Every year that annoying notice comes. It’s open enrollment time. During this time, you can make choices about health insurance. You can compare deductibles, calculate premiums, check coverage, and read policies. Or you can do nothing, and your insurance will automatically renew. If you have employer-sponsored insurance, individual insurance, MNSure insurance, or Medicare, you need to decide.
This is the second in a series of articles on understanding health insurance. Click here for all of the articles.
What is open enrollment?
Open enrollment happens once each year. At this time, you can change insurance coverage. You might choose a different company. You might choose a different plan. You might change from individual to family coverage.
During the rest of the year, you keep the same insurance coverage. Open enrollment offers a limited time to make changes.
Who has open enrollment?
Medicare, Medicaid, MNSure, on-the-job insurance — different rules apply, depending on what kind of health care coverage you have. Here’s a basic explanation of the kinds of insurance. If you have one of the first three kinds of insurance, you have an open enrollment choice.
- Insurance through your employer — This is still the most common insurance. About 70 percent of Minnesotans under the age of 65 had employer-sponsored health insurance in 2011. Usually people with employer-sponsored health insurance pay part of the insurance cost.
- Private individual insurance — People who do not have employer-sponsored insurance may buy private insurance. They can buy directly from an insurance company. Or they can buy insurance through MNSure.
- Medicare — People who are 65 or older are covered by Medicare. They may choose Original Medicare or Medicare Advantage. They may also buy a Medicare prescription drug insurance policy. These are the most common Medicare decisions, but there are a few less common options, too.
- Medicaid and MinnesotaCare — If your income is low, you may qualify for Medicaid or MinnesotaCare.
When is open enrollment?
If you have health insurance through your employer, Open Enrollment is the time when you can change from one health plan to another. Check with your employer for the dates.
If you have health insurance through MNSure, the Open Enrollment time is November 15, 2014 to February 15, 2015. During this time, you can switch from one insurance plan to another.
If you have Medicare, the open enrollment time is October 15-December 7. At this time, you can switch from Medicare Advantage to Original Medicare or from Original Medicare to Medicare Advantage. You can drop or add Medicare drug coverage. You can change from one Medicare drug plan to another.
If you have Medicaid or MinnesotaCare, you can enroll at any time in the year.
What do you need to know?
Insurance policies are complicated. And they change every year. Some of the things you need to look for are:
- Coverage — What does your insurance plan cover?
- Premiums — How much will you pay each month?
- Deductibles, co-payment and co-insurance — What amount of medical costs will your insurance pay, and what part will you pay?
- Doctors, clinics and hospitals — Which health care providers will your insurance company pay for?
I’ll write more about each of these questions in October and November.
Exceptions to the rule
Open enrollment time is a time when anyone can change insurance plans. Under the Affordable Care Act, Special Enrollment lets you make changes when your life changes. If you get married (or divorced), have a baby, move to a new state, lose a job, this is a “qualifying life event.” If one of these events happens, you can get a Special Enrollment time to change insurance coverage. For details on Special Enrollment in Minnesota, go to the MNsure website
It’s tempting to ignore the open enrollment time and do nothing. If you do nothing, your insurance coverage through most plans (MNSure and most private and employer plans) will automatically renew. What’s the catch?
Premiums may go up, so you could pay more. Deductibles, co-pays and the rest of the terms could also change. If you get a subsidy through MNSure, that amount could change, too.
Bottom line: We all need to be vigilant health insurance consumers. Decision-making includes the cost of premiums, in-network and out-of-network providers, tiers of providers, tiers of drugs, co-insurance and more. I’ll cover these topics in several “explainer” articles about health insurance over the next couple of months.