Terms to Know:
Open Enrollment Period (OEP)
A window of time during the year when most anyone can sign up for individual and family health insurance.
Special Enrollment Period (SEP)
The period of time outside open enrollment that requires a qualified life event to enroll in an individual and family health insurance plan.
Why can’t I sign up whenever I want? Good question.
The Answer
In order for an insurance company to stay in business they need:
A large and diverse group of individuals (healthy, sick, young and old)
Reliable and current statistics that will help them predict how many people will need medical services
Enough money coming in regularly from premium payments to cover anticipated losses (medical services required by its members)
Without these factors the system couldn’t survive.
If you take away open enrollment and allow people to sign up whenever they want, you would only have a pool of sick individuals who needed care. A balanced pool of healthy, sick, young and old is absolutely necessary to keep the scale balanced. Not only that, but having individuals regularly paying premiums to cover the medical services of its members.
Healthy members do help pay for the care of the sick members. And at some time or another, we will all need medical services. The insurance company is just betting that not everyone will need care at the same time, or things could go belly up!
Remember when President Obama said we needed enough young healthy Americans to sign up for health insurance when the healthcare system started to change? Well, he understood that the scale had to balance in order for things to work.
The History of the Matter
Not long ago, you could sign up for health insurance whenever you wanted. But insurance companies could deny people if they had pre-existing conditions like diabetes or a heart condition. This sounds mean, but it kept the right balance of healthy and sick people so costs were covered.
On March 23, 2010, the Affordable Care Act was passed, which said insurance companies could no longer reject people for coverage if they had a pre-existing condition. This was great news! But in order for the insurance companies to stay in business, they needed everyone to sign up at the same time so they had the right risk mix of healthy and sick people, with current data to predict future losses, and a regular flow of money coming in for it to go out.
FAQs
Health insurance has an open enrollment period to avoid people buying health coverage only when they're sick. If people only got health insurance when they needed care and then dropped it when their health improved, there wouldn't be enough healthy people paying premiums to offset the costs for sicker members.
How does open enrollment work in California? ›
Open enrollment is the time of year when everyone can apply for a plan through Covered California. This usually happens from November to January. Outside open enrollment, people who experience qualifying life events can apply during special enrollment.
What is the advantage of an open enrollment period to the insured? ›
During this designated period, eligible individuals have the opportunity to enroll in or make changes to their healthcare coverage and benefits. It's a crucial time for anyone seeking to access or modify their insurance plans.
What is the open enrollment period for Covered California 2024? ›
SACRAMENTO, Calif. — Covered California announced today that it will give consumers until Feb. 9 to sign up for coverage in 2024. “We've seen record-breaking enrollment nationally, and Covered California is surging with heightened demand,” said Covered California Executive Director Jessica Altman.
What happens if you do nothing during open enrollment? ›
If you miss open enrollment, you may find that you cannot enroll or make changes to your coverage until the following year. However, qualifying life events can trigger a special enrollment period that will allow for mid-year enrollments and plan changes.
What is the difference between open enrollment and annual enrollment period? ›
Medicare Annual Enrollment is when anyone who has Medicare can make coverage changes for the upcoming year, while Medicare Advantage Open Enrollment is only for people who are currently enrolled in a Medicare Advantage plan.
Is California an open enrollment state? ›
The K-12 Open Enrollment process is a California state mandated program allowing parents or guardians to enroll their child(ren) at a school other than their current school of attendance.
What happens if I miss open enrollment for Covered California? ›
If you miss the enroll-by date, you might have to wait until the next open enrollment period — but there are some exceptions. If you go through a major life change, you may still be able to apply for health insurance with Covered California under special enrollment.
What is the income limit for Medi-Cal 2024? ›
EWC 2024 Income Eligibility Guidelines
| Number of Persons in Family/Household | Monthly Gross Household Income | Annual Gross Household Income |
|---|
| 1 | $2,510 | $30,120 |
| 2 | $3,407 | $40,880 |
| 3 | $4,303 | $51,640 |
| 4 | $5,200 | $62,400 |
5 more rowsMar 8, 2024
chiefly US : a period of time during which someone can join something (such as a health insurance plan) as a member or participant : a period of time during which a person can enroll in something.
The yearly period (November 1 – January 15) when people can enroll in a Marketplace health insurance plan.
What defines benefits open enrollment? ›
What is open enrollment for benefits? In the U.S., open enrollment season is a period of time when employees may elect or change the benefit options available through their employer, such as health, dental and life insurance, and ancillary or voluntary benefits ranging from legal services to pet insurance.
Can I enroll in health insurance anytime in California? ›
Open enrollment for Covered California starts in the fall. Even when open enrollment is over, individuals with qualifying life events can enroll at any time of the year. Medi-Cal enrollment is also year-round.
Did Covered CA extend open enrollment? ›
Yesterday, Covered California announced it will be providing consumers until February 9, 2024, to sign up for healthcare coverage in 2024. According to the announcement, surging demand and technical issues at its service center led to the decision to extend the deadline.
How much do you need to make a year to qualify for Covered California? ›
According to Covered California income guidelines and salary restrictions, if an individual makes less than $47,520 per year or if a family of four earns wages less than $97,200 per year, then they qualify for government assistance based on their income.
How long is open enrollment for most companies? ›
Open enrollment is not required to be a certain length of time. Most employers have an open enrollment period of at least two to four weeks. Need help defining health benefit terms to employees?
Why does Medicare have enrollment periods? ›
The three Medicare enrollment periods — initial, special and general — are specific time frames when you can enroll in Medicare based on certain circ*mstances, such as choosing to delay enrollment if you continue working past age 65. As such, you may qualify for more than one at different times in your life.
What does period of enrollment mean? ›
ENROLLMENT PERIOD Definition & Legal Meaning
Defined period of time with a specific start and end date for registering in a plan to receive benefits.
