What is the Difference Between Open Enrollment and a Special Enrollment Period?
The open enrollment period for individual health insurance plans is now through December 15, 2020. Those who need individual health insurance coverage beginning January 1, 2021, must purchase now. If you miss that window, you can’t purchase health insurance until next year’s open enrollment period. However, if you have a qualifying life event, you become eligible for a special enrollment period (SEP).
What is a Special Enrollment Period?
If you lose coverage or your family changes, you can purchase health insurance outside of the open enrollment period. For insurance purposes, a qualifying life event includes:
- Getting married;
- Having or adopting a baby;
- Losing health insurance coverage when leaving a job or losing coverage through parents on 26th birthday;
- Moving to a new ZIP code;
- Getting divorced or separated;
- Accessing a Health Reimbursement Arrangement through your employer.
If one of these occurred, you have 60 days to purchase new insurance.
Choosing Insurance During a Special Enrollment Period
To make the most informed decision, it is best to get quotes from private insurance plans as well state insurance exchange options. For a full view of your options, use HealthMarkets’ free online health insurance tool that shows multiple plans and pricing customized specifically for you. You can compare benefits, pricing and potential savings among thousands of plans.
Things You Should Know
- During the SEP, an individual and dependents have the same insurance options available through the insurance exchange as during open enrollment. Most private insurance follows the same rules for the SEP.
- If you are updating an Obamacare plan, in most cases, you will need to buy the same level of plan, such as Bronze, Gold, Silver or Platinum you currently have.
- If you do not purchase insurance within the 60-day SEP, you will have to wait until the next open enrollment period.
- Employer-based plans must provide an SEP of at least 30 days
- Be prepared to provide documentation of your qualifying event.
- An SEP is available only if you had minimum essential coverage before the qualifying event. A person without insurance would not qualify for the SEP.
Insurance Buyer’s Cheat Sheet
Whether you’re buying insurance during open enrollment or a SEP, here are a few things to keep in mind.
- Look at the total cost of care when choosing a plan. This includes the monthly premium, the deductible and your out-of-pocket costs when you receive care.
- Consider the plan and network types. Plans like HMOs and PPOs differ in how much choice you have in choosing your doctor. If you want to keep your doctor or another provider, be sure they are in the network you choose.
- You could qualify for tax credits that reduce your monthly premium or cost-sharing reductions to lower your payment for deductibles and co-pays.
For most people, the open enrollment period is the only time you can purchase health insurance. But if you have a qualifying life event, you can purchase it any time of year within 60 days of the event. Most of the same rules apply. Use the 60-day special enrollment period to research all of your options and find the best plan for your needs and budget.