There is a time each year, usually in the fall, when individuals can enroll in health insurance, make changes to their existing plan, or drop their coverage altogether. This time is known as the open enrollment period.
Open enrollment often lasts for little more than a month. If you miss this window of opportunity, you may not be able to change your coverage until the same time next year. There will be an open enrollment period if you obtain your health insurance from your employer, Medicare, or the Affordable Care Act (ACA) marketplace.
Make the Most of Open Enrollment
There are several approaches to take advantage of open enrollment. The first step is to determine your eligibility. Keep in mind that the open enrollment period for your insurance may vary depending on where and how you get your coverage.
The next step is to carefully evaluate your present health situation and your preferred approach to maintaining your health. Ask yourself the following questions:
- Do you have a primary care physician, or do you consult with any medical specialists?
- Which medications do you typically take?
- What diagnostic procedures, such as blood testing and imaging, do you require?
- Are you due for important preventative tests such as vaccines or cancer checks?
- Are you dealing with one or more chronic conditions?
- Do you expect to have any operations or procedures?
Once you have zeroed in on your specific needs, it's time to compare insurance policies. Find a policy that covers all you require for a monthly premium you can afford and that also fits your health care requirements for the future year. You may also consult a professional insurance expert to learn more about the available options. Many insurance companies also host in-person seminars, where they may explain policy details, and you can ask questions.
Remember the "4-Ds" (doctors, medications, diagnostics, and deductibles) while shopping for a plan. Make sure your deductible is affordable, your doctors are part of the network, your medications are covered, and you can access standard diagnostic procedures like blood testing and imaging. You should also think about vision, dental, and hearing insurance and if your plan included access to virtual care and telehealth services.
How It Relates to Your Employer
Open enrollment isn’t only about your options outside of your job. It’s important to research the group plan options your current employer may offer. Not only health insurance, but life insurance as well. Should you go from term life to perm? Is it time you get life insurance? If you’ve been thinking about obtaining life insurance, open enrollment is the time to make that decision.
Whether it’s through a group plan your employer may offer or seeking out a policy on your own, it may be a cost-effective alternative to your current plan. Perhaps your spouse’s new job offers better coverage for you and your growing family. You may have a hard time saving money for medical expenses on your own. HSA (Health Savings Account) plans are designed to help you save money with the expressed design to be used for medical expenses. In fact, any money saved to these accounts are done so tax-free, provided it’s used solely for medical expenses. The open enrollment period offers you the option and luxury to make these changes to benefit your family.
The same hold trues for Disability Insurance (DI). We never think about what could happen. We never like to plan for the unexpected. Health insurance is designed to protect your mental, emotional and physical health. Disability insurance is designed to protect your income in the event an injury or illness prevents you from performing your job. Many employers offer a basic coverage option during open enrollment, and it may behoove you to enroll. It’s also a good idea to seek out disability insurance through your own policy as well.
Navigating Open Enrollment for Various Health Insurance Plans
No matter what health insurance you have, it's essential to examine the whole scope of coverage rather than simply the premiums, like out-of-pocket maximum, deductibles, copays, and coinsurance, as well as the providers participating in the network. Here are some more suggestions to make the most of your health insurance open enrollment time.
Affordable Care Act (ACA)
If you enroll in an ACA Marketplace plan on November 1, make sure of the Advance Premium Tax Credit (APTC). Depending on your income, the APTC might lower your insurance cost. Check your alternatives throughout each open enrollment session because tax credits and subsidies may vary based on local health insurance regulations and plans. 90% of HealthCare.gov customers in 2021 received the APTC. In 2020 and 2021, the average APTC payment covered 85% of recipients' entire premium.
Initial open enrollment is when you can enroll in your workplace's health insurance plan, usually at the employer's discretion. Your workplace may provide a yearly open enrollment period when workers may switch plans, but not all do. Joining a low-premium and high-deductible plan may be smart if your company contributes to a health savings account.
Medicare's initial open enrollment period is seven months if you want to sign up for Medicare health coverage. It starts three months before your first Medicare eligibility, often when you turn 65, continues through the month you turn 65, and ends three months following. The yearly enrollment period for Medicare runs from October 15 to December 7. Learn more about Medicare. (LINK TO MEDICARE ARTICLE)
After open enrollment ends, the only time you can make changes to your coverage is during a special enrollment period that allows you to do so due to a qualifying life event such as a birth, marriage, adoption or foster care placement, loss of coverage, a move, a change in income, or the acquisition of U.S. citizenship. You have either 60 days before the event or 60 days after it has passed to enroll in a new plan.
However, suppose your provider dropped you from your previous health plan because you failed to pay the required premiums or decided to discontinue your coverage willingly. In that case, you will not be eligible for a special enrollment period.
As always, all this information should be discussed with a financial professional. Let them guide you through the facts and help you decide on what best suits you and your family. Open enrollment is designed to help you review your financial plan with regards to health insurance, disability insurance and much more. Who better to do this with than your financial advisor.