What Exactly is Open Enrollment?

If you work for someone else, there’s a good chance that you are, or soon will be, in the midst of Open Enrollment season for your benefit choices. This is the period when your employer allows you to adjust or newly enroll in your employee benefits, like health insurance.

It’s important to pay attention during this time, or you can sometimes be left with a plan that doesn’t fit your needs. For example, a couple of years ago, my husband’s employer switched the open enrollment dates from November to May, and they changed the type of plans as well, so if we didn’t take action, we would have been stuck with a plan that we didn’t want.

Here are some things that you’ll want to ask yourself or others during open enrollment:

Have my needs changed? For example, if you were in your early 20s, you may have still been on your parents’ health insurance, but once you turn 26, you are no longer eligible to do this, so you will probably want to sign up for your own coverage. Or, maybe you now have children that will have some dental needs, and you didn’t have dental insurance before, but now it makes sense to investigate that.

What is the difference in plans? Each year, the premiums usually change, but sometimes the amount of copayments and coinsurance* changes as well. Or, there might be a new type of plan offered. Employers are offering high-deductible plans more and more. This type of plan typically has lower premiums (money out of your paycheck) but you pay for most of your healthcare costs up to a certain amount, called the deductible. With a high-deductible plan, the deductible is just that—high, but the premiums are usually lower than a traditional health insurance plan. The minimum deductible for this type of plan is $1350 for an individual and $2700 for a family. If you are young, single, healthy, and rarely go to the doctor, this might be a good plan for you. However, if you are married with kids and/or have a recurring health condition, you may end up paying more with this type of plan, but not always. This is the kind of thing you’ll want to talk to your plan administrator or benefits specialist about.

*Jill-splain: coinsurance is the amount that the insurance company will pay. For example, if you have 80% coinsurance, then you will be responsible for 20% of all charges and the insurance company will pay the other 80%.

What does the change in providers mean? Sometimes, the health or other insurance provider will have changed completely, and now you may be looking at a plan that may not include your regular doctor. A few years ago, my husband’s dental insurance changed to a provider that almost no dentist took in our area. We ended up having to switch dentists to find one that accepted our insurance.  Or, you might have to declare a PCP-Primary Care Physician, have all your visits go through them, and obtain referrals from them to be able to see someone outside of that person. This is mostly true with HMO Plans.

If you do make changes, it’s important to also see how these changes will affect your take-home pay and budget. You may want to sign up for a Flexible Spending Account or Health Savings Account (only available if you have a high-deductible insurance plan) to help reduce your costs. In my next blog, I’ll talk about what these are.

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