Understanding Open Enrollment by Region

The end of the calendar year is typically the time when health plans are subject to open enrollment periods. This year, open enrollment by region meant that such periods often started and ended in the fall. According to the Affordable Care Act, open enrollment has a specific definition. Open enrollment is the period of time when individuals can add a health plan to their benefits package or drop health coverage if they so desire. For those receiving health benefits through an employer, open enrollment periods are usually determined by an HR decision-maker.

Nevertheless, you should help your employees be more aware of some important facts regarding open enrollment. First, as NerdWallet points out, an employee may choose to decline group health coverage, and there’s a possibility that he or she will not be eligible for premium tax credits. This situation occurs when the group health plan costs less than 9.69 percent of the employee’s annual family earnings and if that plan meets the mandated minimum value standard. Second, and perhaps more importantly, if an employee declines group health coverage but does not participate in the individual market during the open enrollment period, he or she may become liable to pay a penalty for being uninsured.

The rules regarding open enrollment periods vary depending on where you live, so it makes sense to understand the variations in open enrollment by region.

What Your Employees Need to Know About Form 1095-A Read article

The Northeast

The standard open enrollment period nationwide is relatively short this year: November 1 to December 15, 2017. However, some states have elected to extend the period. For example, New York is maintaining its open enrollment period through January 31, 2018. Connecticut is extending open enrollment by one week, to December 22. While Maine and New Hampshire have elected to adhere to the six-week window prescribed by Washington, D.C.

The South

For much of the South, the open enrollment period for 2018 has come and gone. Georgia’s window was open for two weeks, from October 17 to November 3, 2017. Kentucky’s was open only 11 days, October 9-20, 2017.

The Midwest and West

Indiana had its open enrollment period between October 25 and November 15, 2017. Colorado elected for a longer open enrollment period, November 1, 2017 to January 12, 2018. Nevada and Ohio decided to adhere to the national guidelines of November 1 to December 15.

Qualifying Events

Although there are variations in open enrollment by region, all states permit exceptions for special circumstances, which are known as “qualifying life events.” Employees should know that substantial changes in their life situations, such as births, divorces and adoptions, will allow them to alter their health coverage without penalty. The specific details regarding such qualifying events may vary by state, though. Make sure your employees have easy access to these guidelines.

Managing Uncertainty

With respect to health insurance, for many employers and employees, 2017 was an anxiety-provoking year. For much of the year, there was a fair amount of uncertainty as to the direction of national health care policy that directly impacted individuals. Much of that uncertainty started to clear toward the end of 2017, but questions remain. The best way to help manage uncertainty surrounding health benefits is to master these facts yourselves and to communicate with your employees.

This content is provided solely for informational purposes. It is not intended as and does not constitute legal advice. The information contained herein should not be relied upon or used as a substitute for consultation with legal, accounting, tax and/or other professional advisers.

Stay up to date on the latest health care regulations and trends for your small business: subscribe to our monthly e-newsletter.

COVID-19 Resources: Managing Your Business During a Crisis