When Is Open Enrollment For Health Insurance? – Forbes Advisor

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Health insurance is essential, no matter your age or stage of life. While there are a few exceptions, most health insurance plans require you to stick with them for an entire year. If you want to change your coverage or enroll in a new plan, you can do so during the annual open enrollment period. Here’s everything you need to know about open enrollment for health insurance.

What Is Open Enrollment?

“The open enrollment period is a select time each year when you can elect or change your health insurance plan option. However, the timing varies depending on the plan you’re enrolling in, ”said Anand Shukla, senior vice president of individual markets at Aetna, a CVS Health company.

For instance, the Medicare annual enrollment period runs from October 15 through December 7 each year. Meanwhile, the Affordable Care Act (ACA) Marketplace / Exchange open enrollment period begins on November 1.

“If you receive health insurance from your employer, the company likely has an annual enrollment period during which you can sign up or change your coverage. Be sure to confirm these dates with them, ”says Shukla.

How to Maximize Open Enrollment Periods

There are a number of ways you can make the most of open enrollment. First and foremost, know when you’re eligible. “Your open enrollment period depends on how and where you purchase insurance,” says Koleen Cavanaugh, vice president of marketing at Independence Blue Cross in Philadelphia.

Then, take the time to assess your health needs and lifestyle. To do so, Kyu Rhee, MD, Aetna’s senior vice president and chief medical officer, recommends answering the following questions:

  • Do you have a primary care physician or use any medical specialists?
  • What medications do you take?
  • What diagnostic tests, such as blood tests or imaging, do you need?
  • Are you due for key preventive screenings like vaccinations and cancer screenings?
  • Are you managing one or multiple chronic conditions?
  • Do you anticipate any surgeries or procedures?

Once you home in on what you’re looking for, shop around for coverage. Dylan H. Roby, associate professor of Health, Society and Behavior at the University of California, Irvine’s Program in Public Health, recommends looking for a plan that meets your needs for the upcoming year — regarding monthly premium prices and in terms of health needs.

“You can also speak with a local trusted broker or licensed insurance advisor to help you learn about the different plans available in your area. Many insurers also offer local seminars that offer insight on plans and allow for questions, ”says Shukla.

“When choosing a plan, take the 4 Ds — doctors, drugs, diagnostics and deductibles — into account. Ensure your doctors are in network, your drugs are covered, key diagnostic tests like blood tests and imaging are accessible, and your deductible meets your financial needs, ”says Dr. Rhee.

He adds that you should also consider vision, dental and hearing coverage. It’s ideal if your plan covers telehealth visits and virtual care as well. “Your health plan is your ticket to getting and staying healthy,” he says.

Managing Open Enrollment for Different Types of Health Insurance

Regardless of what health insurance plan you have, Roby suggests considering more than just premiums when weighing the details of a given plan. “The deductibles, copayments, coinsurance, out-of-pocket maximum and provider network are really important aspects as well,” he says.

Here are some additional tips to maximize your open enrollment period based on your health insurance plan.

ACA

If you decide on an ACA Marketplace plan, for which open enrollment begins on November 1, you should be aware of the Advance Premium Tax Credit (APTC). “Depending on your household income, you may qualify for the APTC that can significantly reduce the amount of premium you pay for insurance coverage,” says Shukla.

“It’s wise to check out your options during each open enrollment period because the tax credits and subsidies available to you may change due to changes in health insurance policies and plans being offered in your area,” adds Roby.

Nearly 90% of consumers in states that use HealthCare.gov for health insurance received the APTC in the 2021 open enrollment period. Among those who received the APTC, the average APTC amount covered 85% of their total premium during both the 2020 and 2021 open enrollment period.

Medicare

If you get your health insurance through Medicare, the initial open enrollment period spans seven months, according to Carrie Jardine, a revenue cycle manager at Heading Health, a mental health clinic in Austin, Texas. It begins three months before your initial eligibility with Medicare (generally when you turn 65), continues during your birthday month, and terminates three months afterward.

The Medicare annual enrollment period, however, runs from October 15 through December 7 each year. “During this time, you can choose to stay with the traditional Medicare plan or opt into a Medicare Advantage plan through a variety of commercial payers,” says Jardine.

Employer-Sponsored Insurance

“If you obtain health insurance through an employer, the initial open enrollment is the time period when you’re first eligible to enroll with your employer’s health insurance carrier and is generally determined by the individual employer’s discretion,” says Jardine.

Your employer may have an annual open enrollment period in which employees get the opportunity to choose a different plan, but this period is not a requirement for all companies.

“Joining a lower premium, high-deductible plan might make sense, especially if your employer is contributing money to a health savings account on your behalf,” says Roby.

Can I Make Changes Outside Open Enrollment?

After the open enrollment period is over, you can only make changes to your coverage options if you qualify for a special enrollment period because of a qualifying life event — a birth, marriage, adoption or foster care, loss of coverage, change of residence, change in income or becoming a US citizen. Depending on your situation, you may have 60 days before or 60 days after the event to enroll in a new plan.

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