It is that time of year again. Open enrollment is coming soon! That leaves a lot of people, though, with many questions including what is open enrollment and how does it impact you?
We’ve put together some helpful TIPS and To-Dos to help with commonly asked questions about open enrollment and how it impacts the care that you receive.
WHAT IS OPEN ENROLLMENT?
Open Enrollment is the time of year for most health insurance holders where we can explore other options. It means that we can shop around and make informed decisions about what health plan we want, the level of coverage, and who is covered.
WHEN IS OPEN ENROLLMENT?
Most open enrollments are set by specific employers. Plans governed by the state have their own set of enrollment dates. In Pennsylvania. it is November 1-January 15. Medicare open enrollment has already started with dates spanning from October 15-December 7. When in doubt, check with who manages your insurance plan.
WHY DOES OPEN ENROLLMENT MATTER?
Open Enrollment is the 1 time a year where most consumers can enroll in a health plan. We say most because there are exceptions if you have a Qualifying Life Event such as
- Losing your current coverage
- Getting married or divorced
- Having a baby
- Adopting a child
- Death in the family
- Moving outside of your plan’s service area
If you miss open enrollment and do not have a Qualifying Life Event, you have to wait to enroll during the next Open Enrollment period.
WHAT IF I LIKE THE PLAN I PRESENTLY HAVE
That depends. Sometimes you are able to stay in a plan pretty close to what you currently have. Unfortunately due to ever-changing health plan networks and the rising cost of health care, many times there are small changes to plans year over year. However, if your employer determines your health plan, these may change much more drastically. This may mean a change in your providers so always make sure to review what providers are in-network with your new plan options.
WHAT DOES OPEN ENROLLMENT MEAN FOR MY CURRENT PLAN?
Open enrollment means your current plan is coming to an end. Unfortunately, health insurance is a use it or lose it type situation. If you’ve met your deductible or out-of-pocket max, these benefits reset the 1st of the plan year. With many plans, if you have met these thresholds there is little to no cost for many procedures. Similarly, if you have an HSA or FSA, these too are "Use it or lose it" and the funds may no longer be accessible after December 31st.
IF I WANT TO GET AN ORAN APPLIANCE IN 2022, WHAT DO I NEED TO LOOK FOR IN A PLAN TO MAKE SURE I'M COVERED?
Oral appliance therapy is covered by many medical insurances. It is considered Durable Medical Equipment (DME). In most plans, if your plan covers DME it covers Oral Appliances.
If you have questions about your specific plan, you can either call member services for the plan prior to enrolling or give us a call after the beginning of the new year!