Tips for Planning and Preparing for Open Enrollment – A Guide

Posted by Prescription Hope - See Editorial Guidelines (Last Updated On: Mon Jul 10 2023)

Every year thousands of people either need to get new health insurance or switch their health insurance.

And the last thing you want is to be stuck in a health insurance plan for a year that does not work for you.

On the other hand, if you are a health insurance agent, you need to know what each of your clients is looking for and when they plan to enroll.

So, in this article, we are going to discuss everything about open enrollment. Whether you are an individual looking to get insured or an agent selling health insurance, this will benefit you.

What is open enrollment?

The Affordable Care Act (ACA), also called Obamacare, provides an annual open enrollment period where individuals can enroll in health insurance without being denied coverage based on health status or preexisting conditions.

The open enrollment period comes around once a year, and individuals can either select a new health insurance plan or choose to switch plans. This is also the time to disenroll if you decide to do so.

When can you enroll?

When is open enrollment

Open enrollment periods will vary depending on the healthcare plan you choose.

  • Medicare open enrollment generally runs from October 15 – December 7 each year. For those that already have Medicare Advantage, a separate enrollment period occurs from January 1 to March 31.
  • Job-based health insurance open enrollment periods can occur at any time of the year and are set by your employer. Many employers will choose to have their open enrollment period during the fall so that the new plan will take effect at the start of the new year. However, this is not always the case. Contact your human resources department to find out more.
  • The individual and marketplace open enrollment period runs from November 1 to December 15. However, the federal government can choose to extend the period. For example, open enrollment for 2022 was extended till January 15 due to Covid-19. Despite this extension, individuals will need to enroll in their plan by December 15 to have their coverage start on January 1, 2022.

Special enrollment period

There are times when individuals can enroll in a health care plan outside of open enrollment. There have to be extenuating circumstances known as qualifying events that give individuals this opportunity.

If you experience a qualifying event, you will be eligible for a special enrollment period, allowing you to enroll in a health insurance plan outside of open enrollment.

A qualifying life event includes:

  • Involuntary losing health insurance coverage
    • This includes losing or quitting a job, aging off your parent’s health insurance plan, getting divorced, etc.)
  • Moving to an area where different plans are available
  • Getting married
  • Having a baby or adopting a child

Whenever you have a qualifying event and are applying for new coverage, you will need to provide proof of your qualifying event.

Whether it is a marriage license or a letter from your previous health insurance stating that you lost coverage, make sure you have proof of your qualifying event.

It is important to remember that you will not be eligible for a special enrollment period if you voluntarily lose your previous health coverage by not paying your monthly premiums or canceling your previous plan.

Choosing the best health coverage for you

If you are looking to take advantage of the upcoming open enrollment period, you need to know how to choose the best health coverage for you and your family.

Firstly, it’s essential to understand that there will be various tiers of coverage available to you. And narrowing your focus on just one aspect of a tier can do more harm than good.

Let me explain.

When choosing a health insurance plan, you may have a choice between 3, 4, or even 5 tiers. And each tier will have a different deductible, premium and cover a different percentage of doctor’s appointments, medication, and procedures.

If you only look at the premium and decide to go with the plan that has a lower monthly premium, you could get stuck with a high deductible. Having a higher deductible can cause you to pay more out-of-pocket for your medical costs.

So, when enrolling in health insurance, consider the following:

Enrolling in health insurance
  • What is the monthly premium?
  • What is the deductible?
  • What is the estimated yearly cost?
  • How much health care do I need?

Having a chronic condition or health concerns should also affect which health insurance plan you enroll in.

Also, think through what the next year will look like for you. Will you get married or have a child? What are your financial responsibilities? Will you be moving or switching jobs?

Asking yourself these questions will help you get the most bang for your buck when choosing health insurance.

Information you should have on hand

When you have your health care plan options narrowed down, it’s time to make sure you have all of your information handy.

To make the process go smoothly, make sure you have the following information accessible:

  • Name and Date of Birth
  • Household information
  • Mailing address
  • Information about all of the individuals applying for coverage
  • Social Security Number(s)
  • Tax information
  • Employer and income information
  • The health care plan information you are applying for

Questions to ask yourself

When it comes to choosing the best health care coverage, here are the best questions to ask yourself.

  • With this health insurance plan save me money if I don’t have any health concerns?
    • If you are in good health and do not expect you and your family to visit the doctor more than just a few times throughout the year, then look closely at recurring expenses, like monthly premiums. However, you cannot always predict the unexpected, so factor in costs for unexpected care so that it gives you a little cushion.
  • Is the health insurance plan affordable if you become sick?
    • The last thing you want is to come down with a severe sickness that hospitalizes you or a family member. The only thing that will make this worse is if you chose a plan that does not cover the medical expenses you need to make you or your family member better. So, aim for a good balance between expenses like monthly premiums, deductibles, and the out-of-pocket maximum.
  • Are your doctors covered under the health plan?
    • It is important to look at the health insurance plan’s network, especially if you plan to stay with your current healthcare providers.
  • What’s the prescription drug coverage like for this health insurance plan?
    • The majority of people living in America use at least one prescription drug. Be sure to check how much the insurance plan will cover your prescription drug costs. Check the formulary to find out which drugs are covered and how much they will cost. In addition to this, check to see which pharmacies are in the plan’s network.
  • Will this insurance plan make it easy to get care?
    • Consider how much this plan will cover for emergency room and urgent care visits.
  • Will this insurance plan cover alternative therapies?
    • In some cases, your health insurance may cover therapies like visiting a chiropractor, acupuncture, and other treatments. If this is part of your health regimen, then consider picking a plan that covers alternative therapies.
  • Are there any benefits that are included in the health insurance plan?
    • Sometimes there are perks to some insurance plans that can save you money. For example, a plan may offer a gym membership discount. You may want to ask your health insurance agent about the potential benefits and perks.
  • Will this plan help me if I am out of town?
    • There may be times where you need to receive care while you are traveling and across state lines. Consider if this plan will help cover the cost of care that is out of the state you reside in.

Preparing for open enrollment as a health insurance agent

Open Enrollment - Getting the right health insurance

If you are a health insurance agent, then you may be looking to take advantage of the open enrollment Period. In order to do so, here are some tips to help you prepare.

  • Register with – Completing registration and training allows you to become a federally-facilitated Marketplace (FFM) agent.
  • Know which health insurance companies are in your market – Insurance carriers can either enter or return to the health insurance marketplace by offering plans on or off the federal exchange.
  • Start marketing early – It is recommended that insurance agents start marketing around July or August for the open enrollment Period.
  • Know the income level in your area – To provide your clients and prospects with the best plans that fit their needs and their price point, it is essential to know the income level in your area.
  • Keep your leads warm – With most businesses, prospects may not buy right away. So, keep your leads warm by nurturing them and staying in contact with them. They may be more likely to reach out to you when they have questions.
  • Stay engaged with your clients – Throughout the year stay engaged with your clients. This allows you to be seen as a trustworthy source.


The single greatest thing you can do as a health insurance agent is to become trusted. When prospects trust you, they will be more likely to buy from you.

One of the best ways you can get prospects to trust you is by being genuine and showing them that you actually care for their needs. You do this by providing them with resources beyond just health insurance.

The reality is that many health insurance plans either do not cover enough or the monthly premiums are beyond what many can afford. This is where Prescription Hope can help both parties out.

You, the health insurance agent, can offer Prescription Hope as a resource to your prospects and clients when health insurance plans aren’t the best option for them.

Prescription Hope is a medication access serviced-based company that streamlines patient assistance programs for patients who qualify. Outreach kits are available so that you can easily provide your prospects and clients with more information.

Here’s where you can find Prescription Hope’s outreach kit, providing you and your clients with more information.


We hope that this article has helped you understand how you can better prepare for open enrollment.

Whether you have insurance or not, it can still be difficult to afford your much-needed medication. Prescription Hope is here to help you save on brand-name medication.

By working directly with pharmaceutical manufacturers, we can help patients who qualify access patient assistance programs. Fill out our online enrollment form to determine if you qualify and start receiving each of your medications for $60.00 a month through Prescription Hope’s medication access service . 

What is Open Enrollment?

Open enrollment is an annual period, normally from November 1st to December 15th, where individuals can enroll in a health insurance plan without being denied coverage based on health status.

What happens if you miss open enrollment?

If you miss the open enrollment period and were not previously enrolled in an insurance plan that automatically renews, you could be without health insurance. However, there are options for you.

  1. You can check to see if you qualify for a special enrollment
  2. You can check to see if you qualify for Medicaid
  3. Consider getting a short-term insurance plan
  4. Join a health-sharing plan
  5. Get your medication through Prescription Hope

Do I have to wait for open enrollment to get health insurance?

In most cases, you will need to wait until the open enrollment period to get new health insurance or switch plans. Keep in mind that the open enrollment period for your workplace may differ from the federal open enrollment, which is from November 1st to December 15th.

In other cases, you can get new health insurance or switch plans if you have a qualifying event.