Open enrollment is the annual time period when employees can enroll in, change, or select health insurance coverage, and outside of this window they generally must wait for a qualifying life event to make changes.
Key Differences Between Renewal and Open Enrollment
Renewal and open enrollment are two distinct processes that play a critical role in managing health plans. Below, we outline their key differences, considerations, and guidelines to help you navigate these periods effectively.
Renewal: This process involves configuring your company’s plan design for the upcoming year. It must be completed ahead of the required employee notice timeline to ensure compliance and smooth transitions.
Open Enrollment: This is a separate period that begins later, during which employees can review and make their health plan elections for the new year. Open enrollment applications are submitted as new individual policies with the selected effective date, regardless of whether there is an active plan in place.
What is open enrollment?
Open enrollment is the designated annual period when you are allowed to enroll in, change, or renew health insurance coverage.
During this time, you can:
Enroll in a new health insurance plan
Switch to a different plan or insurance carrier
Add or remove dependents
Renew your existing coverage
Outside of this window, you typically cannot make changes unless you experience a qualifying life event.
When does open enrollment happen?
Open enrollment timing depends on the type of health coverage:
Employer-sponsored insurance: Usually once per year, set by your employer
ACA Marketplace plans: Typically November through mid-January (varies by state)
Medicare: Occurs annually in the fall (separate enrollment period)
Each system has its own schedule, and they do not always align.Open enrollment typically begins in early November each year, allowing ample time for employees to make their elections.
Guidelines for Automatic Renewal
If you are considering relying on automatic renewal for your health plan, it is essential to review the renewal notice provided by your carrier. Plans can change annually, including adjustments to provider networks, copays, coinsurance, and drug coverage. Reviewing these changes ensures that the renewed plan aligns with your needs for the upcoming year.
What happens if you miss open enrollment?
If you miss open enrollment, you generally:
❌ Cannot enroll in a new health insurance plan
❌ Cannot switch plans for the upcoming coverage year
❌ Must wait until the next open enrollment period
The only exception is if you qualify for a Special Enrollment Period (SEP) due to a qualifying life event.
What is a qualifying life event (QLE)?
A qualifying life event allows you to enroll or change coverage outside of open enrollment.
Common examples include:
Losing existing health coverage
Getting married or divorced
Having a baby or adopting a child
Moving to a new coverage area
Certain changes in employment status
If you experience a QLE, you may be able to enroll in coverage within a limited time window.
Why does open enrollment exist?
Open enrollment exists to ensure health insurance works as a shared risk system.
It helps:
Keep insurance premiums stable
Prevent people from signing up only when they are sick
Ensure balanced enrollment of healthy and high-need individuals
Without enrollment windows, insurance systems would become financially unstable.