What to Do When You Miss Benefits Open Enrollment

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Each year, employers with more than 50 employees that offer health benefits must offer an "open enrollment" period (most small employers also offer an open enrollment period).

Open enrollment is also available for individuals or families who buy their own health insurance through the ACA exchanges or directly from health insurance companies (ie, off-exchange).

During an open enrollment period, health care recipients can opt in or out of plans, or make changes to the plan they currently have.

Rates are reassessed during this period, and health plan prices are often altered.

Typically, this open enrollment period is the only period of time throughout the year during which changes can be made to an enrollee's coverage.

When Does Open Enrollment Take Place?

If you get your health benefits through your job, you'll typically have an annual open enrollment period. In general, open enrollment periods last only a few weeks or a month.The open enrollment period typically occurs sometime in the fall, but employers have flexibility in terms of scheduling open enrollment. Your company should notify you about your open enrollment period. Contact your Human Resources department if you are unsure or seek further information about your company’s health care plans and policies.

If you buy your own health insurance and have an ACA-compliant plan—as opposed to something like a short-term health insurance policy or a limited benefit plan—you are also subject to open enrollment, as coverage is only available for purchase during that time (or during a special enrollment period if you have a qualifying event later in the year).

If that's the case, your open enrollment period is determined by the U.S. Department of Health and Human Services, under regulations pertaining to the Affordable Care Act (prior to 2014, there was no such thing as open enrollment for individual health insurance, but insurers in most states could reject applications from people with pre-existing conditions, or charge them higher premiums).

 

For 2016 and 2017 coverage, open enrollment for individual market plans (on and off-exchange) ran from November 1 through January 31. It's slated to have the same schedule for 2018 coverage, but that could change. HHS has proposed a shorter open enrollment period for 2018 coverage, running from November 1, 2017 through December 15, 2017. 

The shorter open enrollment period is already scheduled to take effect in the fall of 2018, for coverage effective in 2019. But if HHS finalizes the proposed regulations, it will take effect a year earlier than originally planned, in the fall of 2017.

If you're on top of life's little details, you may be well aware of open enrollment. You may even re-assess your plan during that time each year. However, it is more than possible for an individual to forget about, or miss their open enrollment period. If you miss out, you have limited options.

I Missed My Job-Based Benefits Open Enrollment Period. What Can I Do?

If you miss your company's open enrollment period for health insurance benefits, you may be out of luck. If you have not already signed up for health insurance, there's a good chance you won't be able to do so this year. If you have automatic renewal, you will automatically re-up with the same plan you had last year.

Some organizations are more lenient than others about open enrollment, but very few will make special exceptions for someone who just forgot to show up, as exceptions are generally prohibited by the terms of the health insurance agreement.

Special Enrollment Period

If you miss open enrollment and weren't already enrolled in a plan that was automatically renewed, you may very well be without health insurance, unless you have recently experienced a significant, life-changing event that would trigger a special enrollment period.

A special enrollment period could be triggered if you are covered on someone else's plan and lose that coverage.

For example, if you are covered under your spouse's plan and your spouse loses her job or you become divorced, this would trigger a special enrollment period that would allow you to enroll in your company's health plan right away.

Additionally, if you marry, have a child, or adopt a child, you could enroll your dependents right away in a special enrollment period. These special enrollment periods also apply in the individual market, so if you lose your job-based health insurance in the middle of the year, you're eligible to enroll in a plan through the exchange or directly through a health insurance company, despite the fact that open enrollment for the year has already ended.

If nothing has happened to trigger a special enrollment period, you will most likely have to wait until the next open enrollment period to sign up for health benefits or make a change to your existing benefits.

Updated by Louise Norris.

Sources:

Department of Health and Human Services. Patient Protection an Affordable Care Act, Market Stabilization. February 15, 2017.

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