Open Enrollment is your once-a-year window to take a fresh look at your health coverage, review what you have, update your Marketplace application if anything in your household or income has changed, and choose the plan you want for the upcoming plan year. When renewal season arrives, most consumers renew in one of two ways: active renewals or passive renewals.
And here’s where it gets important: those two paths may sound similar, but they can lead to very different outcomes, what plan you end up with, what you pay each month, and how your subsidy is calculated.
At RevOne, we see how passive renewals can lead to premium surprises, coverage gaps, network changes, and unexpected bills—creating eligibility issues, claim delays, denials, and extra revenue cycle work for hospitals.
That’s why understanding active vs. passive renewals isn’t just “insurance knowledge”, it’s protection for patients and financial stability for providers.
What is a health insurance renewal?
A renewal is when a patient’s Marketplace health plan continues into the next plan year. That happens in one of two ways:
- Active renewal: the patient takes action and confirms their new-year enrollment.
- Passive renewal: the patient takes no action, and the Marketplace may auto-renew them (when possible).
Active renewal patients take control
What makes it “active.”
An active renewal happens when a patient takes action during Open Enrollment by doing at least one of these:
- Updating or reviewing their Marketplace application (income, household size, address, etc.)
- Actively selecting a plan for the upcoming plan year (including confirming the same plan)
The keyword is active: the patient is involved, reviewing, confirming, and submitting enrollment for the next plan year.
Picking the same plan can still be an active renewal
If a patient logs in during Open Enrollment and manually re-selects their current plan, it still counts as an active renewal, because they actively confirmed it.
Why active renewals are strongly encouraged
Active renewals reduce surprises and increase accuracy, both for the patient and for the systems that rely on correct coverage data.
1) Financial help gets re-checked
When a patient reviews their application, subsidy eligibility is re-determined for the new plan year. That means APTC (premium tax credits) and eligibility details are based on current information, not assumptions from last year.
2) Agent/broker info stays accurate (NPN carryover)
If a patient works with an agent/broker, the National Producer Number (NPN) connected to the most recent version of the patient’s application for the current plan year typically carries forward into the new plan year through an active renewal, helping keep that association accurate for the upcoming year.
3) The patient stays in control of the plan fit
Even if the patient loves their current plan, an active renewal is the moment to confirm it still works: network, prescriptions, benefits, and premium. It’s choosing intentionally instead of being auto-placed.
The active renewal flow: What it looks like in practice
An active renewal usually follows this path:
Step 1: Update/review the subsidy application
The patient reviews and updates their application details.
Step 2: Subsidy eligibility is re-determined
The Marketplace re-evaluates eligibility and subsidy amounts.
Step 3: Confirm selections for the upcoming plan year
The patient shops (or re-selects the same plan), confirms choices, and confirms APTC where applicable.
Step 4: Submit enrollment for the new plan year
The patient submits their enrollment to finalize coverage.
The order can be interchangeable
Some patients prefer to update the application first, then shop. Others start with shopping and finish the application afterward. Either route works; the key is completing both before submitting enrollment.
Can someone help with an active renewal?
Yes, with the patient’s consent.
With consent, an authorized agent/broker can assist with the active renewal process (assuming proper licensing in the patient’s state and applicable Marketplace certification requirements). This is often one of the best times to help because Open Enrollment is when patients can make meaningful updates and confirm they’re set up correctly for the new year.
Passive renewal
What makes it “passive”
A passive renewal happens when the patient:
- Does not update their subsidy application during Open Enrollment, and
- Does not make plan selection changes
In that case, the Marketplace (FFM) may auto-reenroll the patient into their current plan, or the closest equivalent plan if their current plan is no longer available.
Think of passive renewal as a safety net
Passive renewals exist to help patients maintain coverage even if they take no action. It’s a backstop designed to reduce coverage disruption.
Important caveat: passive renewal isn’t guaranteed
Passive renewal is not a promise. Sometimes it can’t happen due to plan availability, eligibility changes, or other renewal-season nuances.
How the “closest equivalent” plan happens
When a current plan isn’t available, the Marketplace may use plan crosswalk data submitted by the issuer to CMS to map the patient into a comparable option (when possible).
Active vs. passive renewal at a glance
| Feature | Active Renewal | Passive Renewal |
| Application updated/reviewed | Yes | No |
| Subsidy recalculated | Based on current info | Automatically (may not reflect changes) |
| Plan shopping/confirmation | Yes | No |
| Risk of surprises | Lower | Higher |
| Agent/partner support | Allowed with consent | Not involved |
Why this matters to hospitals and revenue cycle teams
When renewals aren’t reviewed, the problems often don’t show up until the new plan year, right when care resumes, and claims start flowing.
What active renewal helps prevent
- Coverage gaps that lead to self-pay balances
- Network shifts that trigger denials or higher patient responsibility
- Incorrect subsidy or plan status that causes billing confusion
- Eligibility mismatches that slow down claims and payments
The RevOne view: proactive renewals reduce coverage uncertainty
At RevOne, we believe proactive coverage decisions don’t just help patients avoid stress; they help hospitals protect revenue integrity. When patients actively renew, hospitals are more likely to see cleaner eligibility, fewer coverage surprises, and smoother claims, which lowers administrative burden and improves the patient financial experience.
Final takeaway
Passive renewal can keep patients insured.
Active renewal keeps patients in control.
Open Enrollment is the best chance for patients to confirm that their coverage still fits their life today, not last year’s. And when patients are informed and proactive, hospitals experience fewer coverage surprises, better billing accuracy, and stronger financial performance across the care continuum.
If you’d like help communicating this to your patient population or integrating coverage verification workflows into your revenue cycle, RevOne can help, because coverage clarity leads to revenue clarity.
FAQs
1) If I choose the same plan again, is it still an active renewal?
Yes. If you manually log in and re-select/confirm the plan during Open Enrollment, it counts as an active renewal.
2) What happens if I do nothing during Open Enrollment?
You may be passively renewed into your current plan or the closest equivalent (if available), but it isn’t guaranteed.
3) Why is active renewal better for avoiding billing surprises?
Because it encourages patients to update their information and confirm plan details, reducing the chance of subsidy mismatches, plan changes, or coverage gaps.
4) Can an agent/broker help with active renewal?
Yes, with the patient’s consent, and assuming proper licensing/certification requirements are met.
5) Why does passive renewal create extra work for hospitals?
Because plan changes and coverage issues often surface later, at check-in, during authorization, or when the first claim is denied, creating avoidable rework and patient confusion.