What is 'Open Enrollment'?

‘Annual Enrollment’ or ‘Open Enrollment’ is a period of time, usually but not always occurs once per year, when employees of companies and organizations may make changes to their elected fringe benefit options, such as health insurance or Medicare plans.  The term also applies to the annual period during which individuals may buy individual health insurance plans through the online, state-based health insurance exchanges established by the ‘Patient Protection and Affordable Health Care Act’.  Prior to January 1, 2014 insurers offering individual medical coverage typically allowed new members passing underwriting to enroll at any time throughout the year.

Open enrollment is also prominent in Medicare, where almost 50 million enrollees can choose to stay in original Medicare, or join or change plans within the Medicare Advantage and Medicare Part D Prescription Drug programs for the coming calendar year. Individuals usually can make changes to, or sign up for, their health insurance or fringe benefits only once per year during the annual enrollment period or when they have experienced a specific qualifying event. Open enrollment periods are indeed used in insurance markets to limit adverse selection risks resulting when enrollees can switch plans at will.

In Florida, the Open Enrollment period is from November 1, 2020 to December 15, 2020. Other states may have different Open Enrollment dates.

Anyone can enroll for a health insurance plan online, over the phone, or in-person. Enrolling is simple, but  the following information is needed for enrollment:

  • Name, address, email address, social security number, birthday, and citizenship status.
  • Household size and income.
  • Coverage details and premium for any employer-sponsored plan that’s available to your household.
  • Payment information that the insurer will be able to use to charge your premiums.
  • Your doctors’ names and zip codes are helpful, so that you can check to make sure they’re in-network with the health plans you’re considering.
  • A list of medications taken by anyone who will be covered under the policy. Each insurance plan has its own covered drug list, so you’ll want to check to see which one will best cover the medications you need.

Once enrolled, your coverage is going to take effect January 1, 2021 if you sign up during the open enrollment window in the fall of 2020. If you are already enrolled in an individual market plan  and you are selecting a different plan during open enrollment, your current plan will end on December 31 and your new plan will take effect seamlessly on January 1.

However, if you are currently uninsured, it’s important to understand that you could have to wait up to two months from the time you enroll until the time your new plan takes effect, since open enrollment starts a full two months before the start of 2021.

Also, if you are enrolling during the open enrollment period but you also have a qualifying event, you may be able to get coverage before the start of 2021. Check with your enrolling Agent as to what these ‘qualifying events’ are.

Understand that depending on the circumstances, you might still be able to get coverage after open enrollment ends:

Medicaid enrollment is year-round. Medicaid and CHIP  enrollment are available year-round for those who qualify. If your income drops to a Medicaid-eligible level later in the year, you’ll be able to enroll at that point. Similarly, if you’re on Medicaid and your income increases to a level that makes you ineligible for Medicaid.

Native Americans can enroll year-round. Native Americans can enroll in plans through the exchange year-round.

Special enrollment period if you have a qualifying event. If you have a qualifying event during the year, you’ll have access to a special enrollment period (SEP). Qualifying events include marriage (assuming at least one spouse already had coverage prior to the marriage), the birth or adoption of a child, loss of other minimum essential coverage, or a permanent move to a new geographical area where the available health plans are different from what was available in your prior location (assuming you already had coverage prior to your move).

Short-term health plans. Under general federal rules, short-term health insurance plans can have initial terms of up to 364 days and a total duration of up to 36 months, including renewals. But the majority of the states have placed more restrictive limits on the available of these types of plans. States limits and guidelines do supersede the federal rules in these situations.

How can I get a Proposal and Enroll? 

Call our Agency – Mel Himes & Associates Insurance Agency. Our licensed Agents are certified by the exchanges and can explain plan details and help you determine eligibility. They can make plan recommendations based on your particular situation. Our Agents can continue to assist you after the plan is purchased, helping you sort out questions and issues regarding your particular plan.

So, contact our Agency for for information during this ‘OPEN ENROLLMENT’ period.


*Information taken from  HealthInsurance.Org article by Louise Norris and Wikipedia, The Free Encyclopedia