Individual Insurance Enrollment FAQs

A common confusion for many people is when insurance can be enrolled. There is an open enrollment period (November 1 through December 15) for Marketplace based enrollment. It is important to note that the Marketplace is a government-run enrollment system. The coverage is provided by insurance companies like Priority Health and Blue Cross Blue Shield. These plans are for people who do not have employer provided insurance and are not eligible for Medicaid or Medicare. During the open enrollment period, you make decisions on the insurance for the next calendar year, and the coverage begins on January 1.

Another time that someone may be eligible for enrollment in a Marketplace plan is during a special enrollment period, which only happens when you lose qualified health coverage, be it from an employer or losing Medicaid.

If you are outside of the open enrollment period and do not have a loss of coverage, there are Short Term Major Medical solutions available to cover you for up to 6 months.

For those that are Medicare eligible, the open enrollment takes place October 15- December 7 every year. During this period, anyone enrolled in a Medicare plan can make changes or change their plan. If the person who is covered is happy with the benefits offered by their plan, no action is necessary!

Medicare is always effective on the first day of the month in which you turn 65 (i.e. August 25 would be August 1 effective date). The only exception is a person with a birthday on the first day of the month, which shifts eligibility to the first day of the month prior (i.e. Oct 1 would be eligible Sept 1). It is crucial to apply for Medicare Part A and B at least two months prior to the effective date, to assure that you receive your credentials on a timely basis.