What to Consider When Looking for a Health Plan During Open Enrollment

Coverage,Choices for Care,Member Education,Open Enrollment

What to Consider When Looking for a Health Plan During Open Enrollment

11.11.2024 | 5 min read

Rick Notter is vice president, Individual Business U...

It’s important to be prepared when the annual Open Enrollment Periods (OEP) begin. The decisions made about health care coverage during this time will impact what percentage of medical costs a person and potentially their family pays out of pocket, as well as the type of health care coverage they receive for an entire year.

This set window of time allows an individual to enroll in various major medical health insurance plans or Affordable Care Act-compliant health insurance plans. It enables someone to sign up for health insurance, adjust their current plan, or cancel it.

Individuals can buy health insurance directly from a private insurance company or from the marketplace at healthcare.gov. Some employers offer health insurance to their employees as a part of their benefit package. If this is available, an individual’s human resources department may provide information about plan offerings available in 2025 and how to enroll or change selections.

When is open enrollment?

Here are important OEP dates to remember for 2024 going into 2025, per healthcare.gov:

Nov. 1: Open Enrollment starts. This is the first day an individual can enroll, renew or change health plans through the marketplace for the coming year. Coverage can start as soon as Jan. 1.
Dec. 15: This is the last day to enroll in or change plans for coverage to start Jan.1.
Jan. 1: Coverage starts for those who enroll in or change plans by Dec. 15 and pay their first premium.
Jan. 15: Open Enrollment ends, making this the last day to enroll in or change Marketplace health plans for the year. After this date, an individual can enroll in or change plans only if they qualify for a Special Enrollment Period.
Feb. 1: Coverage starts for those who enroll in or change plans Dec.16 through Jan. 15 and pay their first premium.

Preparing for open enrollment: A guide

It can be helpful to make a checklist of items to consider as one goes through the Open Enrollment process. Before enrolling, an individual should:

Review current coverage: Do this before exploring a new plan. Reviewing coverage includes scanning existing benefits and coverage terms. Life changes like getting married or having a baby will impact coverage requirements. By understanding a current plan, one can better evaluate whether it meets health care needs of years past or if an alternate route should be explored.

Evaluate costs and coverage: Premiums are the monthly bill we pay insurance companies, whether a medical service is used or not. Out-of-pocket costs, including a deductible, are paid when one gets care. It’s important to consider these costs, as well as copayments and coinsurance, to compare with the costs, types and amount of health services and prescription drugs one thinks they may need in the next year.

Assess health care needs: Consider current health status, potential upcoming medical expenses and preferred level of coverage. It’s possible for health care needs to change; for example, expecting an upcoming surgery or plans to seek mental health counseling. Figure out whether a comprehensive plan is needed, a plan should be selected to fill a coverage gap, or additional coverage for secondary health benefits like dental or vision care should be considered.

Compare plan options: Take the time to evaluate the health insurance plan and network types and how they differ. The common types of plans include:

Exclusive Provider Organization (EPO)
Health Maintenance Organization (HMO)
High Deductible Health Plan (HDHP)
Point of Service (POS)
Preferred Provider Organization (PPO)

Any or all of these plan types may be available at each “metal” level, which categories plans based on the level of benefits they offer: Bronze, Silver, Gold and Platinum. These metal categories, according to healthcare.gov, show how cost sharing will work. Consider how well each category aligns with specific healthcare needs and financial situations. Based on the plan selected, there is a tradeoff between monthly premiumcost and the amount of money paid when medical care is required. For example, a Bronze plan comes with the lowest monthly premium of the four options and highest out-of-pocket costs when receiving care. The Platinum plan comes with the highest monthly premium and the lowest out-of-pocket costs.

Consider Flexible Spending Accounts or Health Savings Accounts

OEP is also a time to determine whether a Flexible Spending Accounts (FSA) or Health Savings Accounts (HSA) is worth opening. FSAs allow employees to set aside pre-tax funds to cover eligible medical expenses like primary care provider (PCP) visits, prescriptions and medical supplies.

HSAs, meanwhile, are available to individuals with high-deductible health plans (HDHP) chances are you may have chosen to open a health savings account. An HSA is a personal savings account to set aside money for health care expenses today, tomorrow or in retirement. It’s a great way to manage costs for common or unexpected health care expenses and the money in it can be used to pay for health expenses for oneself and eligible dependents.

Rick Notter is vice president of individual business at Blue Cross Blue Shield of Michigan. For more health insurance tips and guidance, visit MIBlueDaily.com.

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