Health Insurance Open Enrollment Options

During Open Enrollment Choose the Best Health Plan Option for You & Your Family

Open Enrollment - During your company's open enrollment period choose the best health plan option for you and your family. SeanLocke/iStockphoto

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, and your employer's annual open enrollment period is your opportunity to make changes to your coverage.

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 your employer's health plan—or make changes to your existing coverage—for another 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. Typically, open enrollment happens near the end of the year, with all plan changes, enrollments, and coverage terminations effective January 1 of the coming year. But this is not always the case, so double check to be sure (note that the open enrollment period in the individual market begins on November 1 every year, and the open enrollment period for Medicare Advantage and Medicare Part D starts on October 15 every year, but employer-sponsored plans have different enrollment schedules).

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:

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 to have 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 fill out the paperwork to switch plans, 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. For that matter, it's important to check that your providers are still in-network even if you're opting to keep your current coverage, since providers can come and go from insurance networks at any time.

Five Things to Watch Out For During Open Enrollment

Employers are trying to save money, especially as the cost of healthcare continues its relentless climb. One way to do this is to reduce health insurance benefits (ie, higher deductibles, copays, and total out-of-pocket costs) and/or shift more of the premium costs to employees.

Make sure to carefully read your health plan materials, as you may find that your benefits and costs will change for the coming year.

  1. Check to see if your dependents – spouse, partner, and children – are covered. Under the ACA, all large employers (50 or more employees) are required to offer coverage to full-time employees and their dependents, but they are not required to offer coverage to spouses. Most employer-sponsored plans continue to be available to spouses, but surcharges apply in some cases, so be sure you understand how your employer's plan will cover your family members.
  2. Review any prior authorization requirements required by the plans. And if your employer's health plan is grandfathered, be aware of any pre-existing condition limitations on the plan. Under the Affordable Care Act (health reform legislation), employer-sponsored health plans cannot impose pre-existing condition waiting periods, but that provision does not apply to grandfathered plans. So if the plan is grandfathered and you've had a gap in coverage prior to enrolling, pay attention to the rules in terms of waiting periods for pre-existing conditions.
  3. If you take prescription medications, check them against the list of approved drugs (formulary) for the health plan (or plans, if there are multiple options) your employer offers. Also, if you take an expensive brand-name medication, find out the amount of the copayment or coinsurance for each medication on each available plan.
  4. 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. The ACA requires individual and small group plans to cover all of the essential health benefits, but that regulation does not apply to large group plans, so understand the limitations of the plan.
  5. 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 Effect of the Affordable Care Act on Your Benefits

Several additional provisions of the Affordable Care Act 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.
  • Lifetime limits on health insurance coverage are not allowed.
  • Annual benefit limits are also not allowed anymore, but this regulation does not apply to grandfathered plans. So if your employer's plan is grandfathered, check to see if it has annual benefit limits.
  • There are upper limits on the out-of-pocket maximum exposure that health plans can have, although these rules don't apply to grandfathered or grandmothered plans.

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 healthcare 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. 

But this generalization isn't always true—sometimes you'll come out ahead in terms of total costs by picking a lower-premium plan, despite the higher out-of-pocket costs, even if you end up having to meet the full out-of-pocket limit for the year. 

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 plans available on HealthCare.gov. If your employers is offering affordable health insurance that provides minimum value, you won't be eligible for premium subsidies (premium tax credits) in the exchange. But depending on the plan your employer offers, whether your employer covers part of the premium for family members, and how much health care you anticipate using, it's possible that a plan purchased in the individual market could present a better value, so it's worth your while to check.

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.

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