Open Enrollment: When Is It and How Does It Work?

Each year, millions of Californians get health insurance coverage during open enrollment. This window lasts for just a few months, and in many cases, it’s the only time of year you can switch your health insurance or get a new plan. Miss it and you might be stuck without coverage until next year.

Read on to learn how open enrollment works, the dates to keep in mind, and how to make the most of this time.

What Is Open Enrollment

Open enrollment is the time of year when you can sign up for health insurance, renew your existing plan, or shop for a new one. If you miss this window, you might not be able to buy health insurance until the next open enrollment period. There are some exceptions to that rule, such as a major life change that qualifies you for special enrollment.

Why Open Enrollment Exists

The open enrollment period is designed to help keep the cost of health insurance down. If the enroll-by date didn’t exist, people might not sign up for a plan until they had a pressing health problem. This would drive up insurance prices for everyone.

Before the Patient Protection and Affordable Care Act (ACA), also known as Obamacare, passed in 2010, insurance companies kept costs down by sometimes refusing coverage to those who were sick. The ACA made this practice illegal. Health insurance companies could no longer deny coverage to someone due to a preexisting condition and had to deliver free preventive care to everyone with a plan. Open enrollment became a way to help keep costs down while still giving people ample time to review their options and enroll in a health plan.

As part of the ACA, California created a free service called Covered California. Covered California connects Californians with high-quality health insurance and the financial help to pay for it. Covered California has its own open enrollment period. If you get health insurance through your employer or Medicare, they may have different open enrollment periods.

When Is Open Enrollment

When open enrollment happens depends on where you get your health insurance. The deadlines for Covered California, Medi-Cal, Medicare and health insurance coverage through an employer all differ.

Covered California

Open enrollment for Covered California runs annually from November 1 through January 31. You can buy health insurance or change your existing health plan for the upcoming year at any point during this time. Sign up online, by phone or in person. When you enroll in November and December, the coverage is for the following year and will start on January 1. Enroll in January and your plan begins February 1.

There are some exceptions to this open enrollment period. If your household income is at or below 150 percent of the federal poverty level (FPL) and you don’t qualify for Medi-Cal, you can enroll in coverage any time of year.

Likewise, members of federally recognized American Indian or Alaska Native tribes can enroll at any time of year.

Medi-Cal

There’s no deadline for enrolling in Medi-Cal, California’s Medicaid program that offers free or low-cost health coverage for low-income individuals and families. You can apply for Medi-Cal online, by phone or in person through Covered California — the same application will let you know which program you qualify for. You can also apply for Medi-Cal in person at your nearest county social services office or by mail.

Medicare

Medicare, the federal health insurance program for adults over 65 or disabled adults of any age, has different open enrollment periods depending on your status.

• If you’re already on Original Medicare, the annual open enrollment period runs from October 15 through December 7.

• If you’re on Medicare Advantage, the annual open enrollment is from January 1 through March 31.

• If you’re new to Medicare, the initial enrollment period (IED) starts three months before you turn 65 and ends three months after.

If you miss the annual open enrollment periods, you might need to wait until the following year to change your plan.

If you miss your IED, you may have a late enrollment penalty tacked onto your monthly premium. This is often a lifetime penalty (not a one-time fee), and the amount of the penalty goes up the longer you wait. Learn more about how to apply or change plans here.

Employer-Sponsored Coverage

If you get health insurance through your employer, the enrollment window will depend on your company and the coverage it offers. You can find out the dates and details on how to get covered through your human resources department.

Get Coverage with Covered California

If Medi-Cal, Medicare, or employer-sponsored coverage aren’t options for you, you can buy health insurance through Covered California. Because having health insurance isn’t just a good idea to safeguard your finances and your health — in California, it’s the law. Here’s how to find financial help and choose a health plan.

Consider Your Needs

Whether you're getting health insurance for the first time or shopping for a new plan, consider these questions: Who needs coverage? How often do you visit the doctor? What services do you need covered?

Financial Help for Health Insurance

Covered California is the place to get financial help to lower the cost of your health insurance. Ninety percent of people who enroll through Covered California qualify for financial help — and many people pay $10 a month or less for their health plan.

In fact, Californians now can get more financial help than ever before. Learn about how this works through both premium tax credits to lower the cost of your monthly premium and cost-sharing reductions that save you money when you get care. You can get a quick estimate to find out how much financial help you might get here.

Finding Your Plan

All plans available through Covered California offer the same health benefits, including emergency care, preventive and wellness services, hospitalization and more. However, they differ in other important ways:

• Coverage level. Plans come in four tiers of coverage: Bronze, Silver, Gold and Platinum. These tiers describe how costs are shared between you and your insurance company. With Bronze you pay less monthly and more at the time of care, while Platinum is the opposite.

• Type of plan. The most common types of health plans are HMO, EPO and PPO plans. The difference between these plans is flexibility to see in- and out-of-network doctors and specialists.

• Provider network. If there’s a doctor you prefer, you may want to see if they are in-network with a plan before making a selection.

Learn more about what to consider when shopping for health insurance here.

Getting Covered Outside of Open Enrollment

In some instances, you may be able to sign up for a health plan outside of open enrollment by qualifying for a special enrollment period.

Qualifying for Special Enrollment

Certain life events qualify you for a special enrollment period through Covered California. For most qualifying life events, you have 60 days from the date of the event to get a new health plan. Your coverage will start on the first day of the following month after you select a plan. Here are common ways to qualify:

• Losing your job and the employer-sponsored coverage that comes with it

• Getting married or entering into a domestic partnership

• Welcoming a new child through birth, adoption or foster care

• Moving to or within California

• Gaining citizenship or lawful presence (for example, green card or DACA status)

Other less common circumstances like experiencing a natural disaster count, too. Check out the full list of qualifying life events.

Get Covered

When you need coverage, Covered California can help you find the health plan and financial help you need. Remember, the dates for open enrollment are November 1 through January 31 — but if you experience a qualifying life event at another time of year, you can sign up during your special enrollment window.

At any time, you can get a quick quote to find out how much financial help you might get to pay for your plan. Free expert help is available all year round over the phone, in person and online. Ready to get covered? You can start here to get a health plan that meets your needs.