Open Enrollment: Your Opportunity to Get The Health Insurance You Need

For Ali Baba and the Forty Thieves, it was the phrase: “Open Sesame” that parted the door for them. For the rest of us, there’s a convenient window for obtaining access to healthcare plans, making changes to existing ones, and exploring what is new in the health insurance market. It’s called Open Enrollment, and in Florida, it runs from Monday, November 1st, and continues through December 15th, 2021. These dates are usually firm, but the federal government may seek to extend the period this year.

What is Open Enrollment?

For those who get their health insurance through their employer, the provider sets specific enrollment periods during which they can sign up, modify, or cancel their insurance plans. For the rest of us, access is permitted each year during the Annual Enrollment Period, also known as AEP or Open Enrollment. It is usually scheduled for the autumn months so that new plans can activate at the start of the new calendar year.

This is generally the only time adjustments are possible, although there are some exceptions in the event of special circumstances, such as a Qualifying Life Event. In most cases, if you do not make any alterations to your existing plan during the Open Enrollment period, your plan will automatically be renewed in its present form.

What kind of health insurance can I get?

There’s a wide range of health insurance plans on the market, and the good news is that by law, you can’t be denied coverage because of a pre-existing condition.

Some available benefits include:

Preventive care
COVID-19 diagnostic tests
Emergency services
Prescription drugs
Maternity care
Mental health
Substance abuse services
Pediatric care

Learn more about the benefits that are covered by various plans here.

Is the Open Enrollment period the same for everyone?

A few types of health insurance determine their own enrollment periods, including employment-based health insurance as part of a group plan, Medicare, Medicaid, and the Affordable Care Act (ACA). Obtaining health insurance through these markets may involve different enrollment periods. Healthcare Savings Accounts need to be synchronized with the tax calendar, since they involve diverting pre-tax income into specialized accounts.

What happens if my needs change between Open Enrollment periods?

The exception to this rule is in the case of a Qualifying Life Event (QLE). This can be any common life event that changes your health or family profile, requiring you to alter your insurance plan. Most plans will allow you to make changes for 60 days from the date of the QLE. A Qualifying Life Event can include:

Loss of your health insurance (except for non-payment of premiums)
Loss of eligibility (Medicaid, Medicare or a Children’s Health Insurance Program)
Loss of health insurance through your parent’s plan when reaching the age of 26
Loss of employment-based coverage by resigning or being fired
Retirement of you or your spouse
Changes in your family through birth, adoption, death, marriage, divorce or legal separation
Changes in residence, especially to a different coverage area (state or county
Student moving to a different school
Employment-based relocation
Changes in income (could affect the coverage you qualify for)
Becoming a US citizen
Release from incarceration

What should I consider when shopping for a Health Insurance plan?

Your choice of a health plan is critical since you will be locked into it until the next Open Enrollment Period occurs. So be sure to take the time to explore your options and determine which coverage is best for you and your family.

Before you begin your search:

Go through your records of previous insurance plans so that you know your past premiums, deductibles and what you ended up spending out of pocket.
Was your coverage adequate for you and your family?
Were your favorite doctor, clinic and hospital in-network?
Were your medications adequately covered?
Decide if you would like to have coverage for other types of healthcare, such as dental, vision or life insurance.

What about Medicare and Medicaid?

Medicare features its own enrollment periods, notably from October 15th to December 7th. If you miss this period, there is short-term health insurance available to bridge the gap. For more on Medicare, visit https://www.medicare.gov

Medicaid is designed to allow people who have limited income and limited access to healthcare coverage. This includes low-income families, the elderly and people with disabilities. Where children are concerned, there’s a program called the Children’s Health Insurance Program (CHIP). There is no specific enrollment period for Medicaid. For more on Medicaid, visit: https://www.medicaid.gov

Individuals on both Medicaid and Medicare may be eligible for a Dual Special Needs Plan, or D-SNP. Again, there’s no specific enrollment period for this kind of plan. More on these dual Medicaid and Medicare plans here.

What kinds of health insurance plans are there?

Most providers offer these basic levels of health insurance plan:

Bronze:

These feature low monthly costs but usually have high deductibles or fewer cost-sharing benefits. This kind of plan is best for young and healthy individuals or anyone who doesn’t anticipate needing a high level of medical care.

Silver:

This is a sensible moderate plan that will usually offer the optimal balance of monthly premiums with the coverage it affords. It is the most popular plan among those who have an average level of medical needs.

Gold and Platinum:

These plans will be the most expensive options, but they offer low or no deductibles and copayments along with the widest array of benefits. These plans are designed for those who have significant medical needs that require a higher level of care.

What about starting my own Health Savings Account?

You can put away a part of your income into a pre-tax account to fund your healthcare needs, including deductibles, copayments, medications and even dental and vision care. These funds are not considered part of your taxable income if spent explicitly on healthcare needs.

More information on the tax ramifications of funds invested in healthcare plans here.

Learn more about enrolling in the health insurance plan that is best for you — contact Skylake of Hollywood, a full-service general lines insurance agency in the State of Florida. The friendly agents at Skylake will help you make informed, sensible and affordable decisions about your and your family’s healthcare insurance.

The SKY is the limit when your dreams are properly INSURED.