In the United States, most people sign up for health care plans during the annual Open Enrollment. Navigating health care plans can be confusing, so it’s important to be well-informed about your options – whether or not you intend to switch your plan.
Open Enrollment is a critical window that can affect you, and your family’s health care options for years to come. Looking at health care plans can bring up questions, especially before Open Enrollment. Going in prepared helps to ensure that you make the best choice for you and your family.
Here’s a comprehensive list of questions and answers to help you easily navigate Open Enrollment.
What exactly is Open Enrollment?
Open Enrollment is when individuals and families in the U.S. can sign up for insurance plans each year. During this period, you can look at and purchase a plan typically through the Health Insurance Marketplace or your employer.
When is the Open Enrollment period?
The Open Enrollment period can vary slightly depending on your employer. Your employer’s Open Enrollment dates are unique. Please contact your Benefits Administrator for more information on your enrollment period to ensure you sign up for coverage within your window.
Pro Tip: Mark these dates on your calendar so you don’t miss this critical window.
What changes can I make during Open Enrollment?
Open Enrollment is the time to evaluate your current and future health care needs and make any necessary changes. During this period, you can choose a new insurance company and plan to find one that best suits your changing health care needs.
You can also renew your health insurance, as well as add or remove dependents or spouses, and adjust your adult vision and dental coverage.
Do I always need to review my options?
It can be tempting to just stick with the plan you already have. It’s important to review your options each year, even if your budget or health care needs haven’t changed.
This is because many factors can affect the price and service offered by your insurance provider that are out of your control. Other factors that may impact your health care plan include states changing the prices of certain premiums or having new insurers enter the marketplace.
Reviewing your options is an important part of being proactive about your health and well-being.
Who needs to enroll during Open Enrollment?
Every person who is not a dependent should take part in Open Enrollment. That includes whether or not you want to make changes to your existing plan. Open Enrollment applies to you whether you’re purchasing insurance through the marketplace, Medicare, or your employer.
What terms do I need to know before Open Enrollment?
There are a lot of confusing terms in the world of health care. Here are some of the top ones you should know before Open Enrollment:
- Deductible: How much you must spend for covered health services before your insurance company pays anything (except free preventive services).
- Copay: A fixed amount of money that an individual is required to pay out-of-pocket for a specific health care service or medication, typically at the time of service.
- Coinsurance: A cost-sharing arrangement in health care where the insured individual is responsible for paying a percentage of the covered medical expenses, typically after meeting their deductible.
- Premium: Premium refers to the amount of money an individual or entity pays to an insurance company in exchange for insurance coverage. This is usually paid monthly or annually.
- Out-of-pocket maximum: The maximum amount an individual is required to pay for covered health care services during a specific period, usually a calendar year.
What happens if I miss the Open Enrollment period?
If you miss the Open Enrollment, your plan typically automatically renews for the next year. If your current plan is no longer available, you may be enrolled in a similar plan instead. If you don’t currently have a health care plan, you may miss your opportunity to enroll unless you meet certain requirements.
The restrictions around Open Enrollment can vary depending on the state, income level, and whether you are eligible for Medicare. Native Americans can enroll in a health plan at any time, without needing a qualifying event.
How do I compare the costs of different plans?
One of the most important factors to consider when choosing a plan is the cost compared to the benefits received. People often just look at the monthly premium, however, there’s much more that goes into the cost of your insurance.
Besides the premium, some other costs to consider are your deductible, copayments and coinsurance, out-of-pocket maximum, and your estimated health care needs for the year.
Will I receive new ID cards this year?
As technology evolves so will your health insurance! No, you will not be receiving your new insurance ID cards in the mail like you typically do. In 2025, all carrier ID cards will be digital.
You receive more information about your new digital ID cards during Open Enrollment. If you’d prefer a physical ID card, you can still request one from your plan carrier.
How should I prepare for Open Enrollment?
It’s almost Open Enrollment, and being prepared will make this process that much easier. Here a few more things to keep in mind as you prepare for Open Enrollment:
- Know how much health care you may need next year, including wiggle room for emergencies or the unexpected.
- See if your preferred providers and hospitals are within the network of the plans you’re looking at.
- Are you or your family expecting any changing medical needs in the next year such as pregnancy or surgery?
Once you have a good idea of your budget and health care needs, ask your employee benefits contact for more information on where and when to enroll. With all this information at your fingertips, you’ll be able to easily pick out the best plan for you and your family.
If you find this blog helpful in understanding health insurance and the open enrollment period, be sure to check out the other blogs in this series for more in-depth information here.
VEBA Resources
MyVEBA Portal: Easily view your current health plan information through the MyVEBA app or online portal. Download the app for Apple or Android, or visit the MyVEBA Portal for desktop access.
Benefit Contacts: For assistance with specific carrier benefits or issues, such as claims or coverage details, visit vebaonline.com/benefit-contacts to contact them directly.
Get Support: The VEBA Advocacy Team can help you review your health plan and discuss it with you in depth. Call 888-276-0250 or visit vebaonline.com/contact for assistance. For urgent requests, use the “Urgent” box on the contact form.
