Fall marks an especially exciting time for those of us that work in the healthcare industry: the open enrollment period! The end of another year offers people the perfect chance to plan for the future (or more specifically, the coming year), offering the opportunity to review their medical expenses from the previous 12 months and use that information to make informed decisions regarding their insurance needs going forward.
Wait a minute: that’s what the open enrollment is for? Like most, you may simply elect to remain enrolled in your current coverage year-after-year. You can certainly do that, but know that not taking this time to truly research your options could end up costing you. Thus, we’ve prepared a comprehensive guide to help get you ready for this year’s period, addressing important questions such as “What is open enrollment?” and “When does open enrollment take place?”. We will also explain important details regarding group health, private and Medicare open enrollment.
What is Open Enrollment?
Few truly understand what happens during open enrollment. Simply put, it’s the time of year reserved to make modifications to your health insurance plan, whether that be to enroll in coverage, modify your plan or switch carriers completely. Your employer may have scheduled a benefits fair to go over these details, or you may be noticing increased correspondence from your insurance provider in your mailbox. It’s all being done to help you know what your options are for the coming year.
When is 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.
Why This All Matters
Why should you care about open enrollment? According to the Internal Revenue Service, the individual mandate introduced by the Affordable Care Act is still in effect, which means you could have to pay a tax penalty if you don’t have healthcare coverage. Plus, planning accordingly during your private, group health plan or medical open enrollment period can help you stay in control of your healthcare costs in the coming year.
How, you ask? Take a look at your healthcare expenses from recent years. Use that information to answer the following questions:
How many times do you (or your family members) go to the doctor?
What types of problems are needing to be treated?
How much have you been spending out of your own pocket on healthcare?
Once you have that information, consider what life events you might be facing in the coming year. Are you expecting a baby? Do you need surgery? Do you have a family member that has a chronic condition? All of these are factors that will influence how often you’ll need to utilize your health insurance next year. Then, take a look at the plan options available to you. Add up the cost of premiums, the deductibles, and the out-of-pocket maximums. Those numbers will tell you the total costs of each plan.
The total cost of each plan is great information to have, but how does it help you control your healthcare spending? Knowing the total amount you’d have to pay before you reach a plan’s out-of-pocket maximum allows you to allocate added pre-tax funds to resources such as a health savings or flexible spending account. That money helps you afford care throughout the year without putting added strain on your household budget. Plus, your research will also show how providers offer added resources to help promote wellness and understand your rights as a policyholder, further helping you to manage the need and cost for care.
Things to Consider This Year
With the issues of explaining what and when is open enrollment now put to bed, here are a few things to consider as you head into this year’s period:
Employer plan open enrollment: High deductible plans are becoming more popular as employers attempt to expand cost sharing. The Kaiser Family Foundation reports that the average deductible for group health plans has risen over $1,200 in the last 10 years. If you don’t anticipate many visits to the doctor, a high-deductible plan can save you money through lower monthly premiums.
Medicare open enrollment: If you’re looking for added benefits you may want to consider switching to a Medicare Advantage plan. Consider your potential prescription costs, as well.
Care transitions: If you are hospitalized, it may be helpful to have a professional resource to assist once you are discharged. The impact of your illness as well as the medications and paperwork provided at discharge may seem overwhelming once you arrive home. Meritage offers an extra layer of care where our care transitions certified team nurses will meet you in the hospital prior to your discharge, schedule a home visit and meet with you at home soon after you leave the hospital. They are equipped with copies of all your documentation so that you can go over all your discharge paperwork in the comfort of your home and have all your instructions explained to you in order to provide the optimal opportunity to successfully recover from your illness.
Behavioral health liaison: If you suffer from depression or anxiety, Meritage offers access to resources and the expertise to navigate complicated insurance systems. Our Behavioral Health team of licensed clinicians can make sure that you get the help you need, quickly, appropriately and with complete confidentiality. We can provide assessment, triage and referral regardless of your insurance plan.
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
Now that you have better understanding of when is open enrollment is, don’t allow it to sneak up on you again this year. Knowing what is 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.