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What type of health insurance or health care program do you want to learn more about?

Employer-Sponsored

Employer-sponsored insurance refers to health insurance offered by employers to their employees, dependents (children), and spouses, as an employee benefit. Employer-sponsored health insurance is also called "Group Insurance" or a "Group Plan".

Which specific enrollment period do you want to learn more about?

Overview
  • There are special circumstances, called "qualifying events", that qualify an employee for a Special Enrollment Period (SEP) where they may enroll in or make changes to a plan. The length of the SEP depends on the plan.
Eligibility
  • Qualifying events include loss of eligibility from other coverage (for example, because of death or divorce), and certain life events such as marriage or the birth or adoption of a child.
Where and How You Can Enroll
  • Your employer should give you information on how to enroll in an employer-sponsored health insurance plan.
  • If you have questions, ask whomever at your job deals with employee benefits for more information.
Tips for Picking a Plan

Here are 3 questions to ask when picking a health insurance plan:

1) What will the plan actually cost me?

In addition to the total cost of a plan, you should also think about the impact your deductible amount will have. Some plans may have a high deductible, which means that you have to pay a lot of money up front, before your plan starts to pay their share of the cost. Other plans may have a more expensive monthly premium, but have a lower deductible and lower out-of-pocket maximum, which spreads the amount you pay out-of-pocket throughout the year.

2) Are my doctors and other health care providers included in the plan's network?

Many plans will not cover medical care that you receive from an out-of-network provider. Even if they do cover some of your medical costs for out-of-network providers - you may have to pay more out-of-pocket.

3) Does the plan cover my prescription drugs?

Check with the plan to see which drugs are covered by the plan. If your plan does not cover prescription drugs you are taking or plan to take, you may end up paying more out-of-pocket to access your medications.

Overview & When Benefits Begin
  • Employees can usually enroll in their employer-sponsored health plan when they are first hired.
  • Employers are allowed to have up to a 90-day waiting period for coverage to begin.
Where and How You Can Enroll
  • Your employer should give you information on how to enroll in an employer-sponsored health insurance plan.
  • If you have questions, ask whomever at your job deals with employee benefits for more information.
Tips for Picking a Plan

Here are 3 questions to ask when picking a health insurance plan:

1) What will the plan actually cost me?

In addition to the total cost of a plan, you should also think about the impact your deductible amount will have. Some plans may have a high deductible, which means that you have to pay a lot of money up front, before your plan starts to pay their share of the cost. Other plans may have a more expensive monthly premium, but have a lower deductible and lower out-of-pocket maximum, which spreads the amount you pay out-of-pocket throughout the year.

2) Are my doctors and other health care providers included in the plan's network?

Many plans will not cover medical care that you receive from an out-of-network provider. Even if they do cover some of your medical costs for out-of-network providers - you may have to pay more out-of-pocket.

3) Does the plan cover my prescription drugs?

Check with the plan to see which drugs are covered by the plan. If your plan does not cover prescription drugs you are taking or plan to take, you may end up paying more out-of-pocket to access your medications.

Overview
  • Employers have an Open Enrollment Period for a period of time each year when employees can enroll or make changes to an existing plan.
  • Open Enrollment Periods vary by employer. If an employer’s plan starts January 1st, then open enrollment is typically in the Fall.
Where and How You Can Enroll
  • Your employer should give you information on how to enroll in an employer-sponsored health insurance plan.
  • If you have questions, ask whomever at your job deals with employee benefits for more information.
Tips for Picking a Plan

Here are 3 questions to ask when picking a health insurance plan:

1) What will the plan actually cost me?

In addition to the total cost of a plan, you should also think about the impact your deductible amount will have. Some plans may have a high deductible, which means that you have to pay a lot of money up front, before your plan starts to pay their share of the cost. Other plans may have a more expensive monthly premium, but have a lower deductible and lower out-of-pocket maximum, which spreads the amount you pay out-of-pocket throughout the year.

2) Are my doctors and other health care providers included in the plan's network?

Many plans will not cover medical care that you receive from an out-of-network provider. Even if they do cover some of your medical costs for out-of-network providers - you may have to pay more out-of-pocket.

3) Does the plan cover my prescription drugs?

Check with the plan to see which drugs are covered by the plan. If your plan does not cover prescription drugs you are taking or plan to take, you may end up paying more out-of-pocket to access your medications.

COBRA

Overview

  • COBRA is a federal law that allows eligible individuals to keep their existing employer-sponsored health insurance coverage after experiencing a "qualifying event."
  • COBRA coverage must be substantially similar, if not the exact same coverage, that you had with your employer-sponsored plan.
  • It is important to remember that COBRA is not an actual health plan; it is the right to keep your employer-sponsored plan for an additional period of time.

COBRA Qualifying Events & Length of Coverage

The chart below lists the qualifying events that would entitle you to coverage under COBRA and the maximum length of time you can keep COBRA coverage:
COBRA Qualifying EventsMaximum Length of
COBRA Coverage
Employment ends or hours reduced18 months
When someone covered on a parent's policy as a dependent child turns 26 and loses coverage 36 months
Covered employee enrolls in Medicare (spouse or a dependent child would be eligible for COBRA coverage) 36 months
Divorce or legal separation from covered employee (spouse or dependent child would be eligible for COBRA coverage) 36 months
Death of a covered employee (spouse or dependent child would be eligible for COBRA coverage) 36 months

Additional Considerations

  • COBRA is one of multiple options, it may be helpful to do the math to which option would be more appropriate for you. Other options include:
    1. Employees who are eligible for COBRA are also usually eligible for a 60-day special enrollment period to buy a new plan from a private insurance company through the Marketplace
    2. When you have lost employer-sponsored health insurance you may be eligible for a Special Enrollment Period to move to another group plan (for example your spouse's plan or a parent's plan if you are under 26)
    3. If you are eligible or will become eligible for Medicare or Medicaid, these may be additional options for insurance coverage.
  • One of the main barriers to COBRA coverage is cost. Typically, you have to pay 100% of what your employer was paying for your coverage, plus a possible 2% administrative fee (for a total of 102%).
  • Despite the cost of the monthly premiums, there may be some significant benefits to choosing COBRA. For example, if you are in the middle of treatment, by electing COBRA coverage you wouldn't have to find a new insurance plan that has the same coverage for your doctors, hospitals, and prescription drugs. Additionally, if you have already met your out-of-pocket maximum or deductible for the year, it may make more sense financially to elect COBRA for the remainder of the plan year rather than finding a new plan and paying another out-of-pocket maximum or deductible. You should do the math to figure out which option would cost you less.

Marketplace / Individual

The Patient Protection & Affordable Care Act (ACA) created a new way to find and buy private health insurance plans for individuals and families: State Health Insurance Marketplaces, also called "exchanges". There are two times when you can enroll in a Marketplace plan, called "enrollment periods".

Which specific enrollment period do you want to learn more about?

Overview
  • When you lose coverage or have a life-changing event, you may qualify for a 60-day Special Enrollment Period.
Eligibility
  • Qualifying reasons include: loss of health insurance, moving, and changes in your household (e.g.,, marriage, birth or adoption of a child, divorce, or death of someone on your Marketplace plan)
  • To be eligible to buy a health plan through the Marketplace, you:
    1. Must live in the United States
    2. Must be a U.S. citizen, or be lawfully present* in the U.S.
    3. Can't be incarcerated
  • If you have Medicare, you may not be eligible to use the Marketplace to buy a health or dental plan.

*Note: While anyone who is lawfully present can buy a Marketplace plan, only individuals who are Legal Permanent Residents, certain Cuban and Haitian entrants, and individuals residing under the Compact of Free Association, are eligible to receive federal financial assistance to buy a Marketplace plan.

When Benefits Begin
    Regular Coverage Effective Dates:
  • If you enroll by the 15th of the month, coverage will start on the 1st of the following month.
  • If you enroll between the 16th and the last day of the month, coverage will start on the 1st of the second following month.
    If You Lost or Will Lose Health Coverage:
  • If you already lost coverage you must pick a plan within 60 days after the date coverage ended. Your coverage will start the first day of the month after you pick a plan. Submit your documents within 30 days of picking a plan.
  • If you will lose coverage in the future, you must pick a plan within 60 days before the date your coverage will end. Your coverage will start the first day of the month after your coverage ends and you pick a plan. Submit your documents within 30 days of picking a plan.
Where and How You Can Enroll
Local Help

To find local help with enrolling in a plan, visit: https://localhelp.healthcare.gov/

Find Local Help →
Tips for Picking a Plan

Here are 3 questions to ask when picking a health insurance plan:

1) What will the plan actually cost me?

In addition to the total cost of a plan, you should also think about the impact your deductible amount will have. Some plans may have a high deductible, which means that you have to pay a lot of money up front, before your plan starts to pay their share of the cost. Other plans may have a more expensive monthly premium, but have a lower deductible and lower out-of-pocket maximum, which spreads the amount you pay out-of-pocket throughout the year.

2) Are my doctors and other health care providers included in the plan's network?

Many plans will not cover medical care that you receive from an out-of-network provider. Even if they do cover some of your medical costs for out-of-network providers - you may have to pay more out-of-pocket.

3) Does the plan cover my prescription drugs?

Check with the plan to see which drugs are covered by the plan. If your plan does not cover prescription drugs you are taking or plan to take, you may end up paying more out-of-pocket to access your medications.

Overview
  • Open enrollment is a set period where individuals can sign up for or make changes to existing health insurance coverage.
Eligibility
  • To be eligible to buy a health plan through the Marketplace, you:
    1. Must live in the United States
    2. Must be a U.S. citizen, or be lawfully present* in the U.S.
    3. Can't be incarcerated
  • If you have Medicare, you may not be eligible to use the Marketplace to buy a health or dental plan.

*Note: While anyone who is lawfully present can buy a Marketplace plan, only individuals who are Legal Permanent Residents, certain Cuban and Haitian entrants, and individuals residing under the Compacts of Free Association, are eligible to receive federal financial assistance to buy a Marketplace plan.

Key Dates

This period typically runs from between November 1st to December 15th

When Benefits Begin
  • The earliest plans can start is January 1st
Where and How You Can Enroll
Local Help

To find local help with enrolling in a plan, visit: https://localhelp.healthcare.gov/

Find Local Help →
Tips for Picking a Plan

Here are 3 questions to ask when picking a health insurance plan:

1) What will the plan actually cost me?

In addition to the total cost of a plan, you should also think about the impact your deductible amount will have. Some plans may have a high deductible, which means that you have to pay a lot of money up front, before your plan starts to pay their share of the cost. Other plans may have a more expensive monthly premium, but have a lower deductible and lower out-of-pocket maximum, which spreads the amount you pay out-of-pocket throughout the year.

2) Are my doctors and other health care providers included in the plan's network?

Many plans will not cover medical care that you receive from an out-of-network provider. Even if they do cover some of your medical costs for out-of-network providers - you may have to pay more out-of-pocket.

3) Does the plan cover my prescription drugs?

Check with the plan to see which drugs are covered by the plan. If your plan does not cover prescription drugs you are taking or plan to take, you may end up paying more out-of-pocket to access your medications.

Medicaid

Overview

  • Medicaid is a joint federal and state funded program that provides free or low-cost health insurance coverage. While the federal government creates some rules for all states to follow, states have flexibility in their Medicaid program.
  • Please Note: Medicaid is VERY state specific. This content will provide an overview of Medicaid enrollment. For state-specific details, please visit your state's Medicaid website.
Eligibility
  • To receive Medicaid, federal law requires states to cover certain groups of individuals, for example:
    1. Low-income families
    2. Qualified pregnant women and children
    3. Individuals receiving Supplemental Security Income (SSI)
  • States may choose to cover other groups.
  • Children whose household income is at or below 138% of the federal poverty level are covered in all states, some states have also chosen to cover adults at this income level (known as expanded Medicaid).
Where and How You Can Enroll
  • Medicaid applications are accepted at any time of the year. As soon as someone thinks they are eligible for Medicaid they can apply right away.
  • There are 2 main ways to enroll in Medicaid:
    1. Marketplace Portal: You can apply through your state's Health Insurance marketplace. You can always start at www.healthcare.gov, which will bring you to the appropriate website for your state.
    2. State Medicaid Agency: You can also apply directly with your state's Medicaid agency. For help finding your state's website:

Medicare

  • Medicare is a government-funded and run health insurance program for eligible individuals. Medicare includes Part A (hospital), Part B (medical), Part D (drug), and Part C (Medicare Advantage). Part A + Part B are referred to as Original Medicare.
  • A Medigap plan is a supplemental insurance plan, sold by private insurance companies for those who choose Original Medicare (Parts A and B) that will help pay for "out-of-pocket" costs for care under Parts A and B (not D) such as deductibles, co-payments, and co-insurance amounts.
  • You have multiple opportunities, called periods, to sign up or "enroll" in Medicare or change your current Medicare coverage.

Which specific enrollment period do you want to learn more about?

Overview
  • Your first enrollment period for Medicare is your initial enrollment period (IEP).
  • Preparing for your IEP can prevent problems down the line, since signing up for coverage after this period ends can result in penalty fees.
Eligibility
  • You will first be eligible for Medicare when:
    1. You turn 65. Three months before you turn 65, your seven-month period to choose a Medicare plan begins.
    2. You have a disability and have received SSDI (Social Security Disability Insurance) benefits for 24 months.
When Benefits Begin
  • 65+: If you would like your coverage to begin when you turn 65, sign up during the 3 months before the month you turn 65. If you wait until the month you turn 65+ (or the 3 months after you turn 65) to enroll, your Part B coverage will be delayed, which could cause a gap in your coverage.
  • Under 65 with a disability (auto enrolled): Coverage begins after receiving SSDI for 24 months.
  • ALS (auto enrolled): Coverage begins first month disability begins.
Where and How You Can Enroll
  • If you have paid into Medicare through FICA employment taxes, you will likely be automatically enrolled in Medicare Part A. If you want Medicare Parts B, C, or D, or you would like a Medigap plan, you have to choose to enroll in this coverage.
  • Enroll in Medicare by contacting the Social Security Administration at www.ssa.gov or 1-800-MEDICARE.
Making Medicare Choices

When you are first eligible for Medicare coverage there are important choices for you to make about how you want to access your Medicare coverage. You have to choose whether you will get your coverage through Original Medicare (with or without a Medigap plan) or a Medicare Advantage plan. To learn more about these choices, visit the page Medicare, Medicaid, and Other Government Healthcare Programs.

Overview
  • You can make changes to your Medicare coverage when certain events happen in your life, like if you move or you lose other insurance coverage – this is know as a Special Enrollment Period (SEP).
Eligibility
  • There are 2 primary ways to qualify for a special enrollment period:
    1. Qualifying life events (e.g., you move out of your current plan’s service area)
    2. When employer coverage ends or your leave your job if working past 65 with credible insurance coverage
Key Dates
  • If you have Medicare and experience a Qualifying Event: Enrollment period lasts 2 months
  • If you delayed enrollment past 65 because you had credible coverage: Enrollment period lasts 8 months after you stop working or lose health insurance through your employer, whichever is first
  • For Medigap plans there may be other cases which qualify as special enrollment periods

  • To see a complete list of ways to qualify for a Special Enrollment Period, visit: Medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan/special-enrollment-periods

When Benefits Begin
  • Generally, changes are effective the first day of the month following the month you choose your plan, if you choose your plan between the 1st and 15th. If you wait until the 16th or later in the month, your plan will take effect the first day of the second following month.
Where and How You Can Enroll
  • Contact the Social Security Administration at www.ssa.gov or 1-800-MEDICARE.
Making Medicare Choices

If you qualify for an SEP, there are important choices for you to make about how you want to access your Medicare coverage. You have to choose whether you will get your coverage through Original Medicare (with or without a Medigap plan) or a Medicare Advantage plan. To learn more about these choices, visit the page Medicare, Medicaid, and Other Government Healthcare Programs.

Overview
  • If you miss your initial or a special enrollment period, you can also enroll in Medicare during the general enrollment period (GEP).
  • Unfortunately, if you enroll in Medicare coverage during a GEP after missing your initial or a special enrollment period, you may have to pay a late enrollment penalty for the rest of your life.
Key Dates
  • For Part A with a premium and Part B, the GEP lasts from January 1st to March 31st every year.
When Benefits Begin
  • Your coverage will take effect the 1st of the month after you enroll.
Where and How You Can Enroll
  • Enroll in Medicare by contacting the Social Security Administration at www.ssa.gov or 1-800-MEDICARE.
Making Medicare Choices

If you plan to enroll in Medicare during the GEP, there are important choices for you to make about how you want to access your Medicare coverage. You have to choose whether you will get your coverage through Original Medicare (with or without a Medigap plan) or a Medicare Advantage plan. To learn more about these choices, visit the page Medicare, Medicaid, and Other Government Healthcare Programs

Overview
  • During the Open Enrollment Period (OEP), you can check to make sure that your current Medicare coverage still works for you and compare your options.
  • You should consider your prescription drug costs, monthly premiums, network, and formulary when comparing plans.
  • Changes that you can make during the OEP, include:
    • Switching from Original Medicare to a Medicare Advantage plan.
    • Switching from a Medicare Advantage plan to Original Medicare; and add a Medicare Part D plan and/or Medigap plan (but you may face medical underwriting when applying for the Medigap plan).
    • Switching from one Medicare Advantage plan to another plan.
    • Switching from one Medicare Part D prescription drug plan to another plan.
    • Signing up for a Part D plan for the first time, but may have to pay late enrollment penalties.
Key Dates
  • The OEP runs from October 15th to December 7th, each year.
When Benefits Begin
  • Changes made to your coverage during the OEP will take effect January 1st of the new year.
Where and How You Can Enroll
  • Contact the Social Security Administration at www.ssa.gov or 1-800-MEDICARE.
Making Medicare Choices

When you are considering making changes to your Medicare coverage during the OEP, there are important choices for you to make about how you want to access your Medicare coverage. You have to choose whether you will get your coverage through Original Medicare (with or without a Medigap plan) or a Medicare Advantage plan. To learn more about these choices, visit the page Medicare, Medicaid, and Other Government Healthcare Programs.

TRICARE

Tricare is the U.S. military's health care program and functions as government-managed health insurance. There are two main types of TRICARE coverage, both with specific enrollment criteria:


  • Premium-based plans (TRICARE Reserve Select, TRICARE Retired Reserve, TRICARE Young Adult, and the Continued Health Care Benefit Program) which you can purchase at any time.
  • TRICARE Prime or TRICARE Select which you can only enroll in or change enrollment during Open Season or after a Qualifying Life Event.

Which specific enrollment period do you want to learn more about?

Overview
  • You can enroll in or change enrollment to TRICARE Prime or TRICARE Select after a TRICARE Qualifying Life Event (QLE) or during the annual fall TRICARE Open Season.
  • A QLE is a certain change in your life, such as marriage, birth of a child, or retirement from active duty, which may mean different TRICARE options are available to you.
  • A QLE opens a 90-day period for you to make eligible enrollment changes.
Eligibility
  • Uniformed Service members and their families
  • National Guard and Reserve members and their families
  • Survivors of deceased Uniform Service members
  • Former spouses
  • Medal of Honor recipients and their families
Key Dates

A QLE opens a 90-day period for you to make eligible enrollment changes.

Overview
  • Each fall, TRICARE Open Season lets you change your health care plan for the next calendar year.
  • TRICARE Open Season applies to you if you have or qualify for TRICARE Prime or TRICARE Select.
  • Open Season doesn’t apply to active duty service members.
Eligibility
  • Uniformed Service members and their families
  • National Guard and Reserve members and their families
  • Survivors of deceased Uniform Service members
  • Former spouses
  • Medal of Honor recipients and their families
When Changes Come Into Effect

Changes you make during this time start on January 1st of the next year.

VA

Overview

Department of Veterans Affairs offers a comprehensive Medical Benefits Package which includes preventative, primary and specialty care, as well as diagnostic, in-patient and out-patient care services.

Eligibility and Enrollment

You may be eligible for VA health care benefits if you served in the active military, naval, or air service and didn't receive a dishonorable discharge.

Indian Health Service

Overview

The Indian Health Service (IHS) is the health care system for federally recognized American Indian and Alaska Natives in the United States.

Where to get care
  • Comprehensive primary health care and disease prevention services are provided through a network of hospitals, clinics, and health stations on or near Indian reservations.
  • These facilities, which are managed by the IHS, Tribes, and Tribal organizations, are primarily located in rural and primary care settings.
  • In addition, the IHS contracts with Urban Indian organizations (UIOs) for health care services provided in some urban centers.
Eligibility and Enrollment

If you are eligible for IHS, you are not able to enroll online. Enrollment requires going to a facility in person, for example, the patient registration department at the facility where you want to receive care.

Disclaimer: The information on this site is intended for U.S. residents only and is provided purely for educational purposes. Health, legal, regulatory, insurance, or financial related-information provided here is not comprehensive and is not intended to provide individual guidance or replace discussions with a healthcare provider, attorney, or other experts. All decisions must be made with your advisers considering your unique situation. © Triage Cancer & Pfizer Inc. 2026

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