What Are the Different Types of Open Enrollment Periods?
Fall is time to make changes to health insurance plans
Fall is time to make changes to health insurance plans
When fall arrives, many people start thinking about their health care needs for the next year. The open enrollment period for many organizations is held during the fall.
During open enrollment, you have the opportunity to review your health insurance plan options to decide which plan is best for you and your family.
“Open enrollment is essentially your one chance to make sure that you’re covered the way you want to be covered,” says Anil Keswani, MD, chief medical and operations officer, accountable care, at Scripps Health. “It’s when people make decisions on which insurance plan and coverage they want, and oftentimes this impacts the ability to select a specific physician, medical group or health system.”
Remember the open enrollment dates that apply to you. If you miss these dates, you will have to wait until the next open enrollment period unless you experience a major life event.
Types of open enrollment periods
Open enrollment periods vary depending on what kind of coverage you have. This can include employer-sponsored insurance, a marketplace plan or government programs like Medicare.
Open enrollment for employer-sponsored insurance often occurs between October and early December.
The Covered California marketplace open enrollment period runs from Nov. 1 to Jan. 15. The Health Insurance Marketplace, established by the Affordable Care Act, helps users find affordable health insurance and financial assistance. In California, it is known as Covered California.
Medicare open enrollment starts on Oct. 15 and continues through Dec. 7.
Special enrollment periods
Open enrollment periods happen once a year, but if you experience a major life event (a qualifying life event), you may be eligible for a special enrollment period. This allows you to sign up for health coverage outside the regular open enrollment dates.
Qualifying events include getting married, having a baby, losing a job, moving, or experiencing a family member’s death.
Review benefits and costs
There are some things you should consider when reviewing your health plan for the year ahead. Cost and coverage are usually at the top of the list.
Each plan has different benefits, so pay attention to things like:
- Copays
- Coinsurance
- Deductibles
- Prescription coverage
- Out-of-pocket maximums
Look for quality care
It’s important to check which hospitals and medical groups are included in the plan you are reviewing. Look for a health system that is known for providing excellent care and service — like Scripps.
“If someone’s picking a health plan, look for one that includes Scripps Health, an organization that has proven outcomes for quality, safety and patient experience,” says Dr. Keswani.
Cost matters but remember your main goal is to get health coverage that fits your needs. Start by making a list of your health care needs for the coming year. Next, compare different health plans. Be prepared to change your plan or switch to a new one if needed.
“Our health is probably our most important thing. People think cost is important, but health really matters. It’s important to take a little more time, do the homework and pick a health plan that’s important to you and that meets your needs,” Dr. Keswani says.
Knowing when and how to enroll or change your plan helps you get the coverage you need. This way, you will have it when you need it.