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What is Open Enrollment?

This time of year, there may be a lot of information, emails, news blasts, and media coverage regarding open enrollment.  Open enrollment is a time when individuals can sign up for new health insurance coverage or renew existing coverage.  Changes to policies may also be made, including adding or removing a family member.  The amount and type of coverage someone may want can also be modified.  Nonetheless, the open enrollment period may vary slightly depending on the type of coverage someone is seeking.

Medicare open enrollment period is from October 15 to December 7. During this time, individuals can change their Medicare coverage and prescription drug coverage.  At this point, if there are changes in their plans' annual coverage, Medicare participants should have been notified.  These changes may be listed in an Annual Notice of Coverage (ANOC) or an Evidence of Coverage (EOC). Individuals with questions may call 1-800-MEDICARE or visit Medicare.gov.

Medicaid and Children's Health Insurance Program (CHIP) enrollment period is any time during the calendar year.  Individuals  who qualify may apply at any time.  However, many states have not yet expanded their Medicaid programs.  Expanding the Medicaid programs increases the number of people who are covered under Medicaid and CHIP.  For example, the state of Missouri has not expanded Medicaid. As a result, a household size of four must earn less than $32,319 (or $15.50 per hour) in order to qualify for Medicaid. That is only 18% of federal poverty level.  Individuals who are eligible in Missouri also include pregnant women with household income up to 196% of federal poverty level, infants under one year of age with households at 196% of federal poverty level, children age 1-18 if household income is up to 150% of federal poverty level, and children are eligible for CHIP if the household income is up to 300% of the federal poverty level ($67,050 annually or $32.23 per hour).


Iowa, on the other hand, has expanded Medicaid.  The state uses a Medicaid managed care model. In Iowa the following individuals are eligible for Medicaid: pregnant women with household income up to 375% of the federal poverty level, children up to 1 year of age with household income up to 375% of federal poverty level, children ages 1-18 with household income up to 167% of federal poverty level, parents and other adults with income up to 133% of federal poverty level.  Iowa also insures children through its state CHIP program, known as HAWK-I, up to 302% of federal poverty level.

Finally, employer sponsored and private health insurace coverage open enrollment begins November 1.  and ends January 31.  Individuals with employer based health coverage are typically notified by their employers when open enrollment begins and ends.  Coverage may also be obtained outside of this time period if the individual experiences a qualifying event, such as job change, change in marital status, birth of a child, or moving out of state.  Private health insurance coverage may be obtained through the health care marketplace.  The health care marketplace is a sort of clearinghouse that assists individuals in shopping for health care coverage.  Individuals may select from a variety of plan options.

Sources:
Centers for Medicare and Medicaid Services. Medicare Open Enrollment, found online at https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-help-others/Medicare-Open-Enrollment.html
Healthcare.gov. Dates & deadlines for 2017 health insurance, found online at https://www.healthcare.gov/quick-guide/dates-and-deadlines/
Medicaid.gov. Eligibility, found online at https://www.medicaid.gov/chip/eligibility-standards/chip-eligibility-standards.html
Healthinsurance.org. Missouri Medicaid, found online at https://www.healthinsurance.org/missouri-medicaid/
Healthinsurance.org. Iowa Medicaid, found online at https://www.healthinsurance.org/iowa-medicaid/
Iowa Department of Human Services. About Iowa Medicaid, found online at http://dhs.iowa.gov/ime/about
Healthcare.gov. Health Insurance Marketplace, found online at https://www.healthcare.gov/glossary/health-insurance-marketplace-glossary/

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