How to Avoid Gaps in Coverage During Open Enrollment Season
September 23, 2025

Open Enrollment season is just around the corner, running from October 15 to December 7 for Medicare and November 1 to January 15 for Marketplace/individual health plans (NYSOH in New York). This is the annual window when you can review, change, or enroll in health insurance and Medicare coverage.


But with deadlines, plan changes, and fine print to consider, many people unintentionally leave themselves exposed to gaps in coverage:  periods when they aren’t insured. These gaps can lead to unexpected costs, denied claims, and stress for you and your family.


Here’s how to make sure your coverage is seamless heading into 2026.


1. Know Your Enrollment Dates

Missing the open enrollment deadlines is the most common cause of coverage gaps. Mark your calendar for:


  • Medicare Open Enrollment: October 15 – December 7, 2025
  • Health Insurance Marketplace (NYSOH in NY): November 1, 2025 – January 15, 2026
  • Employer-Sponsored Benefits: Dates vary by employer


Tip: Don’t wait until the last week. Plans can take time to process, and waiting until December may mean your new coverage isn’t active on January 1.


2. Review Any Notices From Your Current Plan

Insurance companies often send letters in the fall about plan changes for the upcoming year. Some plans are discontinued, premiums may rise, or provider networks may shrink. If you ignore these notices, you could roll into a plan that doesn’t meet your needs, or worse, be left without coverage.


Check your mail and email for plan notices and share them with a licensed agent if you need help understanding the changes.


3. Don’t Assume Last Year’s Plan Is Still Best

Healthcare needs change year to year, and so do insurance options. Prescriptions, providers, or even your financial situation may mean another plan is a better fit. Sticking with last year’s plan without comparing options could result in higher costs or limited benefits.


Make a list of your current doctors, prescriptions, and expected healthcare needs for 2026. Use this to compare plans carefully.


4. Watch for Coverage Overlaps or Lapses

Switching from one plan to another? Be mindful of dates. Sometimes old coverage ends before new coverage begins, leaving a gap. Other times, both plans overlap, causing billing confusion.


Confirm your effective date for the new policy. For most enrollments completed by December 7 (Medicare) or December 15 (Marketplace), coverage will start January 1.


5. Get Help From a Licensed Professional

Navigating Medicare Advantage, Part D, Medigap, or Marketplace health plans can feel overwhelming. Working with a licensed agent can help ensure your coverage aligns with your needs, and that you won’t face any surprises when you need care.


Reach out to Simco’s licensed agents for one-on-one guidance. We’ll walk you through your options and help you avoid coverage gaps.


Final Thoughts

Avoiding gaps in coverage during open enrollment comes down to being proactive, reviewing your options, and enrolling on time. Don’t wait until the last minute. Give yourself the peace of mind that you and your family will be covered heading into 2026.


Simco’s licensed agents are here to help. Whether you’re reviewing Medicare plans, Marketplace options, or supplemental coverage, we’ll make sure you stay protected without interruption.


Contact us today to schedule your coverage review before open enrollment begins.

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