Open Enrollment for 2018 Individual Insurance: What You Need to Know

New Dates, Reduced Advertising, and Reduced Enrollment Assistance

Applies to individual coverage. © Verywell, 2017

Open enrollment for 2018 individual market coverage—both in the exchange and off-exchange—begn November 1, 2017 and ended just over six weeks later on December 15, in most states.

This is much shorter than open enrollment has been in previous years, and half as long as open enrollment was originally scheduled to run this year. It's also the first time that open enrollment ends before the beginning of the new year.

There are a variety of changes and things to be aware of with this fifth open enrollment period. And the executive order that President Trump signed on October 12 and the termination of funding for cost-sharing reductions have added to the confusion that has plagued health care reform in 2017.

But the executive order merely directs various government agencies to make recommendations for changes that could be implemented to achieve the Trump Administration's goals. It doesn't have any immediate effect, and as far as open enrollment for 2018 coverage, nothing changed with the executive order.

The elimination of funding for cost-sharing reductions means that premiums will be higher than they would otherwise be for 2018, although the impact in most states will be on silver plans, and will be offset by larger premium subsidies for most enrollees, resulting in lower after-subsidy premiums for many people, compared with what they paid in 2017. Consumers had to carefully compare the available options during open enrollment, but cost-sharing reduction benefits continue to be available for all eligible enrollees in 2018.

Budget Changes

In addition to a shorter open enrollment period, the Trump Administration slashed outreach and marketing funding for, resulting in far less advertising for the exchange and fewer in-person assisters to help people enroll. 

Covered California analysis finds that the reduced funding was likely to result in one million fewer enrollees in states in 2018 (ultimately, enrollment ended up at 8.7 million in states, down from 9.2 million the year before). And since it's the healthiest enrollees who are likely to forgo enrollment, premiums will have to continue to rise to cover an increasingly sick pool of people.

The U.S. Department of Health and Human Services (HHS) is only spent $10 million on marketing for this fall, down from $100 million last year. For perspective, California—which has its own exchange—was planning to spend $111.5 million—more than 11 times as much as HHS will spend to market, despite the fact that enrolled nearly six times as many people for 2017 as Covered Calfornia did. The Trump Administration has also reduced the budget for Navigator organizations (enrollment assistance) by 41 percent.

The combination of a shorter enrollment period, far less marketing, and less available enrollment assistance could result in a confusing experience for individual market enrollees. So, let's take a look at the changes and what you need to know if you buy your health insurance in the individual market.


In most states, if you were signing up for individual market coverage—on or off-exchange—for 2018, you had a little over six weeks to complete your enrollment or make changes to your existing coverage. This is half as long as you've had during the last few open enrollment periods. HHS changed the dates in April 2017, cutting the scheduled enrollment window in half.

Open enrollment started November 1 in every state and ends on December 15 in all but ten states. Unless you're in one of the states that have extended open enrollment, you won't have an opportunity to enroll or make changes to your coverage after December 15 without a qualifying event.

However, people in Georgia, Florida, South Carolina, Alabama, Maine, and parts of Louisiana, Texas, and Mississippi have until December 31 to enroll in coverage for 2018, due to windstorms and hurricanes in the fall of 2017. And if your insurer is exiting the market at the end of 2017, you've got a special enrollment period during which you can pick a new plan. It continues until March 1, but if you pick a new plan by December 31, it will take effect January 1, 2018. 

Further compressing the enrollment window, HHS announced in a training session in late September that, the exchange enrollment portal used by people in 39 states, would be unavailable due to scheduled maintenance for half the day on most Sundays during open enrollment, and even overnight on the first day of open enrollment, November 1.

This was a highly controversial move, and essentially reduced the open enrollment window by three full days. 

Available Coverage

The November 1 through December 15 open enrollment window applied to individual market coverage that's compliant with the Affordable Care Act (ACA, aka Obamacare), both on and off-exchange. According to an analysis by Mark Farrah Associates, there are about 17.6 million people in this market.

There are open enrollment windows that apply to people with Medicare and with employer-sponsored health insurance, but they are not affected by the changes the Trump Administration has made.

And people who have grandmothered or grandfathered individual market coverage are also not affected. 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 2018, particularly if you're eligible for premium subsidies or cost-sharing subsidies in the exchange.

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 is going up and if you have a premium subsidy through the exchange, understand how much your after-subsidy premium will change.

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 yearend 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.

In past years, people had a chance to make changes to their coverage in January if they were caught off-guard by a higher premium or coverage changes at the start of the new year. That will no longer be available in 2018, so it's essential to make sure you understand the details before mid-December and make any changes that you deem necessary.

States With Extended Enrollment

Ten state-run exchanges have opted to add additional time at the end of the regularly scheduled open enrollment period this fall/winter, and HHS has issued a special enrollment period for some hurricane victims in three states that use Note that these are one-time extensions and will not apply in future years.

Exchange enrollees in these states will have until the following deadlines to enroll in coverage for 2018:

  • Maryland: December 22 (all plans will be effective January 1)
  • Connecticut: December 22 (all plans will be effective January 1)
  • Rhode Island: December 31 (all plans will be effective January 1)
  • Colorado: January 12 (the state has confirmed that this applies off-exchange as well)
  • Minnesota: January 14
  • Washington: January 15
  • Massachusetts: January 23 (enrollments submitted by December 23 will be effective January 1; enrollments submitted between December 24 and January 23 will have coverage effective February 1)
  • DC: January 31
  • California: January 31
  • New York: January 31

DC, California, and New York all opted to keep the open enrollment period that was originally scheduled for 2018 coverage. The other seven exchanges picked earlier deadlines in an effort to get the earliest possible effective dates (January 1 or February 1) while still giving people additional time to enroll beyond the default December 15 deadline.

The flexibility to extend open enrollment is limited to states that don't use—and there are only 12 of them. Two of those 12 did not extend open enrollment—Vermont and Idaho ended open enrollment on December 15.

In addition to the state-run exchanges that have extended open enrollment, HHS announced in late September that some residents impacted by hurricanes in 2017 would have until the end of December to enroll in plans through for 2018. This special enrollment period (December 16 - December 31) applies to people who reside in (or who resided in when the hurricane hit) one of the counties that FEMA deemed eligible for “individual assistance” or “public assistance” following Hurricanes Irma and Harvey.

That includes:

Enrollment Assistance

In addition to shortening open enrollment and slashing funding for marketing, the Trump Administration cut funding for Navigator organizations by 41 percent compared with the funding they received heading into the open enrollment period in the fall of 2016. Finding enrollment assistance may be harder this year.

State-run exchanges run their own budgets for in-person assistance. For example, Connecticut's exchange is ramping up their in-person assistance with various new locations throughout the state. But the majority of the states rely on the federally-run exchange and won't have as much funding this fall for in-person enrollment assistance.

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.

Reasons for Shorter Enrollment

It's important to understand that the shorter open enrollment period, which is part of a market stabilization effort, was actually planned under the Obama Administration, and was slated to take effect in the fall of 2018. The Trump Administration only moved that up a year, having it take effect in the fall of 2017 instead.

The move to shorten open enrollment starting in the fall of 2017 was part of the market stabilization regulation that HHS finalized in April 2017. The idea was that insurers need to have as many people as possible enrolled in full-year coverage in order to keep the risk pool stable, and ending open enrollment before the end of December is the means to achieving that goal.

In previous years, when open enrollment continued into the new year, people could enroll in coverage in late January and have a March 1 effective date. That meant they were only paying premiums for 10 months of the year, rather than 12.

Sick people are not likely to do this. It was healthy enrollees—the people who are most needed in the risk pool in order to keep it stable—who were signing up for partial-year coverage. Insurers and the exchanges knew this wasn't sustainable and the shorter open enrollment period is a means of addressing the issue.

And again, HHS, under the Obama Administration, had come to the same conclusion in regulations that they finalized in early 2016. But the plan at that point was to give insurance companies, exchanges, and consumers more time to prepare for the shorter open enrollment period as it wasn't slated to take effect until the fall of 2018.

Instead, the new dates were rolled out in April 2017, just a little over six months before the start of open enrollment. That didn't give insurers, exchanges, or consumers a lot of time to address the changes, which is why the market stabilization rule specifically notes that state-run exchanges have the option to use their own flexibility to extend open enrollment this fall.

Understanding the Controversy

The concept of a shorter open enrollment period that ends in December, with all plans effective January 1, was controversial even when HHS under the Obama Administration proposed it in late 2015. HHS discussed the dissenting opinions in the regulation that they finalized in early 2016.

So, although President Trump has repeatedly said that he'll "let Obamacare implode," the shorter open enrollment period was not the Trump Administration's idea, and the controversy that surrounds it now already existed before Trump won the 2016 election. But, the reduced funding for marketing, outreach, and enrollment assistance is the Trump Administration's idea and is absolutely destabilizing for the individual market as it will result in fewer, and sicker, enrollees in 2018.

Proponents of a shorter open enrollment period note that it helps to ensure that everyone has full-year coverage. They also believe that a three-month enrollment window is no longer necessary now that the exchanges are functioning smoothly and insurers and consumers are used to the new normal in the individual market.

But opponents of the shorter open enrollment window note that the individual market is volatile, which means that people cycle in and out of it from one year to the next and there are constantly new people needing to purchase individual market coverage for the first time. They also point out that the new window overlaps with the existing Medicare open enrollment period. And, many of the brokers who assist people in the individual market are also helping people in the Medicare market, stretching the assistance resources fairly thin.

The plans for sale in the individual market are also particularly volatile, with insurers exiting and entering the market each year, along with network and benefit changes. This makes it harder (and not generally advantageous) for people to "set it and forget it" when it comes to their individual market health insurance. It's important and often necessary to shop around each year, and the compressed enrollment window makes it more challenging for everyone in the individual market to be able to do that, particularly if they need assistance with the process.

Opponents of a shorter open enrollment window also note that sick people tend to sign up as soon as possible, early in the enrollment window. But young, healthy people (ie, the "young invincibles") are more likely to procrastinate and sign up at the last minute. This year, it is especially important to communicate to that population that open enrollment ends December 15 so that they don't wait too long and miss the window altogether.

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 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 often 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 health care 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 2018 will be limited. You'll be able to sign up mid-year if you experience a qualifying event (eg, loss of coverage, marriage, etc.), and in most cases that applies to plans purchased in the exchange or directly from an insurance company.

But without a qualifying event, 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 2018.

A Word From Verywell

We know that health insurance can be confusing, and 2017 has certainly added to that confusion with the constant debate over healthcare reform. But the overall structure of the individual market will be the same in 2018 as it was in 2017.

Your premium subsidies and cost-sharing reductions will still be available, and the exchanges in every state are functioning just the same as they were during the last open enrollment period. Although the Trump Administration has cut off funding for cost-sharing reductions, the impact of this (higher premiums—particularly for silver plans—in nearly every state) will be mostly borne by the federal government, in the form of larger premium subsidies. The cost-sharing reductions themselves will continue to be available in 2018 to anyone all eligible enrollees. 

And despite repeated headlines about areas with no exchange insurers planning to offer coverage in 2018, every county in the country has at least one insurer lined up to offer exchange coverage. And although the GOP tax bill does eventually repeal the individual mandate, that change doesn't take effect until 2019. So people who are uninsured in 2018 will face a penalty when they file their taxes in early 2019.

The dates have changed for open enrollment in most states though, and the slashed advertising budget for means that people might not be aware of the shorter open enrollment window. So if you know someone who buys their own health insurance, spread the word!

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