It’s healthcare open enrollment season! As you prepare to select the right health insurance plan for you, there are a few things you should know before making that big decision.
Once you’re enrolled in a health plan, you’re committed to it for all of 2023, unless there’s a special qualifying event like a birth, adoption, or marriage.
Learn everything you need to know about when and where to enroll and understand the differences between health insurance plans and health expense accounts.
When Can You Enroll in a Health Insurance Plan?
Depending on how you obtain your healthcare coverage – whether it’s through your employer, your partner’s employer, an agent, or the marketplace – to enroll for health insurance during Annual Open Enrollment you need to:
- Connect with your/your significant other’s employer, an agent, or healthcare marketplace
- Select a 2023 health plan
- Complete your enrollment application
- Submit your enrollment application by the given deadline
If you miss the deadline, there are qualifying life events, such as having a baby or getting married, that will qualify you to enroll.
Here are some other events that will allow you to enroll after the annual enrollment deadline:
- You lose your health insurance due to a divorce or legal separation
- You will be getting married after the deadline
- You turn 26
- You lose your health insurance covered through your job
- You give birth or adopt a child
- You become a US citizen
- You move to another ZIP code, state, or country
- The holder of your current health plan dies and now you have no coverage
You can learn more about other qualifying life events that will allow you to enroll in a health plan after open enrollment ends at Healthcare.gov. Note that qualifying life events may differ for employer plans.
Which healthcare plan is right for me?
Understanding Your Healthcare Coverage Options
Some plans let you use any provider or healthcare facility, while others restrict who you can see or make you pay more if the provider isn’t a part of their network. There are pros and cons to each type of plan. It’s all about selecting the one that best meets your needs. Please note that healthcare plans cover primary and specialty medical care needs. Prescription, dental and vision care is usually covered under separate, individual plans.
HMO (Health Maintenance Organization)
This type of plan usually limits coverage to providers that are contracted with the HMO or are within the plan’s network. The plan usually does not cover out-of-network care except in the event of an emergency. These plans also require a referral from your primary care physician before seeing a specialist.
PPO (Preferred Provider Organization)
This type of plan may also encourage use of in-network providers and may have a smaller deductible, copay or coinsurance if providers in the plan’s network are utilized. Doctors, hospitals, and providers outside of the network can be seen without a referral for an additional cost. This type of plan typically has the highest monthly premium but often has a lower annual deductible, lower copayments and the most flexibility in choosing providers.
HDHP (High Deductible Health Plan)
This plan usually has the lowest monthly premium, but the tradeoff is a higher deductible than a traditional HMO or PPO plan. With a higher deductible, you pay more out-of-pocket initially before the insurance company will begin to cover costs. A high deductible health plan for 2023 is classified as a plan with a deductible of at least $1,500 for an individual or $3,000 for a family. An HDHP’s total yearly out-of-pocket expenses (including deductibles, copayments, and coinsurance) can’t be more than $7,500 for an individual or $15,000 for a family. (This limit doesn’t apply to out-of-network services.)
Understanding What Health Expense Accounts Might Be Available to You
Some people prefer to use a special account to cover their health expenses. If you prefer to have those funds separate, you can choose a medical expense account. That money will cover qualified health expenses such as copayments, deductibles, and prescriptions. Depending on the type of account, there will be different stipulations about what you can and can’t buy.
Here are 2 common health expense accounts:
Flexible Spending Account (FSA)
An FSA is a health expenses savings account set up through your employer to use towards out- of pocket medical expenses. A pre-set amount is deducted from each paycheck and saved in the account. Eligible health care expenses often include a co-pay, deductible payments and certain prescriptions and medical equipment.
Money in an FSA cannot be rolled over to be used the next year, so it is important only to save what you think you will actually need and use each year to avoid losing any un-used funds. Your employer will also set a limit on the amount each individual can put into an FSA each year.
Health Savings Account (HSA)
This type of savings account also allows you save money to use towards approved health expenses. Unlike an FSA, an HSA can only be used in conjunction with a HDHP (all other plans can utilize an FSA). HSAs are used by HDHP participants pay to for health expenses while working towards the annual deductible to help cover health costs as they occur, ranging from office visits, prescriptions, over-the-counter medicines, lab work and other types of diagnostic testing. Using these pre-taxed funds helps to reduce the overall cost of the plan for the patient. Unlike FSAs, unused HSA funds can be rolled over year over year and can even earn interest.
Picking Your Plan
Start by thinking about what medical services you will likely use in the upcoming year. You can try to estimate based on previous health needs or patterns. For example, if you have a chronic condition that requires you to visit a specialist every three months, you can safely estimate four specialty care visits. You may also want to factor in 1 – 2 sick visits per year if you are prone to colds or other seasonal illness. While it is next to impossible to predict exactly what health care you will need, estimating your needs is helpful to determine what each plan’s actual cost may be.
In general, plans with higher premiums pay more up-front costs. Plans with lower premiums (most often a HDHP) will initially cover less of your health care costs. If you don’t anticipate regular trips to the doctor and are not on routine medications, a lower premium plan may work for you. These plans will save you money each month with a lower premium, as long as you are prepared to have a higher annual deductible, which you will have to meet before insurance starts to cover costs when you do need care.
If you tend to be a frequent visitor at your physician’s office or need regular prescriptions, you may want to opt for the higher premium plans (PPO or HMO plans). These plans cost more per month but will cover more of your health care expenses when you receive care.
Understanding the different plans available is an important step towards managing the impact health care has on your wallet. Selecting a plan that best fits your needs by estimating the total anticipated cost of care and utilizing medical savings accounts to help pay for out-of- pocket medical expenses can help reduce the likelihood of being caught off guard by a large claim.
As always, it is important to remember, the plan you chose does NOT impact the quality of care you will receive at Duly Health and Care If you have additional questions specific to your policy, please contact your employer’s benefits department or your insurance carrier.
Once you enroll and your plan is active, schedule an appointment with one of our Duly Health and Care providers. We accept more than a dozen insurance providers, including Medicare.