Since the Affordable Care Act (ACA) in the early 2010’s, pre-existing conditions went away, and open enrollment was put into place.What is open enrollment you say?It is the time- period once a year when you are eligible to select from private medical insurance plans available on the open market, regardless of any pre-existing conditions or how long you have gone without insurance.
Open enrollment is also available at people’s places of employment annually. They can select from the company’s offerings once a year, and only once a year (or maybe when newly hired, depending on the employer’s rules). It is nice when open enrollment aligns with the marketplace open enrollment, so people can shop everywhere that year at one time and truly compare the benefits and costs of all plans available in their state and workplace.
Open enrollment for the marketplace (ACA with private plans) for 2027 is from November 1, 2026, until December 15, 2026. This will provide a January 1, 2027, effective date for the official start of the calendar year. After December 15, 2026, unless the government declares a small extension, you will not be able to purchase insurance again until next year, unless you have what we call a qualified life event mid-year.
A life event, also known as a qualified status change, would be marriage, divorce, birth or adoption of a child, moving outside of the health policies insurance network area, a loss of Medicaid, and the list goes on. These life events will allow for mid-year changes, and there are no other exceptions. Simply electing to purchase at any time is not permitted, and losing coverage due to non-payment will not allow for a new policy mid-year either.
Medicare also has its own open enrollment period each year. We call in the annual enrollment period or AEP. This goes from Oct 15 through Dec 7 every year, and this allows the seniors to change their Medicare Advantage plans for those who are on part C.Medicare supplements are available year-round, yet these policies have a medical questionnaire and a scrub of the medical information bureau (MIB) at application time. When policies require medical reviews, exams, or MIB inspections, they don’t always have an open enrollment.
Well, why?
- Why open enrollment?
- Why only life events?
- Why are medically reviewed plans easily accepted throughout the year?
Let’s start with number 1:
- Why open enrollment? Open enrollment was put into place when pre-existing conditions went away to protect the insurance companies from people getting hurt and just electing to have insurance right after. You might be able to get insurance for and from anyone now during open enrollment, regardless of pre-existing conditions, yet that is the only time you can get the insurance. Regardless of an insurance company’s profitability, no insurance company can afford to have people pick up insurance at any time, like when they need to use it, and then drop off the insurance when they are done. It has always been a rule that no one can go for more than 63 days without insurance. It comes from the time when we had pre-existing conditions, and it still exists today.
- Why only life events? Life events create a need to gain insurance. This situation calls for a need to select new insurance; therefore, the participant is allowed to have insurance outside of open enrollment. When you think about it, too, having a child means the child needs insurance. Getting married creates the need to add a spouse or create a family plan. These life events do not instantly create fear within the insurance company’s mind when receiving a claim.
Insurance has determined, with the government, that these events are necessary and not proof that someone is trying to take advantage. They are not people trying to jump on insurance right away and have a medical issue handled. The one thing the insurance companies were offered protection from was when the ACA was put into place. Pre-existing conditions. People can’t decide whether they do or don’t need insurance at random times; they need to try to carry insurance at all possible times.
- Why are medically reviewed plans easily accepted throughout the year? Medically reviewed plans are easily accepted throughout the year, such as Medicare supplements, because the medical portion is required. The insurance company has the right to deny these plans to people when they are unable to pass the medical exam required for the policy. Therefore, the insurance company is already being protected by medical underwriting, which allows them to do so for these types of insurance products.
The insurance company can decide whether it would like to accept the risk. This is after an application is submitted with a medical questionnaire; the individual’s information is run through the MIB, and maybe there is even a medical exam requiring a blood or urine sample. These plans do not create much risk for insurance; therefore, they do not fall into the open enrollment arena, and the insurance company has the right to deny applications for these plans, too.
It really bothers me a lot that our politicians constantly go on about no pre-existing conditions and how great it is now, yet they don’t ever mention to anyone about open enrollment. So many people have been confused over the past decade about how to gain health coverage. They call insurance to find out they missed the deadline, or they lose Medicaid, and think they are screwed. That is a life event, the loss of Medicaid, yet unless the welfare office tells them, they might not realize it’s an option. Just so much new information in this era with insurance, and I am here to help guide you through it.
The lack of education in this area is quite real and not fair to the everyday American who is being told “pre-existing conditions do not apply anymore,” yet not being told what to do to follow the new suite of health care insurance rules. It is like constantly being told what not to do instead of being told what to do.
At the same time, though, everyone knows that you can’t get into a car accident and then go buy the insurance afterward to cover the claim. Why is everyone confused when their medical insurance works the same way?
Feel free to touch on this in our open forum.
