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Understanding Open Enrollment (Insurance)

The period when insurance companies allow people to make decisions regarding their plans such as add, drop, or change their coverage

Understanding Open Enrollment (Insurance)

Insurance is one of the most significant concerns Americans have about their health. How can someone enroll for health insurance? What kind of insurance can someone enroll in? What will be covered when someone enrolls?

Luckily, these questions can be answered when it comes to open enrollment. Open enrollment is when people can enroll in a health insurance plan for the following calendar year. When is it? How does it work? Those questions and more will be answered in this article.

When Does Open Enrollment Occur?

Open enrollment for health insurance occurs in the fall and winter– usually from early November to late January. Some states, however, have enrollment periods that start or end earlier than usual. For example, Rhode Island’s enrollment period typically starts from mid-October to late December.

During that period, people can enroll in a health insurance plan or make changes to said plan. Those who want coverage at the beginning of the year must select a plan by mid-December. Once someone is enrolled in a healthcare plan, they won’t have to enroll yearly.

Open enrollment usually lasts for around two-and-a-half months. Choosing a healthcare plan can be difficult, and healthcare isn’t cheap. Those under a tight budget need the time to find a plan to benefit them.

Some states mandate health insurance, like-

  • California
  • District of Columbia
  • Massachusetts
  • New Jersey
  • Rhode Island
  • Vermont

Those who live in those states can be fined for not having health insurance.

Open Enrollment Options

Specific health insurances, like Medicare or the Affordable Care Act (ACA), will have open enrollment periods via someone’s job. For ACA, there are five levels to choose from:

  • Bronze
  • Silver
  • Gold
  • Platinum
  • Catastrophic (only available for those under 30 years or those older than 30 with a hardship or affordability exemption)

Bronze and Silver are the most popular levels to choose from because they have the highest deductibles and copays, with 36% and 39% of people choosing them, respectively. However, these levels have the lowest premiums, while Platinum has the highest premiums and the lowest deductibles and copays.

According to the Kaiser Family Foundation, the average premium for ACA is $438 per month. Bronze is the lowest ($329 per month), while Gold has the highest ($462) between it, Bronze, and Silver ($428).

Though Platinum doesn’t show its average price, it does need the insurer to pay 90% of costs, with the policyholder paying 10%.

What Does Health Insurance Cover?

Health insurance covers-

 

  • Hospitalization
  • Emergency care
  • Lab tests
  • Outpatient care (includes chronic disease management)
  • Rehabilitation services
  • Preventive and wellness services
  • Pregnancy and newborn care
  • Child dental and vision care
  • Prescription drugs
  • Mental health and substance abuse services

Besides these services, some healthcare plans cover other benefits.

Tips for Open Enrollment

Open enrollment for healthcare requires proof of income, immigration information, citizenship, and documents on adoption. Once enrolled, these questions will help determine the best healthcare plan.

  • Which doctor/clinic is in network?
  • Which prescriptions are covered?
  • How much was spent on health insurance last year?
  • Are the premiums affordable?
  • Are flexibilities to see specialists or providers outside the network okay?
  • Are the out-of-pocket costs and deductibles affordable?

Those questions and more will help choose the best healthcare plan.

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