Open Enrollment for 2022 Individual Insurance: What You Need to Know

Longer Window, Plus New Enrollment Platforms for KY, ME, and NM

Open enrollment for 2022 individual market coverage—both in the exchange and off-exchange—will begin November 1, 2021. But it will continue until January 15, 2022 in most states, which is a month longer than the enrollment window has been in most of the country for the last few years.

In most states, enrollments will still need to be completed by December 15 in order to have coverage effective January 1. Some state-run exchanges will have later deadlines for January 1 effective dates, and some have set their own enrollment deadlines, either earlier or later than the January 15 deadline that applies in all states that use HealthCare.gov as their exchange platform. These states are discussed in more detail below.

The individual market has stabilized over the last few years, with mostly modest rate changes and new insurers joining the marketplaces in many states. Both of those trends are continuing for 2022; rate changes are mostly in the low single-digits, and new insurers are joining the exchanges for 2022 in many states.

The federal government is continuing to not fund cost-sharing reductions, but that's no longer an uncertain factor for insurers, since they know what to expect. In nearly all states, insurers are adding the cost of CSR to silver plan premiums, which results in larger premium subsidies. In many cases, bronze and gold plans are particularly affordable due to the disproportionately large subsidies that can be used to offset the premiums.

People who aren't eligible for premium subsidies can pick a non-silver plan, or, in many states, a silver plan sold outside the exchange, and avoid having to pay premiums that include the cost of CSR. But the American Rescue Plan's subsidy enhancements are mostly still in place for 2022, so subsidy eligibility extends to more people than it did during previous open enrollment periods.

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Record-High Navigator Budget for 2022

In the fall of 2017, the Trump administration sharply reduced HealthCare.gov's marketing budget and cut the budget for Navigator organizations (enrollment assistance) by 41%. The Navigator budget had been $63 million in the fall of 2016, and was reduced to $36 million in 2017.

In July 2018, CMS announced another drastic cut to the Navigator funding budget, reducing it to just $10 million across all 34 states that received grants. That amount remained steady in 2019 and 2020, with another $10 million distributed to Navigator organizations in the weeks leading up to the open enrollment periods for 2020 and 2021 health plans.

But the Biden administration drastically increased the Navigator funding budget, announcing a record-high $80 million in Navigator grants in August 2021, spread across 30 states. (The number of states that rely fully on the federally-run exchange, and thus receive federal Navigator funding, has dropped to 30, as more states have opted to run their own exchanges.)

The $80 million was distributed to 60 Navigator organizations, allowing more than 1,500 Navigators to provide enrollment assistance during the open enrollment period in the fall of 2021 (quadruple the number of Navigators that were available the year before).

The ostensible justification for the Navigator funding cuts in previous years was based on the fact that Navigators have enrolled a fairly small percentage of the people who have signed up for private plans in the exchanges, and on the assumption that as time goes by, people need less help with the enrollment process.

But public awareness about the enrollment process remains fairly low among people who are uninsured and those who buy their own coverage. And although Navigators don't enroll large numbers of people in private plans, their assistance is invaluable when it comes to Medicaid enrollment (which isn't counted when the groups are judged in terms of their total enrollments).

And many Navigator organizations also partner with volunteer enrollment counselors, but the enrollments facilitated by those volunteers also are not counted. In short, the assistance provided by Navigators is more than it appears at first glance, and the drastic funding cuts in prior years reduced the amount of available assistance. Fortunately for consumers, enrollment assistance will be at record-high levels in the fall of 2021.

With all that in mind, let's take a look at what you need to know this fall if you buy your own health insurance in the individual market.

Timing

In most states, if you need to buy individual market coverage—on or off-exchange—for 2022, you'll have almost 11 weeks to complete your enrollment or make changes to your existing coverage. In almost all states, open enrollment runs from November 1 to January 15, although enrollments will have to be completed by December 15 to have coverage that starts January 1.

There are 18 fully state-run exchanges that run their own enrollment platforms and thus have the option to set their own open enrollment schedules. When the federal government opted to extend the open enrollment period through January 15, they clarified that state-run exchanges could still have longer enrollment windows, and could also elect to have an earlier enrollment deadline, as long as it wasn't prior to December 15.

There are three state-run exchanges where open enrollment has been permanently extended:

  • DC: Open enrollment permanently set at November 1 to January 31.
  • California: Open enrollment permanently set at November 1 to January 31.
  • Colorado: Open enrollment permanently set at November 1 to January 15.

And most of the other 15 state-run exchanges have opted for a January 15 or January 31 deadline for open enrollment. But there are some other deadlines in the mix for 2022 coverage, including two states (Idaho and Maryland) that are sticking with the December 15 deadline (that might change during open enrollment). And as noted above, most states are using a December 15 deadline if you want your coverage to start January 1 (enrollments after December 15 will generally have a February or March effective date).

Once open enrollment ends, you won't have an opportunity to enroll or make changes to your coverage for 2022 without a qualifying event.

If your insurer exits the market in your area at the end of 2021, you'll have a special enrollment period (the first 60 days of 2021) during which you can pick a new plan. But as was the case for 2021, it appears this will not be a widespread issue for 2022 (unlike the situation for 2017 and 2018, when numerous carriers exited exchanges across the country). The reverse is now true; 2022 is the fourth consecutive year of insurers joining or rejoining the exchanges.

Kentucky, Maine, and New Mexico Will Have New Enrollment Platforms

There is a health insurance exchange in each state, although most states use the federally-run platform at HealthCare.gov instead of running their own exchange. In the first few years that the exchanges were operational, several states made changes, switching between HealthCare.gov and their own websites.

For 2018 and 2019, there were no changes; all of the states continued to use the same enrollment platforms they had used in 2017. For 2020, Nevada stopped using HealthCare.gov and transitioned to a state-run enrollment platform. For 2021, Pennsylvania and New Jersey stopped using HealthCare.gov and debuted their own state-run enrollment platforms.

For 2022 coverage, three more states are leaving HealthCare.gov and switching to state-run enrollment platforms. Kentucky, Maine, and New Mexico will all have their own state-run exchanges as of November 2021.

In Kentucky's case, the state-run platform was in use in the early years of the health insurance exchanges, but the state began using HealthCare.gov's enrollment platform in the fall of 2016. Maine and New Mexico have always used HealthCare.gov to enroll in individual/family plans, but both states will have their own enrollment platforms for 2022 coverage.

If you're in Kentucky, Maine, or New Mexico, you'll be able to claim your account on your state's new enrollment platform, with your data migrated over from HealthCare.gov. But you'll want to pay close attention to any communications you receive from the exchange or your insurer, with details about renewing or changing your coverage for 2022. But there's no wrong door in terms of finding the exchange itself: If you start at HealthCare.gov, you'll be directed to the state's new exchange website:

The rest of the states will continue to use the same exchange enrollment platform that they used for 2021.

Available Coverage

The November 1 through January 15 open enrollment window applies to individual market coverage that's compliant with the Affordable Care Act (ACA, aka Obamacare), both on and off-exchange. But only a very small segment of the population is enrolled in individiual market coverage.

As of September 2021, there were 12.2 million people enrolled in plans through the exchanges/marketplaces nationwide. And there are likely fewer than 2 million people enrolled in off-exchange plans (there were a little more than 2 million as of 2019, but that has almost certainly declined now that the American Rescue Plan has temporarily eliminated the income cap for subsidy eligibility in the exchanges).

There are open enrollment windows that apply to people with Medicare and with employer-sponsored health insurance, but they are separate from the enrollment periods that apply in the individual market, and are not affected by Navigator funding, timing changes, the type of exchange a state uses, or state-specific extensions.

People who have grandmothered or grandfathered individual market coverage are also not affected by any changes related to open enrollment. Those plans are no longer available for purchase and thus do not have applicable open enrollment windows.

However, if you have a grandmothered or grandfathered plan, it's absolutely in your best interest to see how it compares with the ACA-compliant plans that will be available for 2022, particularly if you'd be eligible for premium subsidies or cost-sharing subsidies in the exchange. And keep in mind that the American Rescue Plan's subsidy enhancements and elimination of the "subsidy cliff" mean that you might be eligible for subsidies now, even if you weren't in previous years.

What to Know Before Enrollment

It's particularly important that you pay attention to the communications you receive from the exchange—or from your insurer if you have off-exchange coverage. Make sure you understand how much your premium will change for the coming year, and if you have a premium subsidy through the exchange, be sure you're looking at how much your after-subsidy premium will change, since that's the amount that you actually pay each month.

Pay attention as well to the coverage details summarized in the renewal information you get from your insurer and/or the exchange. Insurers can terminate a plan at year-end and "crosswalk" or "map" enrollees to a new plan with similar—but not identical—benefits. Exchanges can also do this if an insurer is leaving the exchange altogether.

Due to the extended enrollment window that's available in most states, there will still be an opportunity to pick a different plan after the start of 2022. So if your plan renews with a premium that's higher than you expected, or if your doctor is no longer in-network, you'll likely still have a chance to pick a different plan after January 1, with an effective date of February 1.

But this will be a very limited opportunity, extending until only mid-January in most states. So it's important to pay close attention to the details of how your plan might be changing, and act quickly to select a new plan if that's your preference.

If you think you might need help selecting a plan or enrolling, it's wise to make an appointment ahead of time with a broker or Navigator in your area or to find out what organizations in your community will have certified enrollment counselors on hand during open enrollment (here's a list of Navigator organizations in states that use HealthCare.gov).

What If I Have Coverage Through My Employer?

The open enrollment changes and provisions described above apply only in the individual health insurance market, so they don't affect people who get health insurance coverage from their employers. But if you have employer-sponsored health insurance, your open enrollment period may overlap with the individual market's open enrollment period.

Many employer-sponsored health plans hold their open enrollment periods in the fall, so that coverage changes can be effective on January 1 of the coming year. That's not always the case, however—your employer might have a plan that doesn't follow the calendar year, so your open enrollment might be a different time of the year. 

Open enrollment for employer-sponsored plans is usually shorter than the enrollment window used in the individual market, but your employer will communicate the key dates that apply to your plan. Your employer may hold meetings for employees to prepare for open enrollment, or they may send personalized information to each employee. If you have questions, now's the time to ask. If you're unsure of any of the terminology used to describe the plans, ask for help before you make a decision.

Employees often stick with the same plan from one year to the next simply due to inertia—even when a better option becomes available. If your employer offers more than one plan option, it's worth your while to carefully consider each plan during open enrollment.

Look at how much you'll pay in premiums (the amount that will be deducted from your paycheck), and how much you'll pay in out-of-pocket costs when you need medical care. Think about your recent healthcare spending, and consider any expenses you expect to incur in the coming year. If one of the other plan options will present a better value than the one you have now, open enrollment is your opportunity to switch plans, and your employer likely has a process in place that will make it easy to do so.

If you or any of your family members take prescription drugs or see a particular doctor, make sure you double-check the covered drug lists (formularies) and provider network details for each of the plans your employer offers. If you switch plans and then find out after the new plan takes effect that your medications and/or doctor aren't covered, you'll have to wait until the next year's open enrollment to switch plans again.

What If I Miss Open Enrollment?

After open enrollment ends, your opportunity to enroll in health insurance coverage for 2022 will be limited. You'll be able to sign up mid-year if you experience a qualifying event (eg, loss of coverage, the birth or adoption of a child, etc.), and in most cases that applies to plans purchased in the exchange or directly from an insurance company.

But it's important to note that some of the qualifying events, including moving to a new area or getting married, only trigger a special enrollment period if you already had minimum essential coverage in place before the qualifying event.

So if you miss the open enrollment period for 2022 coverage and don't experience a valid qualifying event later in the year, you won't be able to sign up for an individual market major medical health insurance plan until the next open enrollment period starts again in the fall of 2022 (coverage, in that case, would be effective January 2023).

Medicaid and CHIP enrollment are year-round, however, for those who are eligible. And Native Americans can enroll in health plans through the exchanges year-round as well. The federal government has also finalized a year-round open enrollment opportunity for people who have household income that doesn't exceed 150% of the poverty level. But this might not continue to be available after the end of 2022, and some of the state-run exchanges might not offer it, even in 2022.

A Word From Verywell

Open enrollment is your opportunity to select the best plan to fit your needs. And the American Rescue Plan's subsidy enhancements have made individual/family health insurance much more affordable than it used to be. If you haven't checked your coverage options since last fall, you might be surprised by how much more affordable the plans are now.

The individual mandate penalty no longer applies, unless you're in a state that has its own mandate and penalty (for 2022, this is DC, Massachusetts, New Jersey, Rhode Island, and California). But going without coverage isn't recommended. If you do go uninsured, you likely won't have an option to get coverage until 2023, and you'd be left uninsured if a medical emergency were to arise mid-year.

Premium subsidies continue to cover the large majority of the cost of coverage for most exchange enrollees, and bronze or gold plans will continue to be particularly inexpensive in many areas for people who qualify for premium subsidies (since the cost of CSR is generally being added to silver plan rates, and subsidies are based on the cost of a silver plan). Open enrollment will run from November 1 to January 15 in most states, and it's your opportunity to sign up for a plan and take advantage of those premium subsidies if you're eligible. So if you know someone who buys their own health insurance, spread the word!

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15 Sources
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