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Lane Keeter, CPA

Partner: Tax Consulting, Estate Planning, and Heber Springs Managing Partner

Open Enrollment – What Is It?

Open enrollment in the context of this article involves coverage for healthcare benefits but refers to two very different programs and types of coverage – Medicare and the Healthcare Marketplace as established by the Affordable Care Act during the Obama Administration. 

Let's take a look at each. First, Medicare. 

Open enrollment for Medicare is the annual opportunity for those covered by it to window shop a bit and assess if their current Medicare plan still suits them best. Medicare's open enrollment period runs from October 15 to December 7, during which time participants can enroll in or switch plans, to be effective the next January 1.

Note, this period is different from initial enrollment in Medicare when someone becomes eligible at age 65. Those who are newly qualified to enroll in Medicare have their own enrollment period, which begins three months before the month of their 65th birthday and ends three months after, for a total of seven months.

During Medicare open enrollment, you can enroll in a Medicare Part D (or prescription drug) plan, or you can change plans, if you are already on one. Additionally, during this time, you can return to traditional Medicare (i.e., Parts A and B) from a Medicare Advantage (Part C) plan, enroll in a Medicare Advantage plan, or move between Advantage plans.

One of the main reasons to review your situation and take advantage of open enrollment is to look for possible cost savings. A large percentage of people who shop around and make a change lower their premiums. 

But there are other considerations as well. For instance, are your doctors still part of your plan's provider network? And how about your prescriptions; are they still on the plan's list of covered drugs? The answers to questions like these will help you with a stay or go decision.

To learn more about this, is a good resource, and you can call 1-800-MEDICARE (1-800-633-4227) as well.

Open enrollment for the Healthcare Marketplace is a similar animal but with a different target market and different terms.

The Marketplace generally is for people who don't have health insurance through a job, Medicare, Medicaid, the Children's Health Insurance Program (CHIP), or another source that provides qualifying health coverage. Coverage is from private insurance companies that provide multiple plans of differing prices and features. What you pay for coverage obtained through the Marketplace is based on your income level, with the premiums being subsidized by federal "premium tax credits" that go down as your income goes up.

Open enrollment for the Marketplace runs from November 1 of each year until January 15 of the following year, so this year will be November 1, 2021 through January 15, 2022. It is during this time period that you need to apply for coverage for the year 2022, if you desire to have health insurance for the coming year and otherwise qualify to use the Marketplace. 

Coverage can only be obtained outside this time period under certain "life event" situations, such as change in marital status, birth of a child, loss of other medical coverage, etc.

During the enrollment period, you can apply for coverage several ways:

  • Online
  • By phone
  • Through an agent/ broker
  • Through certified enrollment partner websites
  • With a paper application

Check out for more information and to determine eligibility.

Decisions about healthcare coverage and benefits are critical to our well-being, both physically and financially. Hopefully, this information has taken some of the mystery out of the process, and set you on the right path to making the decisions that are best for you!

Lane Keeter, CPA, is Office Managing Partner of the Heber Springs office of EGP, PLLC, CPAs & Consultants (a full-service financial firm with offices in Heber Springs, North Little Rock, and Bryant) and past winner of The Sun-Times Reader's Choice Award for Best Accountant

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