It’s that time of year again: open enrollment season is just around the corner, and you’re starting to wonder what’s different this year and whether you really need to keep your current health insurance plan. The good news is, you have options, and we’re here to help you understand them.
Mark Your Calendar
First things first, let’s look at when open enrollment is and how long it lasts. For 2025 coverage, the open enrollment period is November 1, 2024, through December 15, 2024. That’s about six weeks to make one of the most important financial decisions you’ll make for your family’s health and wellbeing. If you don’t enroll during open enrollment, you can generally only change your health insurance plan if you have a qualifying life event, such as marriage, the birth of a child, or losing other health coverage. Missing open enrollment means you’re typically stuck with your current coverage until next year.
Here’s a tip: don’t wait until the last minute to start shopping around. Insurance carriers often release their new plans to the market in early November, which means waiting until December to look at your options may severely limit your choices. Starting your health insurance search early gives you the best selection and more time to compare the different plans available.
Why Pay Attention?
We get it, health insurance can be complicated, and sometimes you just don’t want to think about it. But here’s why open enrollment is important: life happens. You might have gotten diagnosed with a chronic condition that requires regular treatment, or your favorite doctor may have dropped your insurance from her/his panel of accepted providers. Maybe your premiums just skyrocketed, and you’re wondering if there’s a better deal out there. Whatever the reason, open enrollment is your chance to make changes to your health insurance plan without penalty.
At Bowthorpe & Associate Insurance Producers, we work with families each year who could have saved thousands of dollars if they had just taken an hour to review their options during open enrollment. One common mistake is selecting a low premium plan with the intention of “saving money,” only to realize later that you know you’ll need surgery or regular prescriptions and would have been better off paying a bit more every month.
Know Your Plan Options
There are a variety of health insurance plans out there, and it can be overwhelming trying to figure out which one is right for you and your family. You’ve probably heard terms like HMO, PPO, and EPO thrown around, but what do they actually mean? Here’s a quick breakdown of your plan options.
The three main types of plans are HMO, PPO, and EPO.
- HMO plans generally have the lowest premiums but require you to choose a primary care doctor and get referrals before seeing specialists.
- PPO plans cost more but allow you to see any doctor or specialist without referrals or getting permission from your primary care physician. You can even get out of the network if you’re willing to pay a bit more.
- EPO plans work like PPOs but will not cover out-of-network care except in emergencies.
Don’t forget about high-deductible health plans paired with health savings accounts either. If you’re relatively healthy and want to save money on monthly premiums while building up tax-free savings for future medical expenses, these can be excellent options.
What to Look For When Comparing Plans
When it comes time to compare health insurance plans, there are a few key things you should keep in mind.
First, don’t just focus on the monthly premium when shopping for insurance. While it’s important to consider how much a plan will cost you every month, it’s only part of the picture. You also need to look at your deductible (how much you have to pay before insurance kicks in), copays for doctor visits and prescriptions, and the out-of-pocket maximum (the maximum amount you’d have to spend on covered services in a given year).
Most importantly, make sure your current doctors and preferred hospitals or clinics are in-network before you enroll in a plan. There’s nothing worse than choosing an insurance plan based on price and then finding out your longtime doctor doesn’t accept it! We’ve helped countless clients at Bowthorpe & Associate Insurance Producers avoid this problem by double-checking provider networks before enrolling.
Get Help If You Need It
Finally, if you’re feeling overwhelmed by all of this information or just prefer someone else to do the heavy lifting for you, that’s okay too! There are plenty of resources available to help you compare and enroll in health insurance plans, whether you want to do it all online yourself through HealthCare.gov or meet with an experienced insurance agent who can explain your options in person. Either way, working with knowledgeable professionals can ensure you understand exactly what you’re buying and don’t miss out on potential savings through subsidies or tax credits you may not have been aware of.
Think about how often you actually used your health insurance in the last year. How many times did you go to the doctor? What prescriptions do you take regularly? Did you have any surprise emergency room visits or hospital stays? This should give you an idea of what to expect for the upcoming year, which can help predict which plan type will ultimately save you the most money.
Conclusion
As you can see, open enrollment isn’t as scary or confusing as it may seem at first glance. It’s simply your annual opportunity to make sure your health coverage still makes sense for your life. If you start early and take the time to do your research (or ask for help if you need it), we promise it doesn’t have to be difficult. Open enrollment is one of those rare times when an insurance company wants you to change your policy and will go out of their way to make it easy for you to do so. Your future self will thank you when that unexpected medical bill comes in and your insurance actually covers it.
Frequently Asked Questions
When is open enrollment for health insurance?
Open enrollment for 2025 is November 1, 2024, through December 15, 2024. Coverage for most marketplace health insurance plans begins January 1, 2025, if you sign up by the deadline. Open enrollment is the time period each year when you can enroll in or change marketplace health insurance plans.
Can I change health insurance plans outside of open enrollment?
No, if you don’t qualify for a Special Enrollment Period. A qualifying life event like marriage, birth of a child, loss of other coverage, or moving to a new area can trigger a Special Enrollment Period that typically lasts 60 days from the event. Outside of those circumstances, you can only change plans during open enrollment.
What’s the difference between HMO and PPO health insurance?
HMO plans are lower cost but require you to choose a primary care physician and get referrals for specialists. PPO plans are more expensive but allow you to see any doctor or specialist without referrals and have more flexibility.
How can I find out if I qualify for financial assistance or subsidies?
If your income is between 100% and 400% of the federal poverty level, you may qualify for premium tax credits or other subsidies to reduce your health insurance costs. Use the HealthCare.gov calculators to estimate your eligibility based on income and household size.
Do health insurance plans cover pre-existing conditions?
Yes. The Affordable Care Act (ACA) prohibits insurance companies from refusing you coverage or charging you higher premiums because of pre-existing conditions. This applies to all plans offered in the Health Insurance Marketplace.
What if I don’t sign up for health insurance during open enrollment?
You will probably be uninsured until the next open enrollment period unless you qualify for a Special Enrollment Period due to a life change. The downside of being uninsured is you pay full price for medical care and may owe state tax penalties.