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Figuring out the puzzle of open enrollment

Always consult a veteran in the Health Insurance Industry!

If there is a date that you need to remember when thinking about taking care of your health, it’s ‘open enrollment’. It is a period of 2-3 months – typically starting in October--in which you purchase and/or make changes to your current health insurance or Medicare plan.

Aside from the fact that not having insurance can be VERY costly, it is also now against a law that may carry hefty fines if uninsured. You have probably heard stories where families literally lose everything due to the lack of health insurance. Keeping our health through a health insurance policy might seem expensive, but not as expensive as not having it! Peace of mind and health go hand in hand. Open enrollment is part of the must-have dates to keep in mind when discussing your health options.

How many ‘open enrollments’ are there?

There are a couple of dates to keep in mind:

  • For Medicare Advantage plans and Part D: Open Enrollment, also known as the annual open enrollment period: October 15 to December 7th.

  • Covered California, the California version of the Affordable Care Act (ACA) – November 1st to January 31st 2017.

But why only once a year?

Health insurance companies structure their insurance plans based on health risks and health cost negotiations. They need to structure their financial standing on a yearly basis to be able to estimate and cover any costs derived from our health issues, if any.

Why is Open Enrollment so Important?

The open enrollment period is crucial if you need to make changes to your health insurance policy. Did you get married this year? Did you have kids? Do you want additional coverage? Do you want to change your monthly premium? The time to make changes to your policy in NOW!

What should you know about open enrollment?

Open enrollment is an opportunity for you to change your health insurance policy according to your personal circumstances. “It is important to estimate how much coverage you need”, comments Susana Leon Krieger, a 20 year veteran in the insurance industry. “Purchasing health insurance is like a puzzle you try to put together based on your health and current financial situation: do I pay more a month, and get more coverage should anything happen? Or should I pay less of a premium but more out of pocket expenses should I have a medical problem?”

Open enrollment is extremely important for those who want to make changes to the current Medicare plan. You might want to take another look at the original Medicare’s supplement offerings in the ABC’s of Medicare here.

Summarizing, today we have the following choices:

If you are 65 or older, and are not covered by an employer health plan, you need to be enrolled in Medicare and if you choose to do so, purchase the supplement plans. “I highly recommend enrolling in the supplements Medicare offers. Remember that Medicare doesn’t fully cover hospital and physicians services”, comments Susana.

For those under 65, you need to have ‘creditable’ coverage in Cover California through your health insurance provider. Please take note of the fact that some insurance companies have pulled out from the Affordable Care Act – such as Aetna. In this case, you need to research which network of providers your doctor belongs to, or start the process of looking for a new doctor.

What happens if I miss ‘open enrollment’?

Don’t. Hefty penalties apply.

Since the guidelines are very strict, the law allows specific ‘qualifying events’ for individuals and families to enroll outside the open enrollment period. If you had a child and need to include him in a policy would be an excellent example of a qualifying event. Other exceptions are marriage, divorce, becoming a US citizen, moving out of state where your current insurance plan is not accepted, and changes in employer benefits.

Your insurance professional can help you strategize on how to get health insurance. There are so many alternatives out in the market that consulting with an insurance expert that KNOWS the 'ins and outs’ of health insurance is a must. “Don’t do it alone and always seek the help of a professional”, comments Krieger. “She will definitely point you in the right direction and help you determine a strategy based on YOUR health needs; sparing you of unnecessary headaches when trying to figure out this health insurance puzzle”.

Ready to start looking for alternatives? Contact me TODAY!

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