One of the questions that I’m most asked is “if I know I’m planning for a baby, and I want to make sure I have insurance for my child, how do I go about getting health insurance?” This is a handy guide we’ve created for those of you looking to get insurance during open enrollment this year.
Open enrollment is a term that literally means open season for you on health insurance plans, especially if you opt to self-insure instead of, or in addition to, an employment-related plan. Here are some things you need to know to navigate this sometimes dangerous journey.
What happens during open enrollment?
Both state and private health care providers reassess their rates and premiums, and change prices of healthcare packages based on new laws or medical trends. Open enrollment is the time when you can purchase health insurance, or make changes according to your needs or the changes in the insurance package prices. It only happens once a year.
What’s the difference between a PPO and an HMO?
If you are looking to enroll for the first time or change healthcare providers, this is a relevant question. An HMO, or Health Maintenance Organization, has an existing network of participating hospitals and health care providers. A health insurance plan with an HMO will require you to choose a primary care physician (also called a PCP), and see specialists only within that existing network. A PPO, or Preferred Provider Organization, provides coverage without requiring you to choose a PCP, or stay within an existing network. However, you’ll find that in comparing HMOs and PPOs, its flexibility usually requires a higher premium than that of an HMO.
When am I eligible for open enrollment?
If your company has more than 50 employees in total, they should offer an open enrollment period. If you or your family buy health insurance directly from companies or from Affordable Care Act (ACA) exchanges, they also automatically offer a period of open enrollment.
What happens if I miss open enrollment for health insurance?
If you have chosen to auto-renew your health insurance plan every year, it will simply renew itself; with possible changes in the premium or the plan depending on the law or the marketplace. Otherwise, you may actually lose coverage. Your HR may have additional options, or you may attempt to enroll in Medicaid or a short-term health insurance plan. To avoid the confusion, it’s best to enroll during open enrollment.
Is Open Enrollment for Medicare?
Medicare, government-backed health insurance for seniors aged 65 and older, has separate enrollment periods. The main enrollment period is called the annual enrollment period and lasts from October 15th to December 7th each year. If you’re interested in Medicare and want a private plan, you should start by researching the difference between Medigap and Medicare Advantage.
What are deductibles and how do they work?
Not knowing how deductibles work could be costly to you, especially if you are or want to be self-insured. A deductible is an amount you have to pay out when something happens that requires health insurance. It is your out-of-pocket cost before the plan kicks in and you start receiving benefits. On one hand, it usually gives you higher insurance limits. On the other hand, if you’ve misjudged your budget, it may be heavy on the pocket when something arises. Ask explicitly about your health insurance plans deductibles if you self-insure.
What is an out-of-pocket maximum?
This is also called the out-of-pocket limit, and it protects you from paying more than you choose to budget for your deductibles and sometimes co-insurance. Co-insurance means you pay for a percentage of certain health costs. You can only set or change this, along with any deductibles and agreements on co-insurance, during open enrollment.
What is telemedicine and how can I add it to my plan?
Telemedicine is the growing branch of healthcare that allows medical diagnoses and follow-ups to be done over the phone or on a video call. Talking to a telemedicine operator may help you determine whether or not to go to a healthcare institution, or to seek specialized help. It can also help you with follow-ups so you don’t need to return to the institution. You may ask your healthcare provider if this can be added to your coverage during open enrollment.
Can I get coverage for preventive care?
Preventive care usually includes screening and tests that help in early diagnosis. The earlier a condition is caught, the sooner it can be treated, and the less it costs in the long run. Make sure to ask your healthcare provider if preventive care is included in the coverage, and how you can avail of it if possible. Many times preventive care is included but not specifically pointed out, so this will help you know when you can have check-ups and screenings for free.
What is a qualifying life event?
Aside from open enrollment, there are times when you can apply for health insurance during special enrollment. Special enrollment opens when you experience a life change that affects your insurance or that of your family, called a qualifying life event. These include change or loss of employment, additions to the family through marriage or birth, age (turning 26), or change of address.
Who qualifies as my dependent?
Under your employee health coverage, your family members can be registered as long as you declare them. These include spouses, domestic partners (if the employer allows), and biological, adopted, or foster children until they are 26 years old. If allowed, they can be registered through special employment. Otherwise, it’s best to do all the registration you need to do during open enrollment.