Healthcare Open Enrollment Season is upon us!
It's fall! For some of us that means Pumpkin Spice Latte season. But equally as important, if not as fun, it also means Healthcare Open Enrollment Season. That's right, it's time to start thinking about how you can set yourself up for a healthy 2023. So, we're providing a little refresher that will point you in the right direction no matter what type of healthcare you use.
What is an Open Enrollment Period?
Open enrollment is a period of time, usually starting in late fall, when anyone who qualifies can enroll in a health insurance plan. If you are already enrolled in a plan this is the time to renew or make changes. After open enrollment closes, you are not able to make changes to your plan until the next open enrollment period, unless you have a “qualifying life event.”
Different types of health insurance have different enrollment periods:
Healthcare.gov (ACA, Marketplace, Obamacare): Open Enrollment is from November 1, 2022 - January 15, 2023. Plans may automatically renew, but updating your application ensures you get the right coverage for your needs.
BadgerCare (Medicaid in Wisconsin): You can enroll when you become eligible, no matter what time of year. Right now, because of the COVID-19 extended eligibility rules, anyone who has BadgerCare remains eligible at time of their 12-month renewal. Under normal circumstances, BadgerCare users must confirm their eligibility to renew coverage every 12 months after their initial application.
Medicare Open Enrollment: Open Enrollment is Oct. 15, 2022 - Dec. 7, 2023. With a few exceptions, Medicare plans automatically renew each year.
Employer Healthcare Plans: Open Enrollment periods vary by employer, most often in the fall with plans starting in January.
What is a Qualifying Life Event?
A qualifying life event is an event that makes you eligible to enroll in a plan outside of the open enrollment period. Some plans have time limits around these events, and you must enroll within a certain number of days of the event happening, during your “special enrollment period.”
Qualifying events include:
- Getting married or divorced.
- Having a baby or adopting a child.
- Employment change: When you first accept a job, you do not need to wait until open enrollment to join the healthcare plan. When you lose or quit a job, you do not need to wait until open enrollment to find a Marketplace plan, or to enroll in Medicaid, if you qualify.
- Permanent Move: If you move out of your provider’s network, you are able to enroll in a new local plan.
- Turning 65: When you turn 65 you will become eligible for Medicare no matter what time of year. This is called your Initial Enrollment Period. It lasts for 7 months, starting 3 months before you turn 65, and ending 3 months after the month you turn 65.
Will I have a waiting period when I enroll in a new plan?
A waiting period is an amount of time you must wait before getting coverage after enrolling in a plan. An employer can require a 0-90 day waiting period. BadgerCare (Medicaid in Wisconsin) and Marketplace coverage have no waiting period. If you are offered health insurance at an employer and have a waiting period, you can stay on your BadgerCare or Marketplace plan until your employer-provided coverage starts.
Even though many plans do not have a waiting period, there still may be a processing time required before your coverage starts and coverage usually starts on the first of the month. Make sure to ask if this is the case. For example, let’s say you start a new job on February 2nd, with no insurance waiting period. For coverage to start on March 1st, you've been informed that you need to complete enrollment paperwork by February 15th. If you enroll after the 15th, your coverage will not start until the following month, beginning on April 1st.
Need help from a person?
Contact your employer's Human Resources (HR) Department with questions about enrollment deadlines and make sure they give you a Health Insurance Plan Guide to look over.
If you are already enrolled in any healthcare plan, your insurance card will have a “member services” number on it. You can call this number to ask questions about your plan.
Free help is available over the phone for the entire state of Wisconsin through Covering Wisconsin. To make an appointment with a certified-enrollment specialist: Call 608-261-1455 or go to www.coveringwi.org.
We hope you found this information helpful. If you still find it overwhelming, go get yourself that Pumpkin Spice Latte, and then contact one of the sources above for more help!