10 Essential Facts to Know During Open Enrollment

Link to Open Enrollment
The exact dates depend on that type of insurance coverage you have. Medicare open enrollment runs from October 15, 2022 through December 7, 2022 for coverage effective in 2023. Marketplace plans available through Healthcare.gov or state exchanges have varying enrollment dates. Group health plans sponsored by individual employers set their own open enrollment dates, yet they usually follow the same time frame as government and private plans.
During open enrollment, you can shop for health insurance and enroll in a health care plan that meets your needs. With hospital stays averaging around $35,000, getting the coverage you need during open enrollment is a smart move to protect your physical and financial well-being. Here are 10 essential facts you need to know about open enrollment so that you can make the most of your health insurance options.

 1. You Can Decline Employer Health Plans

If you already have health insurance that is paid for by an employer, it is time to review that plan. You should decide now if you will decline your employer’s health coverage and purchase your own through open enrollment. You may hear a lot about federal subsidies when purchasing through open enrollment, but they often don’t apply if your employer offers you certain minimum coverage plans and you decline. In other words, you are free to decline an employer-sponsored health plan, but doing so may make you ineligible for federal subsidies on open enrollment plans.

 2. CHDPs Usually Offer Less Than Employer-Funded Plans

CDHP stands for consumer-driven health plan and refers to the types of plans you can purchase through the healthcare marketplace. These plans usually have lower premiums, but higher deductibles than plans offered through employers. This may or may not be a good deal for you depending on whether your employer will couple a CDHP with an employer-funded health reimbursement arrangement (HRA). HRAs are like savings accounts, but you have to spend the money on health care. Look into the benefits of your employer’s HRA before deciding on a CDHP.

3. You Need to Do the Math

If your employer offers a health plan, then comparing it to a CDHP can be difficult. You need to redefine your employer’s plan in marketplace terms in order to be able to compare it to a CDHP. You may be able to get help from actuaries at your company when doing this. Your company may even have the math worked out for you already.

4. You Need to Reassess Your Health Care Needs

Before you even think about health insurance, you need to determine what level of care you and your dependents require. This can make it easier to rule certain plans in or out and can help you come up with acceptable price guidelines for the kind of coverage you need. Consider what you spent out of pocket on health care in the last year, the number of doctor visits you made, what you pay for prescription medications, and what you think your health needs will be over the coming year.

 5. There Are Risks for Not Having Health Insurance

You can’t afford to not have health insurance, not so much because it is a danger to your well-being (it is), but because the risks can be costly. Without health insurance you may get charged more for care that would otherwise be covered by your plan. This is because an insurance company will not be subsidizing your cost of care or negotiating lower rates on your behalf. Plus, if you are being charged out-of-pocket full price for your healthcare if you get really sick you may find that you’re quickly drowning in medical bills.

 6. Medicare versus Medicare Advantage

Medicare Advantage is a Medicare-approved health plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. Medicare Advantage plans may have lower out-of-pocket costs than original Medicare, and may offer extra benefits that original Medicare doesn’t cover. Keep reading about the difference here.

Medicare Advantage Plan Benefits with Meritage Medical Network include:

  • A yearly limit on out-of-pocket spending for covered services
  • Behavioral health care management
  • Nurse care management
  • Care coordination that includes helping you access resources such as transportation, meals, and DME services

 7. Plans Vary by State

Even though the Affordable Care Act is federal legislation, it allows states to set standards for health plans. While most states choose to go with the federal standards, not all do. Be careful when comparing plan benefits if your state has different standards than most others.

 8. Wellness Programs Can Be Valuable

Most employers offer wellness-promoting programs to their employees. These can range from biometric screenings to access to innovative software that can help with weight loss or smoking cessation. These wellness offerings may make a big difference in your long-term health, so don’t discount them.

 9. Supplemental Benefits Are Worth the Cost

Many employer-sponsored plans offer disability insurance that pays you money when you can’t work due to injury. These plans may also offer life insurance, retirement planning, and critical-illness coverage. These supplemental benefits may make slightly more expensive employer plans well worth the added cost.

 10. If You Miss Open Enrollment, You Have to Wait a Year

Now that you know some essential facts about open enrollment, don’t allow it to sneak up on you this year. Knowing about open enrollment allows you to better prepare to select the right type of coverage for you and your family. Of course, you’re not alone in this process; our experts here at Meritage Medical Network are prepared to answer any questions that you may have, from complex details regarding Medicare open enrollment to simple inquiries about whether or not a doctor is a member of our network. Click here to learn more about how to choose Meritage during open enrollment.

Link to Open Enrollment
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