How Open Enrollment Works: Your Questions Answered

By Mark Fontanella

It’s that time of year again—that short period when you need to make crucial decisions about your health insurance plan for the year ahead. Here are answers to your most pressing open enrollment questions to help you navigate the process and its various nuances with less stress.

What does open enrollment for insurance mean?

Open enrollment is the annual period when people can make changes to or cancel their existing health plan or choose a new one.

When is the open enrollment period?

Most companies’ open enrollment periods run the last few weeks of the year for health, dental, vision, life, and disability plans. The federal open enrollment period for the health insurance marketplace runs from Nov. 1 through Dec. 15. However, N.J. and a handful of other states offer an extended period that runs through Jan. 31, 2021. If you enroll by Dec. 31, your coverage will begin on Jan. 1, 2021. If you enroll by Jan. 31, your coverage will begin on Feb. 1, 2021.

Do I have to wait until open enrollment to get health coverage?

Yes, unless you have a qualifying life event (QLE) that occurs outside the open enrollment period.

Qualifying life events include:

  • Having a baby or adopting a child
  • Marriage or divorce
  • Moving to a new area
  • Changing or losing your job
  • A death in the family
  • Loss of dependent status
  • Earning U.S. citizenship
  • Changes in income that affect the coverage you qualify for

What if I miss the open enrollment period?

If you miss the open enrollment period and don’t qualify for any of the above life events, you may have to wait until the next open enrollment period. In this case, you might want to look into short-term coverage, critical illness plans, or accident supplements. These plans are not regulated by the Affordable Care Act (ACA) and allow year-round enrollment. However, if this is your only health coverage, you will not be in compliance with the ACA’s individual mandate. As a N.J. resident, you will also be charged a penalty for not having the required minimum essential coverage. That said, having some coverage is generally better than having no coverage at all.

How can I save on healthcare costs?

The best way to save money on health insurance costs is to work with an agency or broker who knows the market, understands your needs, and can pair you with the most affordable health plan with the best protection for you and your family. In addition to the vast knowledge they offer in the types of plans available, a broker can explain the various differences between plans, answer any questions, and guide you as you decide what makes the most sense for your needs and the needs of your family.

How can I get health insurance if I have no income?

If you are unemployed and have no income, you may be eligible for free or low-cost family care insurance that covers doctor visits, prescriptions, vision, dental care, mental health and substance use services, and even hospitalization. Your local insurance agent can direct you to the appropriate state or county office to register.

Can I put my children on a plan alone?

While every situation is different, you may be able to set up a child alone on a qualified plan. According to the N.J. Department of Health and Human Services, children age 18 and younger may be eligible for NJ FamilyCare/Medicaid if their family’s total income before taxes is at or below 350% of the federal poverty level. Parents and guardians must be legal, permanent residents for at least five years to be eligible.

What information do I need to provide to become eligible for a subsidy?

If you work with experts like Hanson & Ryan, who are licensed certified navigators for the marketplace, you don’t need to include all of your contact details—just your income and the ages of those you’d like to have on the plan.

Is the quote I receive from an insurance agency higher than what I can find on my own?

Many agencies like Hanson & Ryan do not charge extra for their services. Should you choose to do your own internet search of healthcare options, keep in mind that many plans out there are not qualified plans for the state of N.J. An agency like Hanson & Ryan only works with qualified companies, which means you will only get quotes for plans that are applicable to you—and at the best rates.

At Hanson & Ryan, we understand that choosing the perfect health insurance plan can be a confusing, and often frustrating, experience. However, with over 140 years in the insurance business, we have a complete understanding of the different coverage types, their offerings, and their enrollment processes.

We have a team of certified representatives who can help you obtain government subsidy plans through GetCoveredNJ. For individual off-exchange health insurance plans (private insurance), we work with Horizon Blue Cross Blue Shield of NJ, Oscar, and AmeriHealth. We’ll weigh the best options for your family situation and help guide you to a plan that best suits your life scenario.

At Hanson & Ryan, we advocate for you. Contact us today to speak to one of our insurance representatives.