Frequently Asked Questions About Open Enrollment

Open Enrollment is the critical period each year when you can sign up for health insurance or change your existing coverage. Whether you’re looking to adjust your plan, enroll for the first time, or switch providers, this is the time to do it. But with so many questions surrounding the process, it can feel overwhelming.

We’ll walk you through the most common questions about Open Enrollment to help you feel confident in picking the best health insurance plan for 2025. Whether you’re unsure about deadlines, switching plans, or wondering what happens if you miss your chance, we’re here to make it easy.

What is the Difference Between Open Enrollment and Special Enrollment?

Open Enrollment is the annual period when you can sign up for or change your health insurance plan. For 2025, the enrollment window is open from November 1, 2024, to January 15, 2025. It’s your opportunity to look over your coverage options, check if you qualify for any subsidies, and lock in a plan that suits your situation.

Special Enrollment, however, allows you to get coverage outside of this window, but only if you experience a qualifying life event. These events open up a Special Enrollment Period (SEP), which lets you either enroll in or change your plan. Some everyday qualifying life events include:

• Getting married or divorced
• Having or adopting a child
• Losing your current health coverage (due to job loss, aging out of a parent’s plan, etc.)
• Moving to a new area with different health insurance options
• A major change in income that alters your subsidy eligibility

If you qualify for SEP, you’ll typically have 60 days from the event to make changes or enroll in a plan.

Can I Get Coverage Outside of Open Enrollment if I Miss the Deadline?

If you miss the Open Enrollment period, don’t panic. While you won’t be able to sign up for most health insurance plans outside of the deadline, there are still some options available:

• Special Enrollment Period (SEP): As mentioned earlier, if you experience a qualifying life event—such as marriage, job loss, or the birth of a child—you can enroll in or change your health insurance plan. This typically gives you a 60-day window after the event to get coverage.
• Medicaid or the Children’s Health Insurance Program (CHIP): These programs are available year-round if you meet the income requirements, meaning you can apply at any time, even outside of Open Enrollment.
• Short-term Health Insurance: If you don’t qualify for a Special Enrollment Period or Medicaid, you may want to think about a short-term health insurance plan. These are made to provide temporary coverage but are not as comprehensive as regular health plans. They might cover emergency situations, but many don’t include routine care, prescriptions, or pre-existing conditions.
• Consequences of Missing the Deadline: If you don’t sign up for health insurance during Open Enrollment and don’t qualify for any of the options listed above, you could be left without coverage for the entire year. This means you’ll have to pay out of pocket for any medical expenses, which can be costly. It’s important to plan ahead to avoid this situation.

How Does Open Enrollment Work if I Have Employer-Sponsored Insurance?

If you have health insurance through your employer, the Open Enrollment process works a bit differently than it does for individual marketplace plans. Employers typically set their own enrollment periods, but they usually happen around the same time as the general Open Enrollment for marketplace plans.

Here’s what you need to know:

1. Employer-Sponsored Open Enrollment: During your employer’s enrollment period, you’ll have the opportunity to review your current plan, switch to a different option (if available), or make changes like adding or removing dependents. Make sure to pay attention to the deadlines set by your employer—if you miss them, you may be stuck with your current plan for another year.
2. Coordinating Benefits: If you have access to both an employer-sponsored plan and a plan through the marketplace, you’ll need to compare the two options carefully. Consider factors like monthly premiums, deductibles, and what’s covered. Sometimes, marketplace plans might offer better subsidies or coverage depending on your income level and needs.
3. Multiple Plan Options: If you have multiple options through your employer, such as different tiers of coverage or the ability to add dental and vision, it’s a good idea to review each plan carefully. This is also a time to decide whether you want to add dependents or remove them from your coverage.

It’s important to remember that if you choose to stay with your employer-sponsored plan, you won’t be eligible for marketplace subsidies, so you’ll want to make sure your decision aligns with your budget and health needs.

Can I Enroll in Dental or Vision Plans During Open Enrollment?

Yes, during Open Enrollment, you can typically add or change dental and vision coverage as well, but it depends on the type of health plan you’re selecting. Here’s how it works:

1. Marketplace Health Plans: Most marketplace health insurance plans don’t automatically include dental or vision coverage for adults. However, you often have the option to purchase standalone dental and vision plans during Open Enrollment. This can be done at the same time you sign up for or change your health insurance plan. Standalone dental and vision plans will come with their own premiums, deductibles, and coverage options, so be sure to review them carefully.
2. Employer-Sponsored Plans: If your health insurance comes through your job, your employer may offer dental and vision plans as part of the benefits package. Sometimes these are bundled with your health insurance, and other times they’re available as add-ons. Be sure to check what options your employer offers during their Open Enrollment period.
3. Children’s Coverage: If you’re looking for dental or vision coverage for a child, some marketplace plans include pediatric dental and vision services as part of their essential health benefits. However, it’s important to confirm whether these are included or if they require an additional plan.

What Should I Consider When Choosing a Health Insurance Plan?

Choosing a health insurance plan can feel like a big decision, but breaking it down into key factors can help you make a choice that fits your needs. Here’s what you should keep in mind:

1. Premiums: This is the amount you pay each month for your health insurance. Plans with lower premiums often have higher deductibles, so make sure you’re balancing what you pay monthly with how much you might have to pay out-of-pocket for medical care.
2. Deductibles and Out-of-Pocket Costs: The deductible is the amount you have to pay before your insurance starts covering medical expenses. Additionally, many plans have out-of-pocket maximums, which is the most you’ll pay in a year before the insurance company covers the rest. Make sure you understand both numbers, as they can significantly impact your overall costs.
3. Network Coverage: Most health plans have a network of doctors, hospitals, and specialists. It’s important to check if your preferred healthcare providers are in-network. If not, you could face higher costs or even have to pay the full cost of care. If you see specific doctors or regularly visit certain facilities, it’s crucial to ensure they’re covered under the plan you choose.
4. Prescriptions: If you take regular medications, review the plan’s prescription coverage. Health insurance plans have formularies, which are lists of covered drugs. Make sure your medications are on that list and understand what your co-payments will be.
5. Specialty Care: If you or someone in your family requires specialist care, check to see if referrals are needed, and whether the plan covers specialists you may need in the future.
6. Plan Type: There are several types of health insurance plans, including HMOs (Health Maintenance Organizations), PPOs (Preferred Provider Organizations), and EPOs (Exclusive Provider Organizations). Each comes with different rules about using in-network providers, referrals, and how flexible you can be when choosing doctors and hospitals.
7. Your Health Needs: Consider your current health and any anticipated healthcare needs in the coming year. Are you planning to have a baby? Do you have a chronic condition that requires frequent doctor visits or medication? Aligning your plan with your expected healthcare needs can help you avoid unnecessary costs.

By keeping these factors in mind, you can choose a plan that strikes the right balance between affordability and coverage, ensuring that it meets your healthcare needs throughout the year.

Can I Add or Remove Dependents During Open Enrollment?

Yes, Open Enrollment is the perfect time to add or remove dependents from your health insurance plan. Whether you’ve had a new baby, adopted a child, or need to update your coverage for other family changes, this is the window to make those adjustments.

Here’s what you need to know:

1. Adding Dependents: If you want to add a new dependent, such as a spouse or a child, you can do so during Open Enrollment. Be sure to have the necessary documentation ready, such as birth certificates or marriage certificates, depending on your situation. Keep in mind that adding dependents may increase your premium since you’ll be covering more people under your plan.
2. Removing Dependents: If you no longer need to cover a dependent—perhaps a child has aged out of your plan or your marital status has changed—you can remove them during this period. Removing dependents may lower your premium, but be aware of how it might affect your family’s overall coverage.
3. Impact on Premiums and Coverage: Adding or removing dependents can change your monthly premium and even your deductible or out-of-pocket maximum. It’s essential to review how these changes will affect your overall health insurance costs and make sure you still have the coverage you need.

What Happens to My Coverage if I Move During Open Enrollment?

Moving can have a big impact on your health insurance coverage, especially if you’re relocating to a different state or even just a new region. During Open Enrollment, you can update your address and adjust your plan to fit your new location.

Here’s what you should consider:

1. In-State Moves: If you’re moving within the same state but to a different city or county, your health insurance options may change based on the new network of providers available in your area. You’ll want to review your plan to see if your preferred doctors and hospitals are still covered in your new location.
2. Out-of-State Moves: If you’re moving to a different state, you’ll likely need to switch health insurance plans altogether. Insurance options vary by state, so it’s important to review the marketplace options available in your new area and select a plan that suits your healthcare needs. Moving to a new state qualifies you for a Special Enrollment Period (SEP), which gives you 60 days to sign up for a new plan if you move outside of Open Enrollment.
3. Updating Your Plan: Whether you’re moving across the state or to a new state entirely, updating your address during Open Enrollment ensures your coverage will align with your new location. Failing to do this could result in gaps in your coverage or higher out-of-pocket costs for out-of-network care.

How Do I Know if My Current Plan is Still the Best Option?

It’s easy to stick with the same plan year after year, but Open Enrollment is the perfect time to evaluate whether your current health insurance plan still fits your needs. Here are a few things to consider when reviewing your plan:

1. How Did Your Plan Perform Last Year? Did you meet your deductible? Were there any unexpected out-of-pocket expenses? If you found yourself frequently paying more than expected, it might be time to consider a plan with better coverage or lower out-of-pocket costs.
2. Changes in Coverage or Costs: Health insurance plans can change from year to year, even if the name of the plan stays the same. Check your plan’s new terms for any changes in premiums, deductibles, co-pays, and coverage limits. These shifts can make a significant difference in how much you end up paying or the level of care you receive.
3. Upcoming Healthcare Needs: If you’re planning a major medical procedure, having a baby, or are currently managing a chronic condition, you may want to upgrade your plan to ensure you’re well-covered. On the other hand, if you’ve been healthy and haven’t needed much medical care, you might be able to save money by switching to a plan with a lower premium.
4. Are Your Doctors Still In-Network? If you have preferred doctors or specialists, it’s critical to make sure they’re still in-network for the coming year. Out-of-network care can be much more expensive, so check to see if your current providers are still covered.
5. Plan Comparison Tools: Many health insurance marketplaces offer comparison tools that allow you to see how your current plan stacks up against other available options. Live Health insurance can help you get the best value for your money.

What Are My Options if I Become Unemployed During Open Enrollment?

Losing a job can be a stressful experience, especially when it comes to figuring out your health insurance. Luckily, there are several options available during Open Enrollment to ensure you’re still covered:

1. COBRA Coverage: If you recently lost your job, you might be eligible for COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage. COBRA allows you to continue the same health insurance plan you had through your employer, but you’ll have to pay the full premium yourself, including the portion your employer used to cover. While COBRA can be expensive, it ensures that you maintain the same level of coverage during a transition period.
2. Marketplace Plans: You can also sign up for a health insurance plan through the marketplace during Open Enrollment. Depending on your income level after unemployment, you may qualify for subsidies to help lower the cost of your premiums. Marketplace plans offer a range of options, so you can choose a plan that fits both your budget and healthcare needs.
3. Medicaid: If your income has dropped significantly due to unemployment, you may be eligible for Medicaid, a state and federal program that provides health coverage to low-income individuals and families. Medicaid enrollment is available year-round, not just during Open Enrollment, so it’s worth checking whether you qualify based on your new financial situation.
4. Subsidies and Premiums: Losing your job can make you eligible for increased subsidies through the marketplace, significantly lowering your monthly premium costs. The government offers income-based subsidies that adjust according to your financial situation, helping make health insurance more affordable during unemployment.

Can I Switch From a Marketplace Plan to an Employer-Sponsored Plan During Open Enrollment?

Yes, if you’ve enrolled in a marketplace plan but later become eligible for employer-sponsored insurance, you can switch to your employer’s plan during their Open Enrollment period. Here’s what to consider when making the switch:

1. Employer Open Enrollment: Most employers have their own Open Enrollment period, often around the same time as the marketplace Open Enrollment. Sign up during this window to switch to your employer’s plan. Review the details of your new coverage, and compare it against your current marketplace plan to ensure you’re making the best decision for your healthcare needs.
2. Subsidy Eligibility: If you’re switching from a marketplace plan, it’s important to remember that you’ll no longer be eligible for marketplace subsidies once you have access to employer-sponsored insurance. Employer plans tend to offer pre-tax premium payments, which can help offset the loss of subsidies, but this is something to keep in mind when comparing costs.
3. Coordinating Coverage: If you’ve already paid premiums for your marketplace plan for the year, you’ll need to coordinate the transition between plans to ensure continuous coverage. Cancel your marketplace plan only once your employer-sponsored coverage begins to avoid any gaps in coverage.

What Are Subsidies, and How Do They Work During Open Enrollment?

Subsidies are financial assistance programs designed to help lower the cost of health insurance premiums for those who qualify. These subsidies are available through the health insurance marketplace and can significantly reduce what you pay each month for coverage.

Here’s how subsidies work:

1. Premium Tax Credits: The most common type of subsidy is the premium tax credit. This credit lowers the amount you pay for your monthly health insurance premiums. The amount you qualify for is based on your household income and family size in relation to the federal poverty level (FPL). Generally, households earning between 100% and 400% of the FPL are eligible for some level of subsidy.
2. How It’s Applied: You have the option to apply the tax credit directly to your monthly premiums, which means you’ll pay a lower amount each month. Alternatively, you can wait until you file your taxes to claim the credit in a lump sum.
3. Cost-Sharing Reductions: In addition to premium tax credits, some individuals also qualify for cost-sharing reductions. These further reduce out-of-pocket costs like deductibles, co-pays, and co-insurance but are only available if you choose a Silver-tier plan from the marketplace.
4. Eligibility: To qualify for subsidies, you must meet certain criteria, including falling within the income brackets and being ineligible for employer-sponsored insurance that meets the Affordable Care Act’s affordability standards. If you’re eligible for Medicaid, you won’t qualify for marketplace subsidies.

Can I Cancel My Health Insurance Plan During Open Enrollment?

Yes, Open Enrollment is the time when you can cancel your health insurance plan if you no longer need it or if you’re planning to switch to another provider. However, there are a few things to keep in mind before making this decision:

1. How to Cancel: If you’re enrolled in a marketplace plan, you can cancel your coverage by logging into your account on the health insurance marketplace website and following the steps to end your coverage. Be sure to select the date you want your coverage to end, typically at the end of the month to avoid any gaps. If you’re canceling an employer-sponsored plan, contact your HR department for the proper steps.
2. Impact on Future Coverage: Canceling your plan means you won’t have health insurance coverage for the remainder of the year unless you qualify for a Special Enrollment Period (SEP) or enroll in another plan. It’s important to have a replacement plan in place if you’re canceling, as going without insurance could leave you vulnerable to high out-of-pocket medical costs.
3. Potential Penalties: While there’s no longer a federal penalty for not having health insurance, some states still impose penalties if you go without coverage. Make sure you’re aware of your state’s rules regarding health insurance requirements.
4. Other Coverage Options: Before canceling, consider whether you’ll have other coverage, such as through an employer, spouse, or a government program like Medicaid or Medicare. If you’re canceling to switch plans, make sure your new coverage starts immediately after your old plan ends to avoid any gaps in coverage.

What if I Need a New Health Insurance Plan but Have a Pre-Existing Condition?

If you have a pre-existing condition and need to enroll in a new health insurance plan, there’s good news:

Under the Affordable Care Act (ACA), health insurance providers cannot deny coverage or charge higher premiums due to pre-existing conditions. You don’t need to worry about being denied coverage during Open Enrollment, even if you have a pre-existing condition.

Thanks to the Affordable Care Act (ACA), health insurers can’t turn you away or charge you extra based on your medical history. Whether you’ve had surgeries, are managing a chronic illness, or have other ongoing health issues, you’re covered. This applies to any plan you choose through the marketplace or from your employer.This applies to all plans available through the marketplace, as well as employer-sponsored plans.

Insurance companies are not allowed to charge you more because of your pre-existing condition. Your premiums will be based on factors like your age, location, and the plan you choose, but your health status cannot influence the cost of coverage.

All marketplace health insurance plans are required to cover a set of essential health benefits, which include treatment for pre-existing conditions. This means your new plan will include the care you need for managing your condition, such as doctor visits, hospital stays, and prescription drugs.

Final Thoughts: Navigating Open Enrollment with Confidence

Open Enrollment is your once-a-year opportunity to make important decisions about your health coverage for the upcoming year. Whether you’re enrolling in a plan for the first time, adjusting your coverage, or switching providers, the key is to be informed. Take the time to review all your options, compare plans, and consider your healthcare needs for the year ahead.

Remember, if you miss the Open Enrollment deadline, you may still qualify for coverage under a Special Enrollment Period if you experience a major life event, or you can explore other options like Medicaid or short-term health insurance. Contact the Live Health Insurance team to help you find what you need for the best health coverage yet!