Open enrollment Q&As for regular people

Are you getting ready to sign up for your company’s healthcare benefits? To be honest, open enrollment is confusing for a lot of people. There’s so much jargon that many people come away with more questions than answers. And for something as important as your healthcare, that seems like a gamble to guess on your benefits. That’s why we want to help clarify some common open enrollment terms, processes and deadlines. Then, you can turn this annual “to-do” into an “all-done.”

What is open enrollment?

Open enrollment is the time during the year that you can make changes to your health coverage.¹ For example, you can sign up for health coverage or switch from one type of a plan to another. You can also add a dependent without having a qualifying life event (more on that later). Some plans might let you drop your health coverage during the year. Most only let you add or change your coverage during the open enrollment period.

When is open enrollment?

The enrollment dates and details depend how you get your health coverage. Many folks get their health coverage in one of three ways:¹

• An employer: Employer-based coverage is when you get your health coverage through your job.
• The individual marketplace: Individual coverage means you buy health coverage directly from a health insurance company. You can also buy coverage through a state-run healthcare exchange. Your plan can be just for you or for you and your family.
• Medicare: Most folks can start on Medicare at age 65, but there are special rules that can change when people can enroll.

If your coverage comes from one of these, here are the dates you should keep on your radar:¹

• Employer or job-based health coverage: Companies can choose any dates for their open enrollment window. However, most companies hold open enrollment in the fall.
• Individual coverage: Most states run their open enrollment period from November 1-January 15 each year.
• Medicare: you can sign up for Medicare when you qualify by age or other certain criteria. This is your Initial Enrollment Period. After that, you can make changes during the Annual Enrollment Period. 

When will my coverage change take effect?

Like the open enrollment window, the start date of your coverage change depends on how you get your health insurance.

• Employer or job-based health coverage: Most changes take effect at the beginning of the company’s “plan year.” A majority of companies start their plan year on January 1st. However, some plans and states choose to run on a different schedule. Some employers also might have a waiting period before employees qualify for health coverage. Check with your company’s healthcare benefits administrator for details on your coverage calendar.
• Individual coverage: In most states, plans take effect January 1st. However, some plans and states follow a different calendar. You’ll want to check the details for your state and plan.
• Medicare: Changes made during open enrollment generally take effect on January 1st of each year.

Are there other times when I can change my plan?

Most types of health insurance offer a special enrollment period for people who’ve had a “qualifying life event.”² If you meet certain criteria during the year, plans can flex on their enrollment rules. Examples of qualifying life events are:²

• Losing your other health coverage by leaving a job, aging off your parent’s plan, COBRA expiration, or through a divorce
• Moving out of your plan’s coverage or service area
• Getting married
• Having a baby or adopting a child

Speak with your health plan administrator if you have had, or plan to have, a qualifying life event. Together, you can talk through your options.

What if I miss open enrollment?

If you want to make changes to your health coverage, you must act during the open enrollment window. The only exception is if you have had a qualifying life event. Otherwise, you’ll have to wait until the next open enrollment window to make the changes you wanted. If you need health insurance while you wait, you can buy short-term health insurance to cover you until the next open enrollment period.

How does Teladoc Health work with insurance?

Teladoc Health works with different insurance companies. They offer Teladoc Health services as a benefit to the members of that insurance company’s plan. Each insurance company chooses which Teladoc Health services they will offer to their members. Some services are available at no cost for members. Your company’s health plan administrator can help you learn more about the services and costs with your health plan.

Online healthcare resources

Want to learn more about how Teladoc Health works with your benefits? We can help. With a virtual appointment, you can speak with a healthcare specialist right from your home, your office or wherever you’re most comfortable. We’re here to help you get started today!