Why Does Health Insurance Have an Open Enrollment?

Why Can You Not Buy Health Insurance Anytime You Want?

At one time, you could enroll in a health insurance plan whenever it was convenient. However, you were not guaranteed coverage for pre-existing conditions. If you did manage to get a health insurance company to sell you coverage, your pre-existing conditions could be excluded all together, or had “waiting periods” like 1 or 2 years before that pre-existing condition would be covered.

Creating ‘Open Enrollment’

The Affordable Care Act, which was passed in 2010, required health insurance companies to provide coverage regardless of the individual’s health status. Obviously, this took away a key technique that health insurance companies could control how much money they paid out.

To offset this, the ACA put specific enrollment periods in place to prevent people from only enrolling in health insurance when they were sick or needed surgery etc. It was built around the idea for everyone to have access to health insurance. Healthy people would pay regular premiums, but usually file fewer claims, which makes up for the claims from those with chronic health conditions. With no enrollment periods (and pre-existing conditions being covered), a woman could wait until her 9th month of pregnancy to retain health insurance. This stops people from taking advantage of the system. Now, if you miss the “open enrollment” period, when you go to the emergency room with any condition, the medical bills are going to be sky high.​

What Is Adverse Selection?

Health insurance can be expensive, and those who are generally healthy may wonder if coverage is worth the cost. In an adverse selection scenario, someone may decide to wait until they need health insurance coverage to purchase a policy.

As a result of adverse selection, the majority of policyholders would be those with medical needs. To remain solvent, health insurance companies would have to raise monthly premiums significantly to make up for the higher level of claims filed. Even healthy people with minimal medical expenses would end up paying very high premiums.

By limiting enrollment to a specific time of year, health insurance companies can keep premiums more affordable by ensuring a more balanced mix of healthy people to those high medical utilizers with medical needs and pre-existing conditions.

When Is the Open Enrollment Period?

The Open Enrollment Period is the time period in which you can start, stop or change your health insurance plan. The Open Enrollment Period for Nevada Health Link is November 1st through January 15th.

Special Enrollment Periods

In addition to the Open Enrollment Period, there is a Special Enrollment Period that opens when you experience certain life events. These may include:

• Having a baby
• Getting married
• Losing coverage
• Adopting a child
• Moving outside your health insurance plan’s area
• Changes in household income that qualify you for Medicaid
• Others

What to Do If You Miss an Enrollment Period

If you miss the Open Enrollment Period and do not qualify for a Special Enrollment Period, there are a few options to help tide you over until you can get coverage. Options to consider include short-term health plans, health care sharing ministries and off-exchange insurance plans. A health insurance agent can help you research each option. However, we strongly remind you of this, there is no substitute for an ACA (Obamacare) health insurance plan. Speak with your agent to see if there is any way you could qualify for a SEP – special enrollment period that would allow you to enroll into an ACA plan.​

Finding Health Insurance with Nevada Insurance Enrollment

At Nevada Insurance Enrollment, health insurance agents can help you navigate the enrollment process and find coverage. We assist you in looking at multiple options across several providers to find the right policy for your needs and budget.