Open Enrollment vs. Special Enrollment

Most health insurance plans, like Medicare, individual and family plans and group coverage, have set times when you can enroll in a plan. Open Enrollment, or Annual Enrollment, is the main window, while Special Enrollment lets you sign up when certain life events happen. Learn more about the enrollment periods and how to get a Blue Cross and Blue Shield of Texas plan during them.

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When can I get health insurance coverage?

Most people enroll in Medicare for the first time when they turn 65. For individual and family or group plans, you may choose to enroll when you start a new job or at 26 years old after losing a parent's coverage.

After becoming eligible, each plan type has different times each year you can update or choose a new plan:

Open Enrollment Period
Annual Enrollment Period
Special Enrollment Period

What about Medicaid? Medicaid doesn't follow these same enrollment periods.

How are the enrollment periods different?

Open or Annual Enrollment

A standard yearly enrollment event happens once a year for individual and family, group¹ and Medicare plans. For individual and family and group plans, this is called Open Enrollment. During Open Enrollment, most people can choose different coverage or update their current plan. You don't need to go through a big life change, or a qualifying life event. The plan you enroll in during Open Enrollment is for the upcoming year.

For Medicare, this is known as the Annual Enrollment Period. During Annual Enrollment, those who apply can join or switch Medicare plans. Medicare also has an Open Enrollment Period for Medicare Advantage members.

Special Enrollment

If you go through a life change that impacts your plan's cost, network or the people covered by your plan, you can change your plan during Special Enrollment.² Some common qualifying life events include:

For Medicare coverage: leaving a job (if you worked past age 65), moving, entering or leaving facilities like a nursing home or going through a change with your plan’s coverage. Explore Medicare Special Enrollment.
For individual and family or group coverage: Turning 26, having or adopting a baby, getting married, moving or losing or changing your job. Explore individual and family Special Enrollment.

Important Enrollment Dates and Deadlines

Open and Annual Enrollment happens once a year, every year. Dates are set by the government or your business. Special Enrollment doesn't have set dates, but has specific timelines around your qualifying life event that help you know when to enroll.

Open or Annual Enrollment
Special Enrollment

Two women look at a computer for enrollment together.

For Open or Annual Enrollment, know these dates.

Oct. 15: Annual Enrollment normally starts for Medicare
Nov. 1: Open Enrollment normally starts for individual and family plans
Dec. 7: Annual Enrollment normally ends for Medicare
Jan. 15: Open Enrollment normally ends for individual and family plans
Group coverage doesn't have dedicated start or end dates. For questions, reach out to your company's HR department.

For Special Enrollment, know these important deadlines.

60 days: you normally have a 60-day deadline to enroll in a plan after going through a life event. In some cases, you can enroll up to 60 days before your life event.
8 months: you have 8 months to enroll in Medicare Part A and/or Part B after losing group coverage.
24/7, 365: if you've gone through a qualifying life event and are still within your 60-day deadline, you can enroll any day or time.

When will my health insurance coverage start?

In most cases, your health coverage won't start the day you enroll in a plan. During Open Enrollment and Annual Enrollment, your coverage normally starts in January of the upcoming year. Individual and family plans have might take effect Feb. 1 if you enrolled after Dec. 15.

If you're enrolling during Special Enrollment, your health plan's coverage usually starts on the first day of the month after you enroll. For example, your coverage will start June 1 if you finished enrolling on May 23.

There are some life events, like adoption, fostering or court order, that allow coverage to start on the day of your life event. Sometimes, like with childbirth, coverage can even be applied to past related medical events.

So, you're ready to enroll — let's get started.

You've determined you're able to enroll, you've compared your BCBSTX plan options. What now?

During Open Enrollment or Annual Enrollment, you have a pretty straightforward path to getting a plan:

For individual and family plans: Check if you qualify for financial help, like premium subsidies, compare your BCBSTX options and enroll. Make sure you pay your first premium to make your coverage active. Get started exploring plans.
For group plans: Normally, you just need to explore your company's offered plans and enroll. If you're adding a dependent or partner to your coverage, you may need to upload documents to verify them. Check how to get started your HR department.
For Medicare: Think about your needs and compare the Medicare coverage parts. Then, complete your BCBSTX application. Understand your Medicare options.

During Special Enrollment, you'll follow the same process but may have some extra steps:

For individual and family plans: Depending on your life event, you might need to submit documentation showing proof of your life event, like a marriage or birth certificate, or that you held insurance, like a letter from your employer.
For group plans: You might need to submit proof of your life event for group coverage. You may want to reach out to your HR department to make them aware that you went through a qualifying life event.
For Medicare: You normally need to submit documents, depending on your life event, that shows when your coverage was impacted and your life event took place.

What about Medicaid enrollment periods?

Medicaid doesn't have a traditional Open Enrollment Period or Special Enrollment Period. If you become eligible for Medicaid, you can enroll any time of year. Learn more about Medicaid and find out if you're able to enroll.

Understand Medicaid

¹ Individuals enrolling in a group plan should with their benefits administrator or Human Resources department for questions or assistance.

² Members of American Indian and Alaska Native tribes can apply for health care coverage any month of the year. If you qualify for Children’s Health Insurance Program (CHIP) or other assistance based on your income, you do not need to enroll during the Special Enrollment Period.