Navigating the rules around changing or enrolling in health insurance can be confusing, but understanding the right timing can save you a lot of stress. Whether you’re under 65 or on Medicare, here’s a straightforward guide on when you can make changes to your coverage.

Open Enrollment for Individuals Under 65

For most of the United States, the open enrollment period runs from November 1st to January 15th each year. If you want your coverage to begin by January 1st, be sure to submit your application by December 15th.

For Idaho residents, the window is slightly shorter, ending on December 15th.

During this time, you can either enroll in a new health insurance plan or make changes to your existing plan. If you miss this window, you generally won’t be able to make changes unless you experience a qualifying life event.

What Counts as a Qualifying Life Event?

Qualifying life events include significant changes in your circumstances, such as:

  • Losing employer-sponsored coverage
  • Getting divorced
  • Moving to a different state

However, it’s crucial to note that the event alone doesn’t automatically qualify you for a special enrollment period. For example, if you lose your job or move out of state but didn’t have health coverage before the event, you won’t qualify to enroll.

Many people ask why they can’t simply enroll midyear. The reason is that if the government allowed people to enroll at any time, individuals might wait until they face a serious health issue, such as a cancer diagnosis or the need for surgery. To keep the system fair and sustainable, these enrollment periods are in place.

Enrollment for Medicare Recipients

If you’re on Medicare, your main opportunity to make changes happens during the Annual Election Period from October 15th to December 7th. During this time, you can change or add coverage to your plan.

Medicare Advantage plans don’t require medical underwriting, but if you want to add a Medicare Supplement (Medigap) plan, most states require you to be in good general health to qualify.

There’s also a Medicare Advantage Open Enrollment Period between January 1st and March 31st, where you can switch to a different Advantage plan or return to Original Medicare.

If you miss these periods, you’ll need a special election period to make changes. Remember, switching or adding a Medicare Supplement plan outside these windows typically requires passing medical underwriting.

What’s the Next Step?

Understanding when you can make changes to your coverage is key to ensuring you’re always protected. If you’re unsure about your options or need assistance navigating the enrollment periods, Medigap Pros is here to help.

Book an appointment with us today to review your current plan or explore new coverage options! Click here to schedule.

We’re dedicated to simplifying your health insurance journey!