6 tips for navigating Open Enrollment
Every fall, businesses throughout our area offer an Open Enrollment period opportunities for their employees. It’s the one time of year when health insurance coverage can be adjusted without special circumstances or a qualifying life event. During this time, it’s very important to assess if you have the right coverage with the plan you have, or need to switch to one that can provide the benefits you need.
To make the most of your choices during Open Enrollment, you should take the time to understand what your options are and the steps you need to take to ensure you and your family are set up with the right care and coverage in the coming year.
Here are a few tips to help you understand the process as well as the options available to you:
- Ask questions. Talk to your Human Resources representative and find out when your Open Enrollment deadline is. Ask what changes have been made to your options, including benefit updates for health care plans and if there are increased or decreased costs to you.
- Compare, compare, compare! Look at the plan choices you are offered and compare the out-of-pocket costs; the deductibles; the coverage; and the in-network physicians.
- Prioritize. Determine what is most important to you. Your priority may be keeping your doctor, having access to a certain hospital, or keeping your costs low. Once you know your priorities, making your choices will be easier.
- Plan ahead. Many people choose a health insurance plan based on their current needs. However, it is important to plan ahead and try to anticipate what your family’s medical needs may be in the coming year. Elective surgeries, pregnancies, vision or dental needs can all have an impact on your health care choices. These considerations can affect which plan you choose (such as selectig a PPO or HMO), and also how much money you need to set aside in a flexible spending account (FSA), if that is an option for you. Also, if you take any prescription drugs, check to see if they are covered by the plan you are selecting.
- Consider life changes. A lot can happen in 12 months, so consider what will be happening in your life in the coming year before you make your health care choices. Are you getting married? Having a baby? Changing careers? Is your child moving out of your house and onto his or her own insurance coverage? All of these life changes can have an impact on what type of health insurance you need.
- Understand what you are signing up for. It can be overwhelming to figure out co-pays, deductibles and premiums—can seem like a different language. Take a moment to familiarize yourself with the terminology so that you can compare your choices appropriately. Time spent now can save you money down the road and ensure that the coverage you need is available to you.
Additional resources
Frequently asked questions
Open enrollment is a time of year when you can sign up for health insurance. The dates depend on your employer but are generally offered in the fall. Additionally, you may qualify to enroll if you have a qualifying life event, like losing coverage through your employer.
Dignity Health is not a health insurance company. Dignity Health is a provider network of more than 60,000 caregivers and staff who deliver excellent care to diverse communities in hospitals, physician offices, and other types of care centers in California, Arizona, and Nevada. Headquartered in San Francisco, Dignity Health is the fifth largest health system in the nation and the largest hospital provider in California.
It's a good idea to confirm your doctor and your hospital of choice are covered by your new insurance for the upcoming year by checking the insurance website or calling your insurance carrier directly. Do not assume your physician is covered without checking first. Doctors and hospitals may periodically change the insurance they accept.
The Health Insurance Marketplace (sometimes known as the Health Insurance Exchange) is a way Americans can compare and shop for health insurance. Some may even be able to get help paying for that insurance. In California, the exchange is Covered California.
To be eligible: You must live in the U.S. You must be a U.S. citizen or national, or a lawful resident. Even if you don't qualify because you are not a U.S. citizen, other members of your family might be eligible for coverage. There is no penalty for applying, and your information will not be used for any purpose other than determining if you and your family members qualify for health coverage. Also, health plans available through the Health Insurance Marketplace aren't the only new form of coverage available. Even if you cannot afford to purchase insurance through the exchanges, you may still qualify for free or low-cost coverage through Medicaid or the Children's Health Insurance Program (CHIP). Even now, many Americans who qualify for these programs are not currently enrolled.
You have many ways to apply: in person, over the phone, or online. If you would like assistance, the state and federal exchanges have certified enrollment assistance available both in person and over the phone. Assistance is available at no cost to you. You may apply directly online, and you can complete the application process at Covered California's website.
If you are getting insurance through your employer, please reach out to your HR representative for more information about your open enrollment period and plans they offer.
If you've enrolled into a Covered California plan, coverage will begin the first of each month as long as you have enrolled by the 15th of the previous month. If you enroll after the 15th of the month, coverage will begin on the first of the following month. For example, if you enroll for coverage on December 15, your coverage will go into effect on January 1. If you enroll for coverage on December 16, your coverage will go into effect February 1.
If you enroll in a plan through Covered California, you may be eligible for financial assistance. The amount of money you would have to pay each month depends on your income. The same application used to determine the coverage options you qualify for will also tell you how much financial help you can get.
Health insurance plans are sold in four primary levels of coverage: Bronze, Silver, Gold, and Platinum. They present a range of options. At one end is Bronze, with the lowest monthly premium, but with higher copays and deductibles when you need medical care. At the other end is Platinum, in which enrollees pay higher monthly premiums but pay less when they need medical care. You can choose the level of coverage that best meets your health needs and budget.
Whether you purchased coverage during open enrollment in the last year or two, or you began coverage due to a qualifying event in between open enrollment periods, it's a good idea to assess your coverage each year. The open enrollment period, which generally begins in November and runs through January, is the only time you can make a change unless you have a qualifying event, such as getting married, moving, or having a child. The health plan options available in your area can change each open enrollment. By taking the time to shop around, you may find a carrier or plan which will cost less each month or less when you access services.
Open Enrollment
If you have a doctor or group of doctors you have been seeing or would like to see, be sure they are in the health plan's network. Always be sure to verify with the insurance plan that your doctor is in-network.
Since health plan and network information may change, we recommend confirming your choice is available in your area by contacting the health plan's customer service number listed on its website.