Open Enrollment vs Special Enrollment

Insurers must accept and renew every eligible applicant regardless of health status, without medical underwriting — Guaranteed issue means an insurer must accept every eligible applicant for individual health coverage, and must renew it, without regard to health status, medical history, or pre-existing conditions. Insurers are barred from medical underwriting of individual applicants. Enrollment generally happens during the annual open enrollment period (OEP), with special enrollment periods (SEPs) triggered by qualifying life events such as marriage, birth, or loss of other coverage. Guaranteed issue plus the OEP/SEP structure is a core ACA reform that protects consumers with health problems from being priced out of the market.

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From January 1 through March 31 each year — The Medicare Part B general enrollment period (GEP) runs from January 1 through March 31 each year for individuals who did not enroll during their initial enrollment period and do not qualify for a special enrollment period. Coverage purchased during the GEP generally begins the following month, and the beneficiary is subject to the late enrollment penalty for each 12-month period of delay. The GEP is distinct from the initial enrollment period around the 65th birthday and from the fall open enrollment period used for Medicare Advantage and Part D plan changes, which is October 15 through December 7.

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