Open Enrollment: A Step-by-Step Guide to Finding Insurance Coverage for Eating Disorder Care
Note: As of the date of publication, we know that many are struggling with food and insurance costs, resulting — in part — from the government shutdown. If you need additional support during this time, please take a look at our website Resource Bank or reach out to our case management team.
Why Open Enrollment Matters
Each year, Open Enrollment creates one of the few opportunities to make choices that directly impact your ability to access care. Between November and January, millions of people across the U.S. have the chance to review, renew, or change their health insurance plans for the year ahead.
For those navigating an eating disorder, these few weeks may help reduce a few barriers to accessing care. The right insurance plan can mean access to treatment, stability, and support — while the wrong one can lead to lack of coverage, denials, delays, or greater financial barriers.
Despite clear evidence that eating disorders are among the deadliest mental health conditions, insurance coverage for treatment remains deeply inconsistent. Many plans cover behavioral health care, yet few provide comprehensive, specialized eating disorder care people need.
At Project HEAL, we believe everyone deserves access to equitable, evidence-based eating disorder care — regardless of background, identity, income, insurance type, or any systemic barriers placed in the way of healing. Understanding how Open Enrollment works is one of the ways to explore options and opportunities in a system that often feels stacked against you.
Step 1: Understand What Open Enrollment Is
Open Enrollment is the yearly window when you can sign up for, renew, or change your health insurance plan. Outside of this period, you usually can’t make changes unless you qualify for a Special Enrollment Period (SEP) due to a major life event.
Open Enrollment dates vary depending on your coverage type:
Private Employer Plans
Most employers set their Open Enrollment period between October and December for coverage starting January 1.
Check with your HR or benefits department to confirm dates and available plan options.
Insurance Marketplace Plans (ACA/Obamacare)
Federal Marketplace (HealthCare.gov): November 1 – January 15.
Some states with their own marketplaces may have slightly different timelines. You can learn how to locate your state’s insurance in our Insurance Resource Hub.
Marketplace plans come in “metal tiers” (Bronze, Silver, Gold, Platinum), which balance monthly premiums and out-of-pocket costs differently.
Government Plans
Medicare Annual Enrollment: October 15 – December 7
Medicare Advantage Open Enrollment: January 1 – March 31
Medicaid and CHIP: Open year-round for those who qualify based on income or other criteria
Special Enrollment Period (SEP)
If you miss Open Enrollment, you might still qualify for a Special Enrollment Period if you’ve had a qualifying life event, such as:
Losing employer coverage
Moving to a new state
Getting married or divorced
Having or adopting a child
Step 2: Learn About the Health Insurance Marketplace
The Affordable Care Act (ACA) created the Health Insurance Marketplace to make health coverage more affordable and accessible.
Through the Marketplace, you can:
Compare plans side-by-side
See if you qualify for financial assistance (subsidies or tax credits)
Enroll online via HealthCare.gov or your state’s marketplace
Every Marketplace plan must include mental health and substance use treatment as essential benefits — which means eating disorder treatment should be covered. However, coverage levels still vary, and many people face denials or restrictive criteria.
That’s where education and advocacy come in.
Project HEAL’s Insurance Resource Hub helps you:
Apply for Marketplace coverage
Understand your rights under parity laws
Identify ACA-compliant plans that best support eating disorder treatment
Report life changes that affect coverage
Step 3: Review and Compare Your Options
Before choosing or renewing a plan, it’s crucial to understand how each option covers eating disorder treatment.
✅ Check the Summary of Benefits and Coverage (SBC)
This document outlines deductibles, copays, and coverage for specific services. You can find it:
On your insurer’s website
Through your HR or benefits department
By calling Member Services (number on your insurance card)
✅ Ask the Right Questions
When comparing plans or talking with your insurer, ask:
Does this plan cover eating disorder–specific treatment (residential, PHP, IOP)?
Are therapy and nutrition sessions covered?
Are there out-of-network benefits if no eating disorder providers are in-network?
Can I request a Single Case Agreement (SCA) to see an eating disorder specialist?
What are the deductible, copay, and out-of-pocket maximums?
Advocacy Tip: A Single Case Agreement (SCA) allows you to see an out-of-network provider at in-network rates when specialized care isn’t available in-network — a critical tool for accessing eating disorder treatment.
Step 4: Know Your Rights Under Parity Laws
The Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act (ACA) protect your right to equal coverage for mental health care.
This means your insurance can’t impose stricter limits — like higher copays, fewer visits, or shorter lengths of stay — for eating disorder care than for physical health conditions.
If your claim is denied:
Ask your insurer what criteria (e.g., InterQual, MCG, or LOCUS) they used.
Request the denial letter in writing.
Work with your treatment team to gather clinical documentation that supports medical necessity.
File an appeal — many denials are overturned when challenged with evidence.
Project HEAL’s team has seen countless appeals succeed after persistence and advocacy — you don’t have to accept “no” as the final answer.
Step 5: Take Action — Enroll, Renew, or Update
Here’s how to stay organized:
Mark your calendar with your plan’s Open Enrollment dates.
Gather your current plan information, income documents, and provider list.
Compare plans carefully — especially behavioral health coverage.
Ask direct questions before enrolling.
Enroll or renew before the deadline to avoid coverage gaps.
Step 6: Get Support — You Don’t Have to Navigate This Alone
We know insurance is complicated — and when you’re also managing an eating disorder, it can feel impossible to navigate. You’re not alone.
Project HEAL offers free educational tools and resources to help you:
Understand your insurance options
Navigate the Marketplace or employer benefits
Appeal denied claims
Advocate for the care you deserve
Explore our Insurance Resource Hub for step-by-step guides, checklists, and advocacy templates
Final Thoughts
Health insurance shouldn’t determine who gets to heal — but too often, it does. Open Enrollment is your chance to make informed choices, ask hard questions, and help advocate your right to care.
Project HEAL exists to make sure no one is denied the treatment they deserve because of insurance barriers. Whether you’re just starting to explore coverage options or deep in an appeal process, we’re here to help you navigate the system — and fight for your right to healing.