Health Insurance Coverage and Open Enrollment Periods

Open enrollment is a time each year when individuals can make changes to their health insurance coverage or enroll in a new plan. Coverage begins at a specified date after open enrollment and usually runs a full year. Whether you're covered through an employer, the Health Insurance Marketplace, Medicare, or another type of plan, you can use the open enrollment period to evaluate your needs and ensure your plan provides the best coverage possible.

*Those enrolled in Medicare Advantage by Dec. 31 can make changes to their plan during this period.
**Marketplace Open Enrollment Dates may vary depending on state of residence.

During open enrollment, you should reevaluate your choices even if you are satisfied with your current plan. There are several factors to consider:

• Is my monthly premium affordable?
• Is my cystic fibrosis care center part of my network coverage?
• If considering transplant, is my transplant center part of my network coverage?
• Is my care team part of my network coverage?
• Are my medications covered?
• Will I need prior authorization for medications or services? If so, how do I receive it?
• Are there other types of insurance plans that may be more appropriate for my needs?

What Type of Insurance Do You Currently Have?

Employer-Based (Group) Plan
Plans Through the Health Insurance Marketplace
Private Plans Purchased Directly From the Insurance Company
Medicare
Medicaid and Children Health Insurance Plan (CHIP)
I Do Not Have Any Insurance

Employer-Based (Group) Plan

If you are insured through your employer, your employer decides when you can enroll in their coverage or make changes to a current plan. Most employers hold open enrollment in the fall, and coverage is often from Jan. 1 through Dec. 31. However, your employer may have different open enrollment and coverage periods. Your human resources department or a third-party plan administrator can provide you with detailed information.

Your employer or plan administrator should provide the following information during open enrollment:

• Summary of benefits for each available plan option
• Website link or PDF document for provider network search for each available plan option
• Website link or PDF document for list of covered medications for each available plan option
• List of the employee’s monthly premium for each plan option 

Health Insurance Marketplace Plans

If you have a plan through the Health Insurance Marketplace (also sometimes called the Health Insurance Exchange), you can typically make changes or enroll in a new plan between Nov. 1 and Dec. 15 for plans starting on Jan. 1. Healthcare.gov maintains a list of states with their own exchanges. Visit your state’s exchange (if applicable) to check your state’s open enrollment dates.

You may have heard that your current plan will no longer be available in the next plan year. If your current plan is no longer available and you do not select a new one, the system will automatically enroll you and/or your family on a new plan that is about the same price. This auto-enrolled plan will not be verified to see if it will meet your CF needs, such as coverage for your CF care center or medication, and the open enrollment period will, most likely, already be over when the new plan becomes effective on Jan. 1.

Even if your plan is still available, it is helpful to see if any new plan options or insurance companies offer plans next year in your area. You should also assess whether any changes to your income or household size affect your eligibility for Marketplace subsidies.

Private Plans Purchased Directly From an Insurance Company

Insurance companies in your area may offer plans outside of the Health Insurance Marketplace. These plans also follow the same open enrollment dates from Nov. 1 to Dec. 15. If you are ineligible for Marketplace subsidies, or there is no plan offered in the Marketplace that works for you, plans offered directly from a health insurance company may meet your needs. Healthcare.gov offers a plan search tool for browsing private plan options in your area. If you had a private plan in the previous year, you will be automatically renewed for the following plan year if you do not make any changes.

Medicare

If you are on a Medicare plan, it is important to review availability of any new plan options or insurance companies during open enrollment. During that review, check to see if your plan is changing the terms for extra benefits included such as dental, vision, wellness benefit, or home improvement. During this period, it is helpful to assess whether your income, resources, or household size have changed, which may affect your eligibility for Medicare Extra Help or the Medicare Savings Program. If you are eligible for Medicare Extra Help or have Medicare and Medicaid at the same time, you will be able to make changes once per quarter from January to September, and your changes will be go into effect on the first of the following month. People with CF can make changes anytime in the fourth quarter during the annual open enrollment period.

• Original Medicare: If you currently have Medicare Part A, Part B, or Part D, you can switch to a Medicare Advantage plan or switch to a different Part D prescription coverage during the Medicare open enrollment period between Oct. 15 and Dec. 7. Changes made during this period will become effective as of Jan. 1 of the following year. You must already be enrolled in Part A and Part B to make changes during this period. If you delayed enrollment in Part B when you first became eligible, this annual open enrollment period may not apply.
• Medicare Advantage Plan: If you currently have a Medicare Advantage plan, there are two open enrollment periods. During Medicare open enrollment between Oct. 15 and Dec. 7, you can drop your Medicare Advantage plan, revert to Original Medicare and pick up a standalone Part D prescription coverage, or you can switch to a different Medicare Advantage plan. If you are enrolled in a Medicare Advantage plan on Jan. 1, you will have another chance to drop the current Medicare Advantage plan and switch to Original Medicare and Part D, or switch to a different Medicare Advantage plan between Jan. 1 and March 31.
• Medicare Supplement (Medigap) Plan: Medicare supplement (Medigap) plans have a short enrollment period. There is a six-month initial enrollment period from your Medicare Part B effective date to purchase a Medicare supplement plan or make changes to your current plan. Outside of the initial enrollment period, you might not be able to purchase a Medicare Supplement plan, may have to pay more, or may have a delay in coverage for a pre-existing condition. You are not allowed to have a Medicare Supplement plan and a Medicare Advantage plan at the same time.

Medicaid and Children's Health Insurance Plan

There is no annual open enrollment period for Medicaid and Children’s Health Insurance Program (CHIP). You can apply for coverage at any time of the year. If you are currently on a managed care Medicaid plan, there may be a limited period that you can make changes or switch to a different managed care Medicaid plan.

I Do Not Have Insurance

If you did not have insurance for more than 60 days, the annual open enrollment may be the only time you can purchase a new plan, which will not be effective until Jan. 1 of the following year. You may be eligible for public insurance options, such as Medicare or Medicaid.

No One Has to Do It Alone

Selecting a plan that fits your unique needs and budget can be a time-consuming and complicated process. The CF community has a resource that can make it easier: CF Foundation Compass.

Compass is a personalized service to help with insurance, financial, legal, and other issues you are facing. Last year, Compass case managers helped hundreds of people with CF and their families find health insurance plans that addressed their highly specialized health care needs.

Compass has a plan comparison chart to help you when you are comparing insurance plans during open enrollment. This chart is also used by Compass case managers during personalized, one-on-one sessions. Note that you do not need to fill out this form before speaking to a Compass case manager.

A dedicated case manager is ready to work with you individually to understand your insurance options and find the coverage that's best for you. Connect with Compass today by phone at 844-COMPASS (844-266-7277), Monday through Friday, 9 a.m. until 7 p.m. ET, or by email at compass@cff.org.