However, a handful of states enforce their own individual mandates. California, Massachusetts, New Jersey, Rhode Island, and Washington, D.C. currently charge state-level penalties for residents who go without qualifying health coverage. If you live in one of these states, you could owe a fee when you file your state taxes.
What Happens if You Don’t Act
If you already have a Marketplace plan and don’t do anything during open enrollment, your plan will typically auto-renew. That sounds convenient, but it can cost you. Premiums, networks, and covered medications change every year. A plan that was the best deal last year might not be this year. Your income may have changed too, which affects how much financial help you receive. Taking 20 minutes to log in, update your income, and compare plans can save hundreds of dollars over the course of the year.