When and How Does Health Insurance Renew?

Health insurance renewal is an annual process for most plans, allowing for adjustments based on changing healthcare needs, regulations, and market conditions. Understanding when and how health insurance policies renew is important for individuals to maintain continuous and appropriate coverage.

Individual Health Insurance Plans

Health insurance plans purchased directly from an insurer or through the Affordable Care Act (ACA) marketplace renew annually, often aligning with the calendar year. The primary period for renewing, re-enrolling, or changing these individual plans is called the Open Enrollment Period (OEP). For most states, OEP runs from November 1 to January 15 for coverage starting on January 1 or February 1.

If no action is taken during OEP, many plans will automatically renew for the upcoming year, especially if the current plan is still available. It is important to actively review plan details during OEP, as premiums, benefits, and networks can change. If the current plan is no longer offered, the marketplace may automatically enroll individuals into a similar plan. Outside of the OEP, individuals may qualify for a Special Enrollment Period (SEP) to make changes due to specific life events, such as marriage, loss of other coverage, or a change in residence.

Employer-Sponsored Health Insurance Plans

For health insurance provided through an employer, the renewal date is determined by the employer, often coinciding with the company’s fiscal year or a specific benefits year, rather than a standard calendar year. This allows the employer to reassess and negotiate the terms with the insurance carrier. The renewal process for these plans involves the insurer re-evaluating pricing and offerings, followed by the employer selecting the plans to be offered to employees.

Employees then participate in an internal “open enrollment” period set by their employer, where they can review available options, make changes, or re-enroll for the upcoming plan year. This period allows employees to switch plans if multiple are offered, add or remove dependents, or opt out of coverage. Employers provide specific dates and instructions for this internal enrollment, often several months before the new plan year begins.

Government Health Programs

Government-sponsored health programs like Medicare and Medicaid also have specific renewal processes. For Medicare, the Annual Enrollment Period (AEP) runs from October 15 to December 7 each year. During this time, beneficiaries can make changes to their Medicare Advantage (Part C) or prescription drug (Part D) plans, with new coverage becoming effective on January 1. Original Medicare (Parts A and B) does not require annual renewal.

Medicaid involves an annual “redetermination” process, where state agencies review eligibility to ensure beneficiaries still meet the program’s financial and other criteria. Beneficiaries are notified by mail when it is time to re-verify their information. It is important to respond promptly to these requests to avoid a lapse in coverage.

Understanding Your Renewal Notice

All health insurance providers are required to send a renewal notice or annual enrollment packet to policyholders before their plan renews. This notice details important information for the upcoming plan year. Individuals should examine the notice for changes to monthly premiums, which may increase.

The notice will also outline changes to benefits, deductibles, and out-of-pocket maximums, which are the most an individual will pay for covered services in a year. It is also important to check for any changes to the plan’s network of doctors, pharmacies, and clinics to ensure preferred providers remain covered. After reviewing these details, individuals can confirm continued enrollment, update personal information, or consider shopping for a new plan if the current one no longer meets their needs or if costs have changed significantly.