Haris Ashley
Open enrollment is a period that happens annually, typically in the fall, enabling individuals to sign up for health insurance, adjust their current plan, or cancel their plan. Medicare beneficiaries with Parts A and B can use this period to switch to a Medicare Advantage plan or opt for traditional Medicare. Those with Medicare Advantage can switch to a different Medicare Advantage plan or traditional Medicare and enroll in a Part D plan. Importantly, Medicare Supplemental Insurance (Medigap) policies are not tied to open enrollment, and individuals can apply for a Medigap policy at any time of the year.
| Characteristics | Values |
|---|---|
| Is supplemental insurance subject to open enrollment period? | No, enrollment in Medicare Supplemental Insurance (Medigap) is not tied to the open enrollment period. However, there is a one-time, 6-month Medigap Open Enrollment Period for those 65 or older with Medicare Part B. |
| Open enrollment period | Open enrollment is an annual period, typically in the fall, when individuals can sign up for health insurance, adjust their current plan, or cancel their plan. |
| Special Enrollment Period | A period outside of Open Enrollment when individuals can enroll in or change their Marketplace plans due to a qualifying life event or based on income. |
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What You'll Learn
Medicare beneficiaries and supplemental insurance
Medicare beneficiaries can opt for supplemental insurance, also known as Medicare Supplement Insurance or Medigap, which is sold by private insurance companies. Medigap helps cover some of the "gaps" in expenses not covered by Medicare, such as deductibles, copayments, and coinsurance. It also offers coverage for travel outside the US, although it generally does not cover long-term care, vision, dental, hearing aids, private-duty nursing, or prescription drugs.
Medigap policies are standardized, and in most states, they are named by letters like Plan G or Plan K. The benefits offered by each lettered plan are the same, regardless of the insurance company. The price is the only differentiating factor between policies with the same letter sold by different companies.
Federal law provides a six-month Medigap Open Enrollment Period for individuals aged 65 or older who have Medicare Part B. During this time, beneficiaries can enrol in any Medigap policy of their choice and benefit from better prices and more choices. After this period, beneficiaries may not be able to purchase a Medigap policy, or it may cost more.
In some cases, individuals may be able to purchase a Medigap policy outside of the open enrolment period. These situations are referred to as "guaranteed issue rights" or "Medigap protections." For instance, individuals under 65 with Medicare due to a disability may not be able to buy a Medigap policy until they turn 65, as federal law does not require insurance companies to sell Medigap policies to people under that age. However, some states do offer Medigap policies to individuals under 65.
Medicare beneficiaries can also explore other options for supplemental coverage, such as employer-sponsored insurance or Medicaid.
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Special Enrollment Period
A Special Enrollment Period (SEP) is a period of time outside of the yearly Open Enrollment when you can enrol in or change your health insurance or Marketplace plan. Typically, SEPs are available for consumers based on certain life changes or their yearly household income.
You may qualify for a SEP if you've had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child. For instance, in the state of New York, a permanent move into the state or a move within the state that makes new health plans available to you can be a qualifying life event for a SEP. Life events that cause you to lose or experience a change in health insurance may also make you eligible for a SEP.
Additionally, if your household income is below a certain amount, you may qualify for a SEP. For example, in New Jersey, consumers with an annual income of up to 200% of the Federal Poverty Level ($30,120 for an individual or $62,400 for a family of four in 2025) can qualify for a SEP and access nearly free health plans throughout the year.
It is important to note that the rules and requirements for SEPs can vary by state and insurance provider. For example, the Open Enrollment period typically runs from November 1 to January 15, but the dates can vary by state. Similarly, the specific life events that qualify for a SEP may differ depending on your location and insurance provider. Therefore, it is always a good idea to check with your state's official healthcare website or your insurance provider to understand the specific rules and requirements for SEPs in your area.
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Qualifying for a Special Enrollment Period
A Special Enrollment Period (SEP) allows you to enrol in a health insurance plan outside of the yearly Open Enrollment Period. This is usually due to a significant life event or a change in your circumstances. Here are some scenarios that may qualify you for an SEP:
Loss of Health Coverage
You may qualify for an SEP if you or anyone in your household has lost qualifying health coverage or expects to lose coverage in the next 60 days. This includes losing coverage through your employer or a family member's employer, or if you are no longer a dependent on someone else's plan. Losing Medicaid or Children's Health Insurance Program (CHIP) coverage within the past 90 days may also qualify you for an SEP.
Income Changes
If your household income decreases and you now qualify for savings on a Marketplace plan, you may be eligible for an SEP. This is based on certain income thresholds, such as an annual income up to 200% of the Federal Poverty Level.
Life Events
Certain life events can qualify you for an SEP, including getting married, having or adopting a baby, gaining a new dependent due to a court order, or experiencing the death of someone on your Marketplace plan. Moving to a different state or within your state may also qualify you for an SEP if it makes new health plans available to you.
Complex Health Care Issues
You may qualify for an SEP if you are a survivor of domestic abuse or spousal abandonment and want to enrol in your own separate health plan. Additionally, if you live in an area affected by a natural disaster that is eligible for "individual assistance" or "public assistance" by the Federal Emergency Management Agency (FEMA), you have 60 days from the end of the FEMA-designated incident period to enrol in Marketplace coverage.
Medicare and Medigap
Under federal law, you are entitled to a one-time, 6-month Medigap Open Enrollment Period when you turn 65 and have Medicare Part B. During this time, you can enrol in any Medigap policy offered in your state, and insurance companies cannot deny you coverage due to pre-existing health conditions. In some cases, you may be able to buy a Medigap policy outside of this period if you have guaranteed issue rights.
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Guaranteed issue rights
In the United States, guaranteed issue rights refer to situations where an insurance company cannot deny you a Medigap policy outside of the Medigap Open Enrollment Period. During the Medigap Open Enrollment Period, individuals aged 65 or older can generally enrol in any Medigap policy sold in their state, and insurance companies cannot deny coverage due to pre-existing health problems.
However, guaranteed issue rights allow individuals to purchase a Medigap policy outside of this standard enrolment period. These rights may vary depending on state law, and individuals under 65 with Medicare due to a disability or ESRD may not be able to purchase a Medigap policy until they turn 65. It is important to check with your State Insurance Department to understand your specific guaranteed issue rights.
In the context of life insurance, guaranteed issue life insurance is a form of coverage that does not require a medical exam or health questions. It provides permanent coverage for individuals who may not qualify for standard insurance due to serious health conditions. Typically, individuals within the eligible age range, usually between 50 and 80, are automatically approved for guaranteed issue life insurance. This type of insurance is designed to cover final expenses, including funeral costs, outstanding medical bills, or small debts.
While guaranteed issue life insurance offers the benefit of guaranteed acceptance, there are some potential drawbacks. Most policies have a waiting period of two to three years before beneficiaries are fully protected, and the death benefit paid out may be lower than that of traditional life insurance policies. Additionally, guaranteed issue rates are generally higher due to the increased risk and uncertainty for insurance companies.
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Short-term health insurance
Short-term plans are intended to bridge gaps between longer-term coverage and typically do not cover outpatient prescriptions. They are limited to a duration of four months, including renewals, and may be further restricted by individual states. These plans may or may not have provider networks, and choosing a plan without a provider network may result in balance billing.
If you are considering a short-term health insurance plan, it is important to understand that these plans do not offer the same comprehensive coverage as ACA-compliant plans. Once your short-term plan ends, you will need to wait until the next Open Enrollment Period to select a new plan, and your eligibility for future short-term plans will depend on your current medical history.
If you have recently experienced a qualifying life event, such as losing your existing coverage, getting married, having a baby, or moving, you may be eligible for a Special Enrollment Period. This allows you to enroll in or change your Marketplace plan outside of the Open Enrollment Period. Additionally, you may qualify for a Special Enrollment Period if your household income is below a certain level, making you eligible for savings on a Marketplace plan.
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Frequently asked questions
An open enrollment period is a window of time that happens once a year, typically in the fall, when you can sign up for health insurance, adjust your current plan, or cancel your plan.
It depends on the type of supplemental insurance. For example, Medicare beneficiaries can apply for a Medicare Supplemental Insurance policy (Medigap) at any time of the year. However, there is a 6-month Medigap Open Enrollment Period for people under 65 with disabilities who are already enrolled in Medicare.
A Special Enrollment Period is a period of time outside of Open Enrollment when you can enroll in or change Marketplace plans due to a life event or based on your income.
Qualifying life events include getting married, having a baby, moving, losing health coverage, or a decrease in household income.
