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The open enrollment checklist: 8 questions to ask before renewing your plan
It’s time to sign up for your health plan again. Here’s how you can prepare to do it right and maybe even save some money.
Having a health plan is an important tool for staying well. It can help you see the doctors you want. And it can help you get care and screenings that help you catch possible problems at their earliest stages. Plus, if you get really hurt or sick, you have some financial peace of mind. You know once you spend a certain amount, your plan will likely cover the rest.
But it’s also important to know that you can make changes to your plan. Maybe you have Affordable Care Act (ACA) insurance. That’s a type of plan you get through the government. Or maybe you turned 65 and signed up for Medicare Advantage, a Medicare plan you get through a private company. And if you have health coverage through your job, you may have some new options to consider for the upcoming year.
Another reason to make a change? Your life now may be different than it was last year. So you’ll want to be sure that your new plan fits your needs now. That’s exactly what open enrollment is for.
You can pick a new plan or make changes to an existing one. You could just sit back and let your plan renew itself. But you may be able to save money by checking out other options.
Here are eight questions you should ask before open enrollment.
Use your medical expense account to save on healthcare expenses, including at-home health tests. Look up eligible expenses now.
1. What is my deadline to pick a new health plan?
Picking a health plan isn’t something to leave until the last minute. Put the open enrollment dates on your calendar so you have plenty of time to prepare. Here are the dates you need to know:
- If you’re on an ACA plan, open enrollment runs from November 1 through January 15 in most states. Your new benefits start on either January 1 or February 1.
- If you’re on a Medicare plan, open enrollment runs from October 15 to December 7. Your new benefits start on January 1.
- If you’re on a plan through your employer, open enrollment can happen at different times during the year, although it often happens in the fall. January 1 is a common start date, though it may be different depending on your plan.
Read more about the different types of health plans that are available.
2. How has my current plan changed?
If you’re not sure what may be changing about your health plan, the company that runs your plan will let you know. Here’s how.
- Have an ACA (Affordable Care Act) plan or a plan through your job? You’ll get a summary of benefits and coverage when open enrollment starts.
- Have a Medicare plan? You’ll get your plan’s Annual Notice of Change in September.
Both documents show what your plans cover, what they don’t and how much you’ll pay for care.
It’s a good idea to hang on to these documents, says Caitlin Donovan, senior director of public relations for the National Patient Advocate Foundation. “Don’t assume your plan’s staying the same,” she says.
3. Can I afford the health care I need?
A lot of people pick health plans based on what they’ll pay each month (premium). But if you do that, you might be overlooking some important numbers. These could include1:
- Your deductible. This is how much you must spend before your insurance starts paying for care.
- Your coinsurance. That’s the percentage of health care costs you’ll have to pay for care after meeting your deductible.
- Your copayments (copays). These are fixed dollar amounts you’ll pay for health care after meeting your deductible.
- Your out-of-pocket maximum. This is the most you’d have to pay for covered services in one year. (Covered services are services that a health plan pays for.) It includes your deductible, coinsurance and copays. Monthly premiums aren’t included.
Donovan recommends thinking about those numbers as you’re looking at your plan. For example, maybe you don’t have enough cash to pay down a $5,000 deductible. So it might be a good idea to pick a plan with a lower one. Your monthly bill may be higher. But paying a little more each month may be easier than having to pay a lot at once.
4. Are my doctors in the plan’s network?
Health plans have networks or groups that include certain providers and health care facilities. If you stay in your plan’s network, your out-of-pocket costs will be less. For example, you might pay $25 to see an in-network doctor. You might have to pay $40 to see an out-of-network doctor. What you pay to see an out-of-network doctor could cost more than that, depending on your plan.
Donovan recommends checking your plan’s website to make sure the doctors you use are in their network. “You might want to double-check, though. Call the provider and ask if they’re going to be on the plan for the upcoming plan year,” she says.
Looking for personalized care close to home? Search for Optum providers and clinics near you now.
5. How do I get all my prescription drugs?
Your health plan will pick which prescription drugs you can get. They typically group drugs into different categories, called tiers. The lower the tier, the lower the cost. Also, you may need a special note from your doctor to get drugs in higher tiers.2 And you may have to try a cheaper drug before getting the one your doctor ordered. This is called step therapy.
Donovan says it’s important to check a plan’s drug list for the drugs you use. “The more conditions you have, the more of a pain this is going to be and the more time it’s going to take,” she says. But it’s definitely worth the effort. You want to know if the plan will cover your medications.
6. How can I tell how much care I’ll need next year?
Now is the time to think about how much you’ve spent on health care. Ask yourself: Which benefits will I need next year? Then decide which plan best meets your needs.
For example, if you know you need new eyeglasses, look for a plan that offers that benefit. Or maybe you need hearing aids. Find a plan that will pay or help pay for them.
Of course, no one knows how healthy they’ll be next year. And that’s exactly why it’s important to think about how much you’ll pay before your insurance kicks in. That’s why it’s important to check that out-of-pocket maximum. Do you have enough money to cover yourself?
“Always, always be ready for surprises,” Donovan says. “Nobody is going to get through five years without a health care surprise. That could be some tendinitis in your shoulder. Or it could be a cancer diagnosis. Whatever it is, you need a plan that’s going to at least give you that wiggle room.”
If you are on an employer plan, be sure to check out benefit accounts, which can help save you money throughout the year. Most of these accounts only let you sign up once a year.
There are accounts that can help save you money. They do this by letting you put pre-tax dollars aside for certain expenses. These accounts include:
- Health savings accounts (HSAs)
- Flexible spending accounts (FSAs)
- Dependent care FSAs
Some employers offer pre-tax programs to cover the costs of your work commute. Be sure to check out all the benefits available to you to help you save even more.
Optum also offers a calculator that can help you figure out how much to set aside. And Optum has a search tool to learn what you can use your HSA/FSA dollars on, depending on what kind of health account you have.
7. Where do I sign up for my health plan?
If you still need help understanding your health plan or where to sign up for it, help is on the way. Here are some great resources.
- Have a plan through your job? Talk with your human resources department.
- Have an ACA plan? You can get help through healthcare.gov.
8. Can I sign up for a health plan outside of open enrollment?
You might be able to, if you qualify for a Special Enrollment Period, or SEP. This gives you more time to join, usually 60 days, if you:
- Become a U.S. citizen
- Experience a death in your family household
- Get married or divorced
- Have a baby or adopt a child
- Lose your insurance
- Move to a new ZIP code or county
For a complete list of events that get you an SEP, go to healthcare.gov. Read more about SEPs.
You may also be able to make changes to your Medicare Advantage plan outside of open enrollment. This, too, is called an SEP but has different qualifications. Check medicare.gov for more information.3
Having the right health plan is important. So is doing your homework on what kind of care you’ll need every year. And if you do that, you may be able to save some money. Your wallet will thank you later.
- Healthcare.gov. 3 things to know before you pick a health insurance plan. Accessed July 21, 2022.
- Medicare.gov. Consider these 7 things when choosing coverage. Accessed July 21, 2022.
- Medicare.gov. Special circumstances (Special Enrollment Periods). Accessed July 25, 2022.
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