Open enrollment is a set window each year when you can sign up for health insurance, switch plans, or cancel coverage. Outside this period, you’re generally locked into whatever plan you have (or locked out entirely) unless a major life change qualifies you for a special exception. The exact dates depend on whether you get insurance through the marketplace, Medicare, or an employer.
How Marketplace Open Enrollment Works
If you buy your own health insurance through the federal marketplace (HealthCare.gov) or a state exchange, open enrollment runs from November 1 through January 15. During this window, you can enroll in a new plan, renew your existing one, or switch to a different option for the coming year.
Timing matters for when your coverage actually starts. If you enroll or make changes by December 15, your new coverage begins January 1. If you enroll between December 16 and January 15, coverage starts February 1. Either way, you’ll need to pay your first premium before coverage kicks in. After January 15, the door closes for the year unless you qualify for a special enrollment period.
Employer Open Enrollment Is Different
If you get health insurance through your job, your employer sets the open enrollment dates, not the government. Most companies run their enrollment window in the fall, typically lasting a few weeks, so that new benefits take effect at the start of the calendar year. Your HR department will announce the specific dates and available plans.
The choices during employer open enrollment are similar to the marketplace: you can keep your current plan, switch to a different one your company offers, add or remove dependents, or opt out of coverage. Some employers also bundle other benefits like dental, vision, and flexible spending accounts into the same enrollment period, so it’s worth reviewing all your options at once rather than just auto-renewing.
Medicare Has Its Own Schedule
Medicare’s annual enrollment period runs from October 15 through December 7. During this time, you can join, drop, or switch Medicare Advantage plans (with or without drug coverage), move between Original Medicare and Medicare Advantage, or change your standalone prescription drug plan.
There’s also a separate Medicare Advantage Open Enrollment Period from January 1 through March 31. This one is only for people already enrolled in a Medicare Advantage plan. It lets you switch to a different Medicare Advantage plan or drop your Advantage plan and return to Original Medicare with a separate drug plan.
Comparing Plan Levels
Marketplace plans are organized into four metal tiers that reflect how costs are split between you and the insurer. The tiers don’t indicate quality of care. They indicate how much financial risk you take on versus how much the plan absorbs.
- Bronze: The plan covers about 60% of costs, you pay 40%. Monthly premiums are lowest, but you’ll pay more each time you use care.
- Silver: The plan covers about 70%, you pay 30%. Silver plans also unlock extra savings for lower-income enrollees, which can push the plan’s share as high as 94% to 96%.
- Gold: The plan covers about 80%, you pay 20%. Higher premiums, but more predictable costs when you need care.
- Platinum: The plan covers about 90%, you pay 10%. The highest premiums with the lowest out-of-pocket costs at the doctor or hospital.
If you rarely see a doctor and mainly want protection against a catastrophic event, a Bronze plan keeps your monthly costs low. If you use care regularly, a Gold or Platinum plan may save you money overall despite the higher premiums. Silver plans are often the sweet spot, especially if your income qualifies you for the extra cost-sharing reductions that only apply to Silver-tier plans.
Financial Help With Premiums
If you buy coverage through the marketplace, you may qualify for a premium tax credit that lowers your monthly bill. Eligibility is based on your household income relative to the federal poverty level. Your income needs to be at least 100% of the federal poverty line for your family size. In most years, the credit phases out above 400% of the poverty line, though Congress has temporarily expanded eligibility in recent years.
You can take this credit in advance, applied directly to your monthly premium so you pay less each month. Or you can claim it when you file your taxes. If your income changes during the year, it’s important to update your marketplace application, because getting too much credit in advance means you’ll owe money back at tax time.
What You’ll Need to Enroll
Before you sit down to enroll, gather a few things. You’ll need income documentation: your most recent tax return or W-2s work if your income hasn’t changed, or recent pay stubs if you’ve switched jobs or expect your earnings to shift. You’ll also need Social Security numbers for everyone in your household who’s applying, along with immigration or citizenship documentation if the marketplace needs to verify your status.
If you have a child through adoption or foster care, you may need placement documents or a court order. The marketplace will tell you during the application process if additional verification is needed and give you a deadline to submit it.
What Happens If You Miss Open Enrollment
Missing the window doesn’t necessarily mean you’re uninsured for the entire year. Certain life events trigger a special enrollment period, giving you 60 days to sign up outside the normal schedule. These qualifying events fall into a few categories.
Losing existing coverage is the most common trigger. This includes being laid off or leaving a job, aging off a parent’s plan at 26, or losing Medicaid or CHIP eligibility. Household changes also qualify: getting married or divorced, having a baby, or adopting a child. Moving to a new ZIP code or county opens a window too, as does gaining U.S. citizenship or being released from incarceration.
Changes in income can also qualify you, particularly if your earnings drop enough that you become newly eligible for Medicaid or marketplace subsidies.
State Penalties for Being Uninsured
The federal penalty for not having health insurance was reduced to $0 in 2019, so there’s no federal tax consequence for going uninsured. However, a handful of states enforce their own individual mandates. Massachusetts has had one since 2006. New Jersey, the District of Columbia, and Vermont have also enacted mandate legislation. California and Rhode Island have joined as well. If you live in one of these states, you could face a state tax penalty for going without qualifying coverage. The penalty amounts and rules vary by state.