Health Insurance Enrollment 101

No one wants to think about something going wrong, but the law of averages eventually catches up with us all. At some point you, your spouse, your partner, or your kids will get sick or hurt. When that happens, you can either add the stress of how much it’s going to cost, or you can rest easy knowing that you can focus on your loved one (or yourself, of course). That’s what health insurance is for and why it’s so important to know about health insurance enrollment.

Types of enrollment

There are two types of enrollment which will determine when you can sign up for health insurance.

Open Enrollment

This is generally when you’ll be signing up for/making adjustments to your health insurance plan. Typically, you’ll have one shot per year and get a heads-up from your insurance company or the government, depending on whether you have an employer-sponsored plan or one from the marketplace (more on that later).

As the name implies, open enrollment is available to everyone, so it is the best time to get covered if you’re not already. Regardless of your current health status or life situation, you’ll be able to participate in health insurance enrollment. However, make sure to note that your insurance coverage will not begin on the spot. If you enroll during open enrollment, your coverage will usually begin on January 1st of the coming year. Basically, you don’t want to go booking a bunch of appointments until AFTER your insurance kicks in.

Special Enrollment

You’re most likely to use special enrollment to change an existing plan rather than signing up for a new one. Unlike open enrollment, special enrollment is only for those who have a qualifying life event. These events include things like getting married, having a baby, or losing other health coverage. Be sure to remember that you will have to provide proof of your qualifying life event, so don’t try to cheat the system. They heavily frown upon that.

Another key difference between open enrollment and special enrollment is when the coverage kicks in. As soon as you verify and complete your special enrollment, your coverage begins immediately, which is awesome. On the other hand, you only have a limited window to make any policy changes after a qualifying life event (usually 60 days), which is a bit less awesome. Health insurance enrollment is likely not going to be on the top of your to-do list after a major life event happens.

How to enroll

There are a few steps involved, but there’s nothing to fear. If you have any issues, your HR department or the insurance company you’re signing up with will be able to help you through the health insurance enrollment process.

  1. Gather your info
    • Personal – Name, D.O.B., SSN.
    • Contact – Address, phone number, email.
    • Household – Names, ages and relationship to you of other members of your household.
    • Employment – If you have an employer-sponsored insurance plan, you’ll need to provide information about your job and income.
  2. Check your options: If you’re getting your insurance through your employer, they will basically give you a menu of plans. If you have to purchase your own insurance, you can either look through the Healthcare Marketplace or check private insurance companies.
  3. Compare plans: Consider things like the cost of premiums, how high the deductible is, co-pays, coinsurance, and the insurer’s network.
  4. Apply: If you’re going through your employer, your HR department will get you set up. If you’re going it alone, you can typically get the necessary forms via the provider’s website (for those using the Healthcare Marketplace, that would be healthcare.gov).
  5. Pay up: Yes, you’ll have to pay your first premium BEFORE your insurance starts. For employer-sponsored plans, it will come directly from your paycheck. Outside of that, you will have to set up payment.
  6. Get your insurance card and review your coverage: Make sure you understand the ins and outs of your plan. If you have questions, your insurance card will have a contact number for your insurance company. It will typically also have info like effective date and dependents covered.
Image of a sample Humana Medicare health insurance card, front and back.
Image of a sample BlueCross BlueShield health insurance card, front and back.

Group health insurance

Group health insurance is used to, you guessed it, insure a group of people. As long as you are eligible through your group (i.e. you’re past your probation period with your job), you and your dependents can be covered. Also, since there is no individual medical exam for eligibility, it tends to be much easier to be covered. ALSO also, because the overall premium costs are divided between you and your employer, it keeps the cost down, meaning you can be covered for less. Finally, because the insurance company uses the health risks of everyone in the group, you’re likely to see more stable premiums and lower overall costs compared to if you had an individual insurance plan. This is typically why it is better to get insurance at work.

Now, while this is usually associated with employer-sponsored insurance, there are other ways to get access to the benefits of group health insurance enrollment. Trade unions, professional associations, and even members of certain clubs or organizations may have insurance plans available. If you happen to be part of one of these groups or plan on joining one, check and see if they have health insurance enrollment available. Freelancers and other contract workers, in particular, can greatly benefit from this.

The wrap up

All in all, getting insurance isn’t that difficult. The bigger issue is making sure you’re informed so you make the best decision for your situation. Read all the reviews, ask all the questions, and check all the numbers. Never let a lack of knowledge keep you from getting the most out of your health insurance enrollment!

Headshot picture of the writer of this article, Kenneth Medford III, with a muted black and white filter.
Kenneth Medford III

Writer, rhymer, gamer: the easiest way to define the man known as Kenneth Medford. I’m a simple man who loves to learn and loves to help and I wander the digital world trying to find ways to sate my hunger for both. Basically, I’m Galactus but helpful.

Check out my other work here or reach out to me on LinkedIn.

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