An open enrollment period for health insurance is typically offered for one or two months a year by many companies to allow employees to make changes to their insurance coverage.
Although, you may be thinking about which candidate to vote for in the November elections, you should also pay close attention to changes in your health insurance benefit. Many companies offer several health plan options that may have different costs and benefits.
Open enrollment usually happens towards the end of each calendar year and in many companies is only held once and often for only one to two weeks. If you miss your company’s annual open enrollment, you may not be able to enroll in one of your employer-sponsored health plans until the following year.
Check with your company’s human resources department to find out when your open enrollment period begins and ends, and when your health insurance policy goes into effect.
Choosing a Health Plan During Open Enrollment
Make sure to look carefully at all your health plan options to decide what plan is the best fit for you and your family. Many people choose the plan that has the least impact on their paycheck – the plan with the lowest premium. However, that may not be the best option for you.
Invest some time and do your homework!
Your company should provide you with written materials that explain your benefits. Many employers offer benefit plan meetings where you can ask questions about your health plan options. If you do not understand your insurance options, ask for help – remember, once you make a decision, you may not be able to change plans until next year.
Understand basic health insurance terms
If you don’t understand the terms of your insurance it could cost you more during the coming year. Some important things to learn about are:
- What is the difference between a copayment and coinsurance?
- What is an annual deductible and how can it impact your monthly premiums and out-of-pocket expenses?
- What is a provider network and what happens if you use a doctor who is not in the network?
- What are the differences between PPOs and HMOs and which one is the best choice for you?
Examine your health care spending during the past year
Review the medical care and costs that your family used this year and think about changes in the healthcare services you may need in the coming year. For example, are you planning on having a child or was someone in the family recently diagnosed with a chronic illness such as diabetes?
Check to See if Your Healthcare Providers Still Accept Your Insurance
Before you sign an application to join a new health plan, confirm that your doctor, nurse practitioner, and hospital are part of the network for the health plan you are choosing. Depending on where you live, your providers may not be in the network if you are switching your insurance company or are switching to a different health plan.
Five Things to Watch Out For During Open Enrollment
Employers are trying to save money, especially during the current economic downturn. One way to do this is to reduce health insurance benefits and shift more of the premium costs to employees. Make sure to carefully read your health plan materials, you may find that your benefits and costs will change for the coming year.
- Check to see if your dependents – spouse, partner, and children – are covered. Some plans cover dependents, while other plans do not. Be sure to clarify about stepchildren.
- Review any pre-existing condition exclusions and prior authorization requirements required by the plans. Under the Affordable Care Act (health reform legislation), health plans cannot exclude coverage for pre-existing conditions for children under age 19. However, this does not go into effect for adults until 2014.
- If you take prescription medications, check them against the list of approved drugs (formulary) in each health plan booklet. Also, if you take an expensive brand-name medication, check the copayment that each plan requires.
- If you or any family member needs ongoing physical therapy or has a mental health problem that requires therapy, review what your health plan will and will not cover.
- Check to make sure that you and your family have adequate coverage for emergencies if you are traveling either in the U.S. or in a foreign country.
The Affordable Care Act – Your Benefits and Costs
Several of the provisions of the Affordable Care Act that took effect on September 23, 2010 impact group health insurance. These changes, which you should know about when choosing a health plan provided by your employer, include:
- You can keep your adult children on your health plan until they are age 26.
- Your health plan cannot exclude coverage for pre-existing conditions for children under age 19.
- Lifetime limits on health insurance coverage are not allowed.
- Limits on annual coverage amounts are being phased out.
Some Tips From Dr. Mike
Typically, if you pay a higher premium, your annual deductible and copayments will be lower. Therefore, you may want to consider a plan with higher premiums and lower out-of-pocket expenses if you anticipate using a lot of health care services throughout the coming year. And, if you are young and healthy and do not have any children, you may want to choose a plan with low premiums and higher out-of-pocket expenses.
Although, your employer-sponsored plan is most likely your least expensive option and offers better coverage, you may be able to opt out and shop around. Speak with a health insurance agent in your community or check out the online quote tool at eHealthInsurance.
If you want to learn more about the health plans being offered by your employer or if you are not satisfied with the answers to your questions during open enrollment, contact your state insurance department. Your state’s online information should include the number and types of complaints made about the health plans licensed in your state.