For many, health insurance can confuse and frustrate, but it doesn’t have to. In fact, with a little prep work, open enrollment for health insurance can go off without a hitch.
To help you prepare for this year’s open enrollment period, Kristi Speers, Payer Account Program Director for Banner Health Network provided some helpful tips to get you through open enrollment with minimal confusion.
Open enrollment timeframe
Open enrollment, the specific time period you can sign up for health insurance, depends a lot on your employer and the plan type:
- If you get insurance through the Affordable Care Act with coverage starting January 1, 2021, you would need to sign up between November 1 and December 15, 2020.
- Medicare open enrollment starts on October 15 and ends on December 7, 2020, for coverage starting January 1, 2021. If you elect to join a Medicare Advantage plan, this is the time you can select a new plan or make changes to your existing plan.
- With health insurance offered by your employer, it will depend on the coverage start date and could happen during the middle of the year.
“The ACA and Medicare have open enrollment during the end of the year with effective dates starting on January 1st while employer-based open enrollment may occur at a different time and benefits may start mid-year,” Speers said.
Missing the open enrollment deadlineIf life gets in the way and you miss open enrollment, you’ll need to act quickly. For employer-offered insurance, you need to contact your human resources department immediately to discuss your options.
If you miss the ACA open enrollment deadline, you may still be able to get coverage through a special enrollment period, according to Speers. However, you will need to have a qualifying life event, such as a loss of health coverage, marriage, divorce, death, birth or adoption.
If you don’t qualify for the special enrollment period, you may want to find out if you can qualify for Medicaid. Or, you can see if your children qualify for a state-offered Children’s Health Insurance Program. Speers said you may also be able to buy a short-term medical insurance policy to cover you until the next open enrollment.
“There are other circumstances that may qualify you for a Special Enrollment Period, so it is important that you reach out within 60 days of the event,” Speers said.
Missing Medicare open enrollment is a little more forgiving—if you were already on a Medicare or Medicare Advantage plan. These plans will continue, but you must make sure you are aware of any benefit changes. Be sure to check with your plan for benefit information.
Preparing for open enrollment
Getting ready for open enrollment does take a little bit of legwork on your part. You should have some information handy to make getting through the process quicker.
It may be helpful to prepare lists with the following information:
- Primary care physicians, specialists and ancillary providers, (such as physical therapy, durable medical equipment, etc.) for you and your family.
- All health concerns and possible upcoming surgeries or treatment programs
- All prescription medications
You should have access to a Summary of Benefits sheet, which is an easy-to-understand document that provides an overview of your health insurance coverage. This document can help you make decisions about which plan to select. And, remember if at any point you have questions about open enrollment or insurance, contact your human resources department.
Other open enrollment considerations
Speers had other advice for people as open enrollment approaches. Among the things you need to consider include:
- PCPs and specialists may change, so make sure you confirm they participate in your plan
- If your company offers any type of flexible spending account, do your research and see how this option may help you save money.
- Be aware of the open enrollment timelines, so you don’t miss a critical date.
- Often, prevention and wellness services do not require any type of out-of-pocket contribution. These services are critical to maintaining optimal health.
- Life events, such as marriage, divorce or a birth or adoption of a child, allow you to make changes outside the open enrollment window. However, make sure you check with human resources to learn how much time you have to make changes.
“Employees need to evaluate their health insurance options by evaluating costs, benefits and the provider network,” Speers said.
The choice is yours. To learn more, check out these related articles:
- 7 Health Insurance Questions, Answered
- Get Smart About Health Insurance
- FSA Vs. HSA: How to Work Them to Your Advantage
Article updated October 30, 2020.