Open enrollment is your opportunity to change your health insurance coverage.
For most types of health insurance, there are rules about when people can buy new coverage or change the coverage they already have. Open enrollment, on the other hand, is a period of a few weeks each year when anyone can change their coverage. If you have health insurance provided by your employer, they should provide information about your open enrollment period.
If you are a Medicare recipient, or have coverage through a state or federal Insurance Marketplace your open enrollment period is approaching soon. Read on to learn more.
Marketplace (Exchange) Open Enrollment
Open enrollment runs from Nov. 1 – Dec. 15
Marketplace or health insurance exchange open enrollment runs from Nov. 1 – Dec. 15. This is a shorter window than last year, allowing only six weeks to enroll, renew or change your coverage. Healthcare.gov offers a document check list and other resources to help you prepare. Click here.
Medicare Open Enrollment
Open enrollment runs from Oct. 15 – Dec. 7
The Medicare open enrollment period runs from October 15 – December 7. During this time you can join Medicare Advantage Plan or stand-alone prescription drug plan (PDP). You can also switch from a Medicare Advantage Plan to Original Medicare with or without a stand-alone Part D plan during this time. Medicare.gov offers a six-point guide to reviewing and selecting coverage, enrolling and finding help if you need it. Click here.
The following resources may be helpful as you explore your health insurance options:
- Medicare plan selection: www.Medicare.gov, 1-800-633-4227
- Marketplace plan options in your state: www.Healthcare.gov, 1-800-318-2596
- Caring Voice Coalition: One-on-one support to identify coverage that will meet your needs: www.caringvoice.org; (888) 267-1440
- The Medicare Rights Center can help people navigate the Medicare enrollment process: MedicareRights.org; 800-333-4114.
- PHA insurance resources: www.PHAssociation.org/Patients/Insurance, 301-565-3004 x749
Tips for choosing among your plan options
The tips below can help you gather the information you need to make an informed choice among your health insurance plan options.
- Use Medicare.gov (Medicare) or Healthcare.gov (Marketplace) to build a list of your plan options.
- List medications you take and medical care that you expect to need in the upcoming year including routine tests and hospitalization.
- Note whether the plan choices available to you include coverage for prescription drugs or if you will need to purchase that separately.
- Note the premium, or monthly cost, for each option.
- Find out if any of the options require you to pay a deductible, or initial amount, before coverage begins. If so, how much is the deductible?
- Next, review your list of anticipated medical needs and note whether they are covered. Are your PH medications included on the prescription formulary? Is there a limit on the number of nights in the hospital the plan will cover?
- Next, note how much of the cost of these items your plan will cover. For example, for each of your PH medications will you be charged a set dollar amount called a copay, or will you be responsible for a percent of the drug price, which is called a co-insurance?
- At this point, you may want to take a second look at the premium, or monthly cost for each plan option. Plans with more expensive premiums may cover more services or cover them at a higher rate, making them a better deal in the long run.
- Finally, double check the information on pharmacy network. Individuals with PH should pay special attention to pharmacy network, as it is critical that you be able to receive your medications through specific specialty pharmacies.