The Ultimate Guide to Health Insurance Open Enrollment

Who Needs to Use Open Enrollment?

Simply put, everyone needs to use open enrollment for health insurance, as described above. It’s a means to protect insurance companies and individuals from being screwed.

 

The most common avenue of health insurance is through your job—it’s a common incentive employers use. If you don’t have coverage through a job, Medicare, CHIP, or other qualifying coverage, you are required to get coverage through the Marketplace, the health insurance exchanges I mentioned earlier.

Unsurprisingly, the health needs of you and your dependents may change from year to year. Compounded by changing financial health and lifestyle, we need a health insurance program tailored to our specific needs. Open enrollment is the annual opportunity to get a different type of plan that’s a better fit for you.

When Should I Enroll?

In order to meet the open enrollment deadline, it’s best to prepare beforehand.

First, figure out when your plan’s renewal period is. That’s the perfect time to conduct an audit of your current plan. When you figure out what is and isn’t working, you can then go ahead and calibrate so you’ll be ready for open enrollment.

 

During your renewal period, consider these questions:

  • Has your medical, dental, and/or vision plan changed? If so, is the change positive?
  • Have your employees’ needs changed? For example, do you have more families on your team? If that’s the case, what other benefits would help them out?
  • Is your team satisfied with your current offering? If you don’t know off the bat, an anonymous employee survey will help you get a sense of how people are feeling.

Open Enrollment Benefits

In order to comply with the Affordable Care Act, all health insurance plans must at a minimum satisfy the ten essential health benefits defined by the legislature. This mandate applies to all plans created after March 2010. Before then, less than two percent of plans provided all ten benefits.

If you believe you enrolled in a health insurance plan prior to 2010, it may have been grandfathered in. Unfortunately, many insurance companies have dropped these plans in order to comply with federal law. If this is the case for you, it is imperative you switch to plans that do provide this coverage on the exchanges.

The ten essential health benefits are:

  1. Preventive and wellness visits: Preventive care visits have no copay under Obamacare. This includes support for breastfeeding, contraception, and domestic violence screening.
  2. Maternity care: Considered preventive care, maternity, and newborn care is provided without cost.
  3. Mental and behavioral health treatment: This includes treatment for alcohol, drug, and other substance abuse.
  4. Services to help people with injuries, disabilities, or chronic conditions: The ACA requires coverage for equipment needed to treat chronic diseases.
  5. Lab tests.
  6. Pediatric Care: Dental and vision care is covered.
  7. Outpatient Care.
  8. Prescription Drugs: Plans must cover at least one drug in every category in the U.S. Pharmacopeia.
  9. Emergency Room Services: Obamacare plans don’t charge extra if you go to a hospital without pre-authorization.
  10. Hospitalization: Not all plans cover hospitalization, as costs can be incredibly hefty. A single day can cost between $2000 and $20,000.

In addition to the essential health benefits, all plans through the health insurance Marketplace cover pre-existing conditions and preventive services.

As a quick note, keep in mind that the above list has been written and edited for clarity to discuss a broad overview of the benefits one can expect when enrolling in an ACA compliant health insurance company.

In addition, not all insurance plans will offer the same degree of coverage. Obamacare allows each state to create a benchmark plan that all others plans will model, to make sure it is not too expensive for businesses to offer.

Before you apply for insurance, it’s critical you speak with trusted professionals who can ensure you fully understand what plan you decide to purchase.