If you want to get a new health insurance plan or renew, change or update your current plan, the Healthcare Marketplace open enrollment period is when you can do that. Medicare open enrollment runs from Oct. 15 to Dec. 7,[1] and Affordable Care Act (ACA) health insurance open enrollment is from Nov. 1 to Dec. 15.[2] During open enrollment, you can apply and enroll in a Marketplace health insurance plan. You may even qualify for a premium tax credit that lowers your insurance premium.
Before you make any health plan purchases on the Marketplace, make sure you understand how Healthcare Marketplace open enrollment works and how to find out if you’re eligible for a tax credit to save money on monthly premiums.
Below are four things to know about Healthcare Marketplace open enrollment.
1. Open enrollment happens every fall
Every year from November 1 to January 15, open enrollment takes place on the Healthcare Marketplace at Healthcare.gov. During this period, you can enroll in a health insurance plan. Even though open enrollment lasts through January 15, don’t wait until the last minute to enroll if you want your health plan coverage to start on January 1. You must enroll in a Marketplace plan by December 15, for coverage that begins on January 1.
Find out: How to Appeal a Health Insurance Claim Denial
2. You may not be able to enroll later
If you miss enrolling in a health insurance plan during Marketplace open enrollment, you won’t be able to enroll until next fall unless you have one of these qualifying life events:
- Losing your job
- Moving to a new state
- Getting married or divorced
- Becoming a widow or widower
- Aging off your parent’s plan
- Having a baby or adopting a child
If you miss open enrollment and need health insurance later due to a qualifying life event, you may have 60 days prior to the event or 60 days after to enroll in a health insurance plan on the Marketplace with what’s known as a “special enrollment period.”
3. More people are eligible for premium tax credits
“More people than ever before” qualify for a tax credit to lower their premiums, even those who weren’t eligible before, thanks to the American Rescue Plan Act of 2021, according to Healthcare.gov. The amount of your premium tax credit is based on the amount you provide to the Marketplace for your estimated household income.
Marketplace savings information is available November 1, 2021, at Healthcare.gov. To get an idea before that date of whether you may qualify for a premium tax credit, visit Income Levels and Savings at Healthcare.gov. If your household income meets tax credit eligibility requirements, you may be able to save significantly on health insurance premiums.
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4. You may also qualify for cost-sharing reductions
In addition to any premium tax credit you receive when you enroll during Marketplace open enrollment, you may also qualify for extra savings. You may be eligible for “cost-sharing reductions” that allow you to pay lower out-of-pocket costs such as deductibles, copayments and coinsurance for medical services.
“If you qualify for cost-sharing reductions, you also have a lower out-of-pocket maximum — the total amount you’d have to pay for covered medical services per year,” according to Healthcare.gov. “When you reach your out-of-pocket maximum, your insurance plan covers 100 percent of all covered services.”
Find out: 5 Tips to Start Paying Off Your Medical Bills
How to get local help with Marketplace health plan decisions
If you’re ready to enroll in a Marketplace plan and want to discuss health plan choices with a local health insurance agent or broker, enter your information at Get Help Applying & More at Healthcare.gov. An agent or broker will contact you, usually within the same business day.
Avoid healthcare marketplace fraud and open enrollment scams
Unfortunately, open enrollment season also brings out fraudsters eager to prey on concerns about getting the best health insurance available at an affordable cost, warns the Federal Communications Commission.[3]
Health insurance is confusing enough without adding in scammers seeking access to your sensitive personal information or trying to sell you fake health insurance plans. You don’t have to be a health insurance scammer’s next victim, though.
Unsolicited calls or email
Don’t trust people who call, send letters or show up at your front door uninvited asking for your personal information so they can enroll you in a health plan on the Marketplace. These solicitors may be trying to steal your identity, according to the OIG.
Never give financial information such as banking, credit card or account numbers to someone who shows up at your home uninvited, even if that person claims to be from the Marketplace, warns HeathCare.gov.
Medicare or ACA plan representatives won’t contact you with unsolicited messages by email, phone or in person unless you’re already enrolled, according to the Better Business Bureau.[4]
Scammers can even use “spoofing” technology to make a legitimate health insurance provider’s phone number appear on you caller I.D. If you answer the call and become suspicious that the caller isn’t legit, hang up. Always contact legitimate insurance providers directly at the customer service number listed on their website or on your billing statement, says the FCC.[5]
Never pay a fee to enroll in a health plan
When you enroll in a 2022 health plan on the Marketplace, you’ll usually have to pay in advance for the first month’s premium. However, you won’t have to pay a fee just to enroll. Beware of people who claim they can enroll you in Marketplace or “Obamacare” insurance, but only if you pay a fee, warns the Office of Inspector General (OIG), a department of the U.S. Department of Health and Human Services.
Legitimate enrollment assisters won’t ask for money for the service of enrolling you in a Marketplace health plan, says the OIG.
The Marketplace has agents/brokers and assisters who are trained and certified to provide help with your open enrollment application. They can discuss health plan options, determine whether you qualify for a premium tax credit and help you choose the best health insurance for your needs and budget at no cost for the service.
To find a local Marketplace agent/broker or assister, visit Find Local Help at HealthCare.gov.
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Medicare imposters
If you receive a call or recorded message from someone claiming to be a Medicare “health care benefits advocate” or a similar title, beware. The caller may promise a better Medicare supplement or Medicare Plus plan that allows you to keep all your current benefits but at a lower cost.
All you seemingly need to do to get that “better” plan is provide your Medicare I.D. number. The call is a scam, however, and giving that personal information opens you to the possibility of identity theft. To enroll or re-enroll in Medicare, visit Medicare.gov. To enroll in an ACA health insurance plan, go to Healthcare.gov.
Find out: How to Stop Insurance Fraud and Medical Identity Theft
Run from high-pressure tactics
If you receive high-pressure visits, letters, emails or phone calls from people pretending to work for the government, don’t give in to pushy tactics. And don’t cave to empty threats, either. “No one should threaten you with legal action if you do not sign up for a plan,” says the OIG. “Always ask for identification if someone comes to your door.”
Demands for quick action or immediate payment
When you sign up for health insurance, you typically have to pay for the first month in advance, so that’s not usually a sign of a scam. However, if the broker or caller is threatening that your Medicare or ACA plan will be canceled unless you make immediate payment or take action now, hang up and call your insurance provider directly instead.
Find out: A Guide to Managing Medical Benefits When You Leave or Start a Job
Free “health screenings”
Most providers offering affordable health screenings are legitimate, but some health insurance scammers use free health screenings to bait you into handing over sensitive personal information so they can steal it for nefarious purposes, says the BBB.[6]
When you arrive for your free screening appointment, scammers may slip a blood pressure sleeve on you and check cholesterol levels to appear legitimate, but what they really want is your health insurance I.D. or your Medicare or Social Security number.
Once they have that information, scammers can bill your insurance company for thousands of dollars’ worth of tests, access your personal genetic information or steal your identity, says the BBB.
Offers of promotional gifts
Any time an insurance broker offers you an expensive free gift, free health screening or similar special deals, those offers should raise a red flag, warns the BBB. That’s because the next step towards receiving that free gift is often providing your health insurance or Medicare I.D. number or other personal information.
Always decline promotional gifts offered in exchange for personal information.
A call from the Marketplace might be legitimate
When you’re vigilant about recognizing fraud attempts, getting a phone call from someone saying that he or she works for the Marketplace will likely put you on high alert. That’s great if the caller is a fraudster after your personal information. However, sometimes the caller is a legitimate Marketplace representative.
After you apply for health insurance on the Marketplace, a representative may call you if more information is needed or to verify something in your application. Don’t hand over that information without first making sure the caller is actually a Marketplace representative, though.
HealthCare.gov offers these tips for making sure you’re speaking with a Marketplace rep:
Check the number on your caller ID. Legitimate callers may show the following:
- Health Insurance MP
- InsMarketplace
- 1-855-997-1890
- 844-477-7500
Even if these names or numbers display, keep in mind that scammers often use “spoofing” on caller ID to mask their true identities and gain your trust. That’s why you must take further steps to make sure the caller is legitimate
Verify the caller’s identity. If someone is calling from the Marketplace, that person must provide a first name and agent ID number, according to HealthCare.gov. Write both down for your records. Beware of callers asking for personal financial information. If a fraudster gains your trust under the guise of being a Marketplace representative, the information that he or she asks you to provide can be a red flag that the caller isn’t actually from the Marketplace.
For example, an actual Marketplace rep may ask you to verify your identity, full name, address, Social Security number, application ID, policy ID, user ID, date of birth or phone number. The representative may also want to verify income, household and employment information.
However, a Marketplace representative won’t ask for personal financial information such as your bank name and account number. They also won’t ask about any personal health information such as your medical history or conditions.
Learn: 8 Things to Know About Buying a Medicare Supplement Plan
Knowledge is key to fraud prevention
Learning the basics of getting health coverage at the Marketplace is a good place to start if you want to avoid becoming a victim of Marketplace fraud. You can find information about how to enroll during open enrollment, tax premium credits and what to expect when you enroll in a health plan on the Marketplace at HealthCare.gov.
