What Is Open Enrollment?

Open Enrollment Explained

Doctor with digital tablet talks to patient in exam room

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Open enrollment is the annual period in which you can enroll in or change benefits. Although the term is often associated with health insurance, open enrollment can also apply to other benefits, like life insurance or savings plans.

The open enrollment process can differ by benefit sponsor. Some open enrollment processes require you to take action every year, while others only need your input when you must add, change, or eliminate a benefit. Although open enrollment usually only runs for a few weeks, you can amend certain benefits during qualifying life events. 

Let’s explore how enrollment works, its different types, and what might qualify you for a special enrollment period.

Definition and Examples of Open Enrollment

Open enrollment is a period when people can enroll in a health care plan or make changes to existing coverage. Held annually in the fall, open enrollment may also apply to other types of benefits, such as dental and life insurance.

Open enrollment applies to employer-sponsored health insurance and coverage purchased from a government Marketplace. Typically, open enrollment periods run for at least two to four weeks.

Employers that only offer one health plan may not extend an open enrollment period. Open enrollment doesn’t apply to the U.S. federal government’s Children’s Health Insurance Program (CHIP) and Medicaid programs, which allow qualified applicants to apply for benefits at any time.

During open enrollment, you may choose to switch to another health insurance plan or add dental coverage.

  • Alternate name: Open enrollment period, open enrollment season, open season
  • Acronym: OEP

Open enrollment may apply to a wide variety of employer-sponsored benefits, from legal services to pet insurance.

How Does Open Enrollment Work?

Open enrollment is your opportunity to enroll in a new benefits program or make changes to an existing one. Although time periods and procedures may vary, the open enrollment process is relatively straightforward, regardless of who provides your benefits.

Open Enrollment Periods

The federal government sets open enrollment dates for its Health Insurance Marketplace. Employers determine open enrollment dates for the benefits they sponsor.

Changes made during open enrollment take effect on Jan. 1 of the following year. For instance, if you change your health care plan on Nov. 15 during open enrollment, your current coverage will continue through Dec. 31 and the new plan will kick in the next day.

Typically, open enrollment takes place around the same time each year. For example, open enrollment for the federal Marketplace usually runs from early November through mid-December.

But under certain circumstances, open enrollment dates can change. For example, in 2021, the federal government held Marketplace open enrollment from mid-February through mid-May due to the COVID-19 pandemic.

Making Changes

Depending on the benefits you have, open enrollment may enable you to make several types of changes. For instance, you may need to add or remove certain dependents, cancel a health plan, switch to another plan, or enroll in an insurance plan for the first time.

During open enrollment, you can apply online for a new marketplace health plan or make changes to existing marketplace coverage. Some employers also offer open enrollment websites. Employers may also require you to complete and submit a form, either on paper or electronically.

Active Enrollment vs. Passive Enrollment

Open enrollment may follow active or passive rules. It’s important to understand which type of procedures apply to your benefits.

  • Active enrollment requires an enrollee to re-enroll for a benefit each year during open enrollment. For example, you would need to re-enroll in your health insurance plan annually, even if you don’t need to make any changes.
  • Passive enrollment enables you to retain a benefit without re-enrolling. For instance, if you were happy with your dental insurance plan, your coverage would automatically re-enroll from one year to the next, without any participation by you during open enrollment.

Special Enrollment Period

You may qualify for a “special enrollment period” if you experience certain qualifying life events. If you have a federal Marketplace plan, you may need to enroll within a specific time frame: from 60 days before to 60 days after the event, depending on the type of event. Employer-based plans must provide a special enrollment window of at least 30 days before or 30 days after the qualifying event.

Qualifying special enrollment period events can include:

  • A change in the number of household members: Getting married or divorced, adopting or giving birth to a child, or placing a child for foster care
  • A change in locations: Moving to a new ZIP code, to or from transitional housing, to attend school, or from another country or U.S. territory
  • A change in Marketplace eligibility: Newly eligible for Marketplace coverage due to becoming a U.S. citizen, release from incarceration, a change in income, or gaining status as a federally recognized tribe member
  • Loss of health insurance: Losing employer-sponsored health insurance due to job loss, loss of insurance due to a decrease in salary, or aging out of a parent’s health care coverage after turning 26

The federal Marketplace is only available to people who live in the United States, U.S. citizens, and U.S. nationals. Incarcerated citizens are not eligible for Marketplace health insurance.

Preparing for Open Enrollment

Open enrollment gives you the opportunity to modify your benefits to fit your current or future needs. For example, if you plan to have a baby in the coming year, you may need a different health care plan and a new life insurance policy. Or you may need to switch to a new health insurance plan to cover a teenager who’s going away to college.

In the runup to open enrollment, calculate how much you spent on health care the previous year and evaluate how well your current health care plan performed. When contemplating a new health plan, consider its costs, including annual deductible, copayments, and monthly premium. Also look at what it covers, including services and medications, and whether your doctor is in the network.

Moreover, open enrollment allows you to adjust a flexible savings account (FSA) or health savings account (HSA). These types of accounts enable you to deposit pre-tax income to pay health care costs. If you don’t have an FSA or HSA, you might want to open one during open enrollment—or you might need to adjust the contributions to an existing account.

Open enrollment is also the time to get rid of benefits you don’t use. Perhaps you can drop pet insurance because your beloved dog recently died. If you’re unsure what benefits you pay for, check out the payroll deductions on your paycheck stub, which should itemize all contributions.

If your benefits include life insurance, decide if you need to add or remove certain beneficiaries. Consider, for example, benefit changes needed to accommodate upcoming retirement plans or a new domestic partner or spouse.

Key Takeaways

  • The annual period in which you can add or change existing benefits is called open enrollment.
  • Open enrollment can apply to benefits such as health insurance, life insurance, or savings plans.
  • Employer- and government-sponsored health insurance plans are subject to open enrollment periods.
  • This time generally takes place in the fall, usually for several weeks.
  • Special enrollment periods are available for people who experience qualifying life events outside the open enrollment period.