For many of us, it’s open enrollment time, a time that can create many questions and uncertainties. From reviewing existing coverage to signing up for an entirely new plan, there are many options, caveats, and add-ons to know about to ensure you’re making the right choice for your physical and mental health needs. Let’s take a look at what open enrollment means and what to keep in mind as you’re considering your plan.
First, What Is Open Enrollment?
Open enrollment is an established time period each year where you can sign up for, modify, or renew your healthcare plan to ensure you are covered for the next year. This is a key time to review current coverage and make any necessary changes before the deadline.
During open enrollment, you can:
- Learn the different types of plans, including HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), and HDHP (High-Deductible Health Plan)
- Enroll in a new medical plan, or renew existing coverage Enroll in or adjust contributions to an FSA (Flexible Spending Account) or HSA (Health Savings Account)
- Add or remove beneficiaries and dependents
When Does Open Enrollment Start?
Dates for open enrollment vary according to specific companies and their plans. Employer-sponsored plans, or those offered by your company as part of employment, typically take place once a year per the company’s benefits calendar. Individual marketplace plans, such as the Affordable Care Act, usually begin open enrollment in November or December, while Medicare enrollment runs from October 25th to December 7th.
Note that you may enroll in a healthcare plan outside of established dates if you meet certain qualifying life events. These include starting a new job, divorce, birth of a child, relocating, and other circumstances.
How Do I Prepare for Open Enrollment?
Human Resources departments are a valuable resource as individuals prepare for open enrollment, keeping you informed of important dates and plan information. If you are on an individual plan, preparation will require more of your own research, such as this helpful how-to guide on HealthCare.gov. Regardless, it’s important to ensure you understand the ins and outs of open enrollment so you make the best decision for yourself and your family.
To prepare, ask yourself the following questions:
- What plans are available to you?
- What do these plans cost per month and how do those costs fit within your budget?
- How much did you spend on healthcare needs last year? For example, annual visits, surgeries, one-time services vs. ongoing needs.
- Did you meet your deductible? Do you expect to meet it again next year?
- Is your preferred doctor or office in network? If not, are you willing to change providers – and find one suitable to your needs?
- Are any required medications covered?
- Does the plan offer mental health coverage, such as free or reduced therapy visits?
- If you are currently under the care of a mental health provider or clinic, are they in network?
- If you have a Limited Benefit Plan, does it include mental health benefits?
What Mental Health Options Should Be Considered?
Fortunately, mental health services are considered an essential health benefit under the Affordable Care Act. This means that behavioral and mental health services can be included in your plan, especially as mental health awareness continues to grow. These services may include:
- Inpatient or outpatient therapeutic care
- Psychiatric care
- Virtual therapy
- Virtual coaching
- Employee Assistance Program (EAP)
- Stress/anxiety-reduction apps
If you are interested in mental health support, consider what that may look like and what works for your lifestyle. Then, compare that to what each insurance plan offers so you can determine the appropriate level of care and coverage.
What if I Miss the Deadline for Open Enrollment?
First, don’t panic! There are options if you miss the deadline. To start, see if you have a qualifying life event that will allow for a special enrollment period. If not, investigate short-term healthcare options. These plans may not be as comprehensive or offer the same level of benefits but will allow you to address immediate and important health needs until the next open enrollment period.
If neither of these are an option, it may be beneficial to determine if you qualify for Medicaid or CHIP (Children’s Health Insurance Program).
What to Know – A Quick & Easy Open Enrollment Checklist
- Open Enrollment Dates: Open & End Dates
- Types of Plans Available: PPO, HMO, HDHP
- Costs per Month: Premiums, Deductibles, Copays, Out-of-Pocket Maximum
- Coverage: Preferred Providers, Offices, Hospitals
Where to Go for Additional Help
We hope this blog has helped address some uncertainties around open enrollment. Still have questions about any aspect of your healthcare plans? Reach out to your HR department or health plan representative for clarification on types of plans, costs, and coverage.
