Why Are Open Enrollment Deadlines So Important?
It’s your only chance each year to update your health plan
It’s your only chance each year to update your health plan
When fall arrives, many people start thinking about their health care needs for the next year. The open enrollment period for many organizations is held during the fall.
During open enrollment, you have the opportunity to review your health insurance plan options to decide which plan is best for you and your family.
“Open enrollment is essentially your one chance to make sure that you’re covered the way you want to be covered,” says Anil Keswani, MD, chief medical and operations officer, accountable care, at Scripps Health. “It’s when people make decisions on which insurance plan and coverage they want, and oftentimes this impacts the ability to select a specific physician, medical group or health system.”
Remember the open enrollment dates that apply to you. If you miss these dates, you will have to wait until the next open enrollment period unless you experience a major life event.
Types of open enrollment periods
Open enrollment periods vary depending on what kind of coverage you have. This can include employer-sponsored insurance, a marketplace plan or government programs like Medicare.
Open enrollment for employer-sponsored insurance often occurs between October and early December. Check with your Human Resources department for your exact dates.
The Covered California marketplace open enrollment period runs from Nov. 1 to Jan. 15. The Health Insurance Marketplace, established by the Affordable Care Act, helps users find affordable health insurance and financial assistance. In California, it is known as Covered California.
Medicare open enrollment starts on Oct. 15 and continues through Dec. 7.
Special enrollment periods
If you miss open enrollment, you may still qualify to sign up for or change your plan during a special enrollment period, but only if you experience a qualifying life event. These include:
- Getting married or divorced
- Having or adopting a child
- Losing health coverage (such as a job-based plan)
- Moving to a new area
- Death of a family member
Choosing the right plan: What to review
When it’s time to review your health plan or consider new options, cost and coverage are often top of mind.
Open enrollment is your chance to make sure your current plan still fits your needs — or to find one that offers better value, more flexibility or broader benefits for the year ahead.
Start by thinking about the type of care you may need in the coming year. If you’re planning to have a baby, manage a chronic condition or schedule surgery, you may want a plan with more comprehensive coverage.
As you compare options, take a close look at key features like:
- Coverage levels: What services are included and what’s not?
- Provider networks: Are your doctors, specialists and preferred hospitals in-network?
- Prescription drug coverage: Are your medications covered and how much will they cost?
- Premiums and out-of-pocket expenses: What will you pay each month and what could you owe when you receive care?
Don’t just look at premiums – Review all costs
Monthly premiums are just one part of the total cost of your health care. To get the full picture, be sure to review these key cost-related terms:
Copays: A set fee you pay when you visit a doctor or fill a prescription.
Coinsurance: The percentage of medical costs you pay after meeting your deductible.
Deductibles: The amount you pay out of pocket for covered services before your plan starts to share costs. Check if your deductible applies to preventive health and wellness services.
Prescription coverage: Helps reduce the cost of medications included in your plan’s formulary (approved list of covered drugs).
Out-of-pocket maximums: The most you’ll pay in a year for covered care.
HMO vs. PPO: What’s the difference?
When selecting a health plan during open enrollment, you’ll likely choose between a Health Maintenance Organization (HMO) plan and a Preferred Provider Organization (PPO) plan.
HMO plans typically cost less and require you to stay within a specific network of providers. You’ll need to choose a primary care doctor and get referrals to see specialists. Care outside the network is only covered in emergencies.
PPO plans offer more flexibility, with larger provider networks and the option to see specialists without a referral. You can go outside your network for care, but it usually costs more. PPOs often have higher premiums and deductibles.
Looking for quality health care in San Diego
When selecting a health plan, make sure your preferred doctors, hospitals and health systems are included — especially if you want care from a trusted name like Scripps.
“If someone’s picking a health plan, look for one that includes Scripps Health, an organization that has proven outcomes for quality, safety and patient experience,” says Dr. Keswani.
Don’t be afraid to change plans if another offers better support for your needs. Your main goal should be finding coverage that fits your personal health needs.
“Our health is probably our most important thing. People think cost is important, but health really matters. It’s important to take a little more time, do the homework and pick a health plan that’s important to you and that meets your needs,” Dr. Keswani says.
Act before the deadline
Knowing your open enrollment dates — and acting before they pass — ensures you’ll have the right health insurance in place for the year ahead. Don’t wait until it’s too late. Review your options, compare plans and choose coverage that supports your health and your life.