How to Navigate Health Insurance Open Enrollment | Solstice

Navigating Open Enrollment on the healthcare marketplace might seem a bit overwhelming at first. But don't worry, you've got this! Open Enrollment is the designated time each year when you can sign up for health and dental insurance, tweak your current plan, or switch to a new one. There are a few important steps to keep in mind. You'll need to know the key dates, gather the right documents, and explore the different plan options.

We're here to break down everything you need to know so you can breeze through Open Enrollment with confidence and ease!

Key Takeaways:

• Open enrollment is when you can sign up for new health insurance or change your plan.
• A special enrollment period is for qualifying life events, like loss of benefits or birth of a child.
• There are federal and state marketplaces to enroll in health insurance
• Open enrollment runs on the marketplaces from November 1 through January 15
• There are four types of health plans: EPO, HMO, PPO and POS
• Marketplace plans are for individuals and families, while companies can also offer it to employees

What is Open Enrollment?

Open Enrollment is the time of year when you and your family can sign up for health and dental insurance or make changes to your current plan. If you happen to miss this window, you will need to wait until the next Open Enrollment period unless you qualify for a special enrollment period.

What is a Special Enrollment Period?

If something big happens in your life, you can sign up for or change your health insurance outside of the Open Enrollment period. These special enrollment periods can happen for things like:

• Losing health coverage
• Getting married
• Having a baby or adopting a child
• Changes in household income
• Moving to a new area

What information do I need to enroll?

To enroll in health insurance on the marketplaces, you'll need to gather some extra documents. Depending on your situation, here’s a list of what you might need:

• Proof of income: A 1040 tax return, W-2 or 1099, pay stub, or self-employment ledger (Schedule C). Social Security statements or an unemployment benefits letter may also suffice.
• Proof of Citizenship: Citizens of the U.S. need to provide proof like a U.S. passport, a state-issued driver’s license or a birth certificate.
• Immigration information: If you immigrated to the U.S., you will need to provide a resident card, re-entry permit, refugee travel document, or employment authorization card.
• Adoption paperwork: To add an adopted or foster child to your health insurance, provide proof of parenthood or guardianship, such as an adoption letter or foster care papers.

When can you enroll in health insurance coverage?

For individual and family plans on the ACA Marketplace, Open Enrollment runs from November 1 through January 15 in most states. You'll use a specific marketplace website to sign up for benefits depending on your state. You can find out more about the federal and state marketplaces here.

The Annual Enrollment Period for Medicare is from October 15 to December 7 and usually starts at age 65. For coverage through Medicaid and Dual Eligible Special Needs Plans (DSNP), you can enroll anytime during the year.

Meanwhile, open enrollment for health insurance through an employer typically happens in the fall and is set by the company.

Which state uses the federal marketplace?

There are 31 states in the U.S. that use the federal marketplace for healthcare open enrollment, which are:

• Alabama
• Alaska
• Arizona
• Arkansas
• Delaware
• Florida
• Hawaii
• Illinois
• Indiana
• Iowa
• Kansas
• Louisiana
• Michigan
• Mississippi
• Missouri
• Montana
• Nebraska
• New Hampshire
• North Carolina
• North Dakota
• Ohio
• Oklahoma
• Oregon
• South Carolina
• South Dakota
• Tennessee
• Texas
• Utah
• West Virginia
• Wisconsin
• Wyoming

Which states have their own marketplace?

22 states have their own health insurance marketplace, and they are:

• California
• Colorado
• Connecticut
• District of Columbia
• Georgia
• Idaho
• Kentucky
• Maine
• Maryland
• Massachusetts
• Minnesota
• Nevada
• New Jersey
• New Mexico
• New York
• Pennsylvania
• Rhode Island
• Vermont
• Virginia
• Washington

What types of health insurance are available on the healthcare marketplaces?

When you are looking for health insurance on the federal and state marketplaces you will come across four types of plans:

• Exclusive provider organization (EPO): An EPO requires you to use in-network providers and choose a primary care physician (PCP). You'll pay full cost out-of-network, except in emergencies, and need a referral from your PCP to see a specialist.
• Health maintenance organization (HMO): Like EPO plans, HMOs require you to have a primary care physician and get referrals for specialists.
• Point of service (POS): POS plans require a primary care physician but allow out-of-network providers at a higher cost. In-network services usually don't require a deductible.
• Preferred provider organization (PPO): PPO plans let you see any provider, with lower costs in-network. No primary care physician or referrals needed.

How can employers use the marketplace?

If you have 50 or more full-time employees (or the equivalent), you need to offer health insurance. As an employer, you might be curious if public healthcare plans on the ACA marketplaces could be a good fit for your team. Private group health insurance can sometimes be pricier and more complicated, and they often have minimum participation requirements.

In the end, whether you choose private or public insurance for your employees, it needs to be affordable and provide good value to at least 95% of your full-time staff and their dependents. If not, there could be some penalties to consider.

Navigating the marketplaces

Whether you're signing up for health insurance on a state or federal marketplace, you'll need to enter some basic info like your ZIP code, date of birth, and the number of dependents you'll be including on your plan. Before you make your final choice, you can use the handy comparison tools on the marketplaces to check out and compare the plans available in your area.

We’re cheering you on as you navigate your healthcare journey and hope this info makes things a bit easier. For more handy tips, grab your free Open Enrollment cheat sheet with all the terms you need to know.

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