How To Navigate Open Enrollment

Tips and Insights to Make Open Enrollment Simple

Open enrollment is essentially your yearly checkup for your health insurance. Whether you get your coverage through work or buy it yourself, it’s that important time when you can switch things up or stick with what you’ve got. Let’s break down what you need to know.

Why is Open Enrollment Important?

Making the right benefit choices can significantly impact your financial well-being.

Cost-savings: Choosing the right plan can save you money on premiums and out-of-pocket expenses.

• Coverage needs: Your healthcare needs change over time. Ensure your coverage aligns with your current situation.
• Dependent coverage: If you have a family, make sure your dependents are properly covered.
• Avoiding gaps: Failing to enroll or make changes could result in coverage gaps.

When is Open Enrollment

2024 Open enrollment in the individual marketplace begins November 1st and ends January 15th. There are a few states that have different dates (CA, ID, MA, NJ, NY, RI, D.C.).

How to Prepare for Open Enrollment

To make the most of open enrollment, follow these steps:

Review Your Current Coverage: Assess your current plans to determine if they still meet your needs.

• Have your healthcare needs changed since you enrolled in your current plan?
• Has your budget or financial situation changed?
• Are there new plan options available that might be a better fit for you?

Understand Your Options: Consider factors like deductibles, co-pays, and network size when choosing a plan. Read each plan’s fine print to learn about their differences  and their coverage details.

Review Plan Types: Does your current plan (HMO, PPO, HDHP) still meet your needs for flexibility and cost?

• HMO (Health Maintenance Organization): Offers lower premiums in exchange for limited provider choices. Requires a primary care physician (PCP) referral for specialist visits.
  • Suitable candidates may include: a young, healthy individual with a limited budget who sees their doctor regularly for check-ups and prefers a streamlined healthcare experience.
• PPO (Preferred Provider Organization): Provides more flexibility with provider choices, both in-network and out-of-network, but typically has higher premiums.
  • A family with varied healthcare needs, including specialists for chronic conditions, who prefer to have the option to see providers outside their insurance network.
• HDHP (High Deductible Health Plan): Features lower premiums but a higher deductible before insurance kicks in. Often paired with a Health Savings Account (HSA*) for tax-advantaged savings.
  • Suitable candidates may include: a young, healthy professional with a high deductible plan and an HSA* to save for future healthcare costs.

Consider You & Your Family’s Needs by Estimating Healthcare Costs for the Upcoming Year

Routine care: Consider how often you visit doctors and specialists.

• Preventive care: Check if the plan covers wellness visits, screenings, and vaccinations.
• Chronic conditions: Evaluate coverage for medications, treatments, and specialist care.
• Dental care
• Vision care (Glasses/contacts)
• Mental Health Services: Therapy, medication
• Prescription Medication and over-the-counter medications
• Upcoming surgeries or hospitalizations
• Other costs
  • Premiums: Monthly cost of the plan.
  • Deductibles: Amount you pay out-of-pocket before insurance coverage begins.
  • Copays: Fixed amounts you pay for services.
  • Coinsurance: Percentage of costs you share after the deductible.
  • Out-of-pocket maximum: The most you’ll pay for covered services in a year.

Ask Questions: Don’t hesitate to contact your HR department or benefits provider for clarification. Be sure to utilize available resources like webinars or benefits counselors.

Common Benefits to Consider

While benefit packages vary, here are some common options in addition to typical health insurance:

• Dental Insurance: Covers dental care, such as cleanings, fillings, and orthodontics.
• Vision Insurance: Covers eye exams, glasses, and contact lenses.
• Life Insurance: Provides financial protection for beneficiaries in case of death.
  • Determine the appropriate amount of coverage based on your dependents’ needs and financial situation.
• Disability Insurance: Replaces a portion of your income if you become unable to work due to illness or injury.
• Flexible Spending Accounts (FSAs): Allow you to set aside pre-tax dollars for eligible medical and dependent care expenses.
  • Be mindful of the use-it-or-lose-it rule for FSAs and estimate your eligible expenses accordingly.

Navigating the Marketplace

If your employer doesn’t offer benefits, you’ll need to purchase health insurance on your own. The Affordable Care Act (ACA) created health insurance marketplaces where you can compare and enroll in plans.

• Understand your options: Explore different plans based on your budget and healthcare needs.
  • Tip: Consider factors like deductibles, co-pays, network size, and prescription drug coverage when comparing plans.
• Qualify for subsidies: You might be eligible for financial assistance to lower your premium costs.
  • Tip: Use the Marketplace website or contact your state’s health insurance assistance program to determine your eligibility.
• Timely enrollment: Be aware of open enrollment periods to avoid penalties.
  • Tip: Set reminders for open enrollment deadlines and enroll well in advance.
• Research providers: Ensure your preferred doctors and hospitals are in-network.
  • Tip: Use the Marketplace’s provider search tool to find in-network doctors and hospitals.

Tips for Making the Most of Open Enrollment

• Enroll Early: Avoid the last-minute rush and potential errors.
• Read the Fine Print: Understand the terms and conditions of each plan.
• Consider Long-Term Needs: Think about your future healthcare goals.
  • If you anticipate significant medical expenses (major surgeries, prescription medication, specialized treatments, etc), a PPO might be preferable to an HDHP.

Bottom line: Choosing the right health insurance is a big deal. It’s part of building a strong financial plan. Open enrollment is your yearly chance to make sure your plan still fits your life. By taking the time to compare options, you can save money and protect yourself.

*HSA (Health Savings Account): A tax-advantaged savings account used to pay for qualified medical expenses. Can only be used with an HDHP.