In this article, we’ll cover steps you can take to prepare for and enroll in private individual health insurance during the annual Affordable Care Act (ACA) open enrollment period.
For coverage beginning Jan. 1, 2023, the open enrollment period for most states is from November 1, 2022, through January 15, 2023.
However, a handful of states that operate their own exchanges have opted to extend open enrollment beyond January 15. And in Idaho, open enrollment ends on December 15, 2022 (although Idaho’s enrollment window also began earlier, on October 15, 2022).
Note that your new policy’s effective date will vary depending on when you enroll. In general enrollments completed by December 15 will have coverage effective January 1, while enrollments completed after December 15 will have coverage effective February 1. But these deadlines vary somewhat among the states that run their own exchanges.
While most states will use the November 1 to January 15 enrollment window, these state-run exchanges have different open enrollment schedules:
- California: Nov. 1, 2022 to Jan. 31, 2023 – California passed legislation in 2017 and again in 2019 to ensure a permanent 3-month health insurance open enrollment period.
- Idaho: Oct. 15, 2022 to Dec. 15, 2022
- Massachusetts: Nov. 1, 2022 to Jan. 23, 2023.
- New Jersey: Nov. 1, 2022 to Jan. 31, 2023.
- New York: Nov. 1, 2022 to Jan. 31, 2023.
- Rhode Island: Nov. 1, 2022 to Jan. 23, 2021.
- Washington D.C.: Nov. 1, 2020 to Jan. 31, 2023 – A “special enrollment period for future open enrollment periods” motion was passed in May, 2019 to permanently extend the open enrollment period to three months.
Remember, unless you qualify for a special enrollment period or another form of minimum essential coverage that offers year-round enrollment, like Medicaid, you can only enroll in individual major medical insurance during annual open enrollment. So it’s a good idea to take some time right now to review your healthcare needs, current/past insurance coverage, and make some decisions for the coming year.
In the remainder of this blog post, we’ll walk you through the steps to take to get ready for and enroll in health insurance during the open enrollment period for 2023 coverage.
How to Prepare for 2023 Open Enrollment and Get Coverage
Follow the steps below to make sure you get coverage to fit your needs in 2023.
1. Get up to speed – understand what has changed for the ACA in 2023.
- Remember, there is still no federal tax penalty for going without ACA-qualifying minimum essential coverage in 2023, however, some states have their own penalties.
- The “family glitch” is expected to be fixed.
- The Inflation Reduction Act has extended the American Rescue Plan’s affordability provisions, so they will not expire at the end of 2022.
- Find out what else is new for 2023 open enrollment.
Remember, if a medical concern is discovered during a routine or preventive care check, it could cause you to become ineligible for some non-ACA-compliant health insurance options. But it will not change anything about your eligibility or premiums for ACA-compliant plans. (Note that non-ACA-compliant health insurance is not sold through the health insurance marketplace.
2. Understand your options if you’re shopping around for individual health insurance:
- If you had individual major medical coverage in 2020, be on the lookout for a letter from your insurance company and/or the ACA Exchange likely arriving in October. Review these materials and decide if you should automatically re-enroll in your current plan or shop around.
- If you’re enrolling in individual coverage for the first time or you know your previous plan no longer fits your needs, review this complete guide to choosing health insurance to understand your options.
- Make sure you know the difference between ACA health insurance and limited benefit insurance policies like short term medical insurance.
- Already planning to enroll in major medical insurance? Make sure you understand the ACA metal levels so you get the right cost-sharing structure for you.
2a. Understand your group health coverage options if you get benefits through your employer:
- Learn about health reimbursement arrangements (HRAs) if your employer is offering either an excepted benefit HRA or an individual coverage HRA for the upcoming plan year.
- Understand and enroll in additional benefits that you may need if they’re available, such as long or short term disability, critical illness and/or accident insurance, dental insurance, vision insurance, and life insurance.
- Avoid being underinsured – If the health plans you’re considering have out-of-pocket costs that are too high for your budget, you might want to consider supplemental medical gap insurance. These plans can be used to cover out-of-pocket costs for individual/family or employer-sponsored health insurance.
Because of this, if you are maintaining a grandfathered or grandmothered/transitional health insurance policy, make sure it has withstood the test of time and still offers you the level of benefits and coverage you need. Conversely, if your insurance company stops offering your grandfathered or grandmothered plan, you’ll have to shop around this year.
Learn more about grandfathered health plans, including options if your grandfathered health plan is canceled.<
3. See if you qualify for a subsidy for ACA health insurance in 2023.
- Learn how to estimate your income for 2023 (HealthCare.gov).
- Use the ACA Subsidy Calculator and find out the next steps whether you’re ACA subsidy-eligible or not eligible to receive ACA subsidies.
4. Enroll in coverage. If you’re enrolling in individual insurance:
- Decide whether to enroll in a plan from the public ACA Exchange or away from the Exchange. (If you plan to use a federal subsidy, you’ll have to select a plan from the ACA Exchange.)
- Find out where to access your ACA Exchange – some states run their own websites while others use healthcare.gov.
- When you enroll in ACA coverage, you’ll need to provide basic information about your household members and income. Make sure you have all the materials you need to make the enrollment process smoother (Healthcare.gov).
- Opting for non-ACA, limited benefit health insurance? Get a short term health insurance quote to compare plans in your area (it just takes a minute to generate results). Remember, these are not ACA-qualifying so are not guaranteed-issue and are not required to cover the essential health benefits. most do not cover services like preventive care, prescription drug, or maternity care.
- Make sure to follow safe online shopping practices when sharing sensitive information and enrolling online.
5. Know where to get help:
- For ACA plan help, find local help from Healthcare.gov or contact the Marketplace Call Center at 1-800-318-2596.
- Speak to a licensed agent at myhealthinsurance.com – powered by IHC Specialty Benefits – by calling [phone_number] for help understanding your individual health insurance options.
- For help with your employer-provided group benefits, speak to a representative at your workplace.
6. Consider Supplemental Insurance:
- If you’re underinsured or have a coverage gap, you may have trouble affording your deductible. Consider supplemental medical gap insurance to help with out-of-pocket costs and even costs that are not associated with your healthcare, like transportation and housing.
- Don’t forget dental insurance for the family. While coverage may be available to you and your dependents via an ACA plan, you will likely find more options to choose from in the private marketplace. Get a quick quote for dental insurance.
Summary + Next Steps
Health insurance is unique for each person and family, and health and financial circumstances can change from year to year.
That’s why it’s important to review your coverage and policy options each year when open enrollment comes around to ensure you have the right kind of coverage and enough benefits for the type of healthcare you’re likely to need.
There is no single coverage or benefits solution that works for every situation. ACA-qualifying major medical coverage may be enough for you.
Or you may find that you want to supplement your major medical benefits to help with out-of-pocket costs.
Or if you tend to be healthy, are not eligible for any ACA subsidies and prefer to pay a lower premium for less coverage and benefits, paying more of your healthcare costs on your own, you may opt for a limited benefit medical policy (your premium amount ultimately depends on the benefits you select).
Work the steps and find the right fit for you – and make sure to do it before the end of open enrollment! Remember, for most people, once open enrollment is over, it’s difficult to enroll in major medical insurance until the next open enrollment period.
Need help? Speak to a licensed agent by calling [phone_number] to talk through your coverage options.
Check out the related ACA resources below for more help navigating open enrollment.
- What’s New for 2023 Open Enrollment
- ACA Subsidy Calculator
- Your Guide to the Federal Poverty Level – Income Limits to Qualify for ACA Subsidies
- ACA Tax Credits and Subsidies – Two Ways to Lower Your Insurance Costs
- Next Steps if You’re ACA Subsidy-Eligible
- Next Steps if You’re Not ACA Subsidy-Eligible
- Where to Shop for ACA Health Insurance by State
- State Health Insurance Mandates and Penalties
- Should I Buy Health Insurance from the Public Marketplace or Shop off the Exchange?