Choosing the right health insurance plan for yourself and your family is an important decision, as is choosing the right Medicare option as you approach 65 and in the years following. Enrollment can seem confusing, especially because it can differ from company to company and person to person based on your specific situation.
UPMC provides most Highmark members with full, in-network access to all UPMC doctors, hospitals, and services in the greater Pittsburgh and Erie areas. For questions, please call our help line at 1-855-646-8762.
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What Is Open Enrollment?
Essentially, open enrollment is the time of year when people with commercial insurance (likely through their employer or spouse’s employer) can sign up for a new health insurance plan or change health insurance plans for the coming year. (Medicare “open enrollment” is different; see below for details.)
If you’re working for a company that offers health benefits, open enrollment typically happens in the fall, although for some companies it may be in the spring or early summer.
If you have insurance through your employer (or your spouse’s employer), the employer will specify the dates for open enrollment. This information may also be found in an employee handbook or on an intranet site for employees. These internal resources may also include information about the benefit options available so you can evaluate which one best meets your needs.
Commercial health insurance also can be purchased through the Marketplace at HealthCare.gov.
Why Is Open Enrollment So Important?
Open enrollment for health insurance is often the only time each year where you can make changes to your health insurance coverage, unless you have a “qualifying event.”
A qualifying event is a change in your life that allows you to revise or sign up for insurance outside of open enrollment. Qualifying events include:
- Having a baby
- Getting married
- Changing jobs
Many other activities are also considered qualifying events, so it is important to consider how changes in your life may impact your health benefits.
What Is Open Enrollment for Medicare?
Open enrollment for Medicare is actually called the Annual Election Period (AEP), but it is similar in concept to open enrollment for commercial health insurance plans.
The Medicare AEP is Oct. 15 to Dec. 7 each year, giving people the option to sign up for a Medicare Advantage plan, switch to another Medicare Advantage Plan, or select Original Medicare coverage.
If you’re signing up for Medicare coverage for the first time, you generally have seven months to enroll. The seven months include:
- The three months before you turn 65
- The month of your birthday
- The three months after your birthday
This seven-month period, and even before, is the best time to research your coverage options, talk to an expert, and enroll in a plan that best fits your needs.
How Do I Sign up for Health Insurance?
If you’re wondering how to sign up for health insurance, here’s what to do:
- Health insurance marketplace: If you are buying through the national health insurance marketplace, enrollment takes place during November and December for the following year. Each state has its own marketplace—some are run by the state, and others are federally facilitated. Residency and other factors determine which marketplace you may use. You may have more than one plan option, and you can choose based on coverage type, deductibles, health care providers, and price. You can apply online, by phone, mail, or even in person during the enrollment period.
- Employer plans: Your company will provide information about your insurance options—some companies provide multiple options and/or multiple providers. You may need to fill out paper forms or go online to choose what you want. The options provided to you can differ in cost, deductible amount, provider selection, and coverage. Your direct supervisor, or a human resources department representative, can answer your questions about the different options or refer you to other resources for help.
- Medicare: You should evaluate your Medicare coverage every year, because things like providers, costs, and processes can change from year-to-year. Some people prefer to use Medicare consultants to help find the best plan for them, because plans vary depending on location and other factors. Each year, you’ll also want to look at the prescription plan, Medicare Part D.
For more information about your choices in health insurance or open enrollment dates, it is best to speak with your employer, human resources representative, or Medicare consultant.
For specific questions about your coverage, costs, and pending changes, you may want to contact your insurer directly.
Finally, for questions about choosing an insurance plan with full, in-network access to UPMC doctors and hospitals, please call our help line at 1‑855‑646‑8762 or visit UPMC.com/AccessAnswers.
Editor's Note: This article was originally published on , and was last reviewed on .
Headquartered in Pittsburgh, UPMC is a world-renowned health care provider and insurer. We operate 40 hospitals and 800 doctors’ offices and outpatient centers, with locations throughout Pennsylvania, Maryland, New York, West Virginia, and internationally. We employ 4,900 physicians, and we are leaders in clinical care, groundbreaking research, and treatment breakthroughs. U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside as one of the nation’s best hospitals in many specialties and ranks UPMC Children’s Hospital of Pittsburgh on its Honor Roll of America’s Best Children’s Hospitals. We are dedicated to providing Life Changing Medicine to our communities.