The Most-Asked Questions About Open Enrollment — Answered!
Open Enrollment for 2021 health care benefits is here, and if you’re like most people you may have questions about the many options available to you. While it’s always been a good idea to spend some time going over all of your options, it’s more important than ever before to understand your options, as your choices can have a significant impact on the availability and affordability of your health care in the upcoming year.
Company-Sponsored Group Insurance Plans
If you’re eligible for coverage through your employer’s group plan, in most cases, you should talk to the benefits representative in your company’s HR department or reach out directly to your company’s insurance broker or insurance provider if you have questions about your plan options. Company-sponsored coverage packages vary greatly from company to company but be sure to find out what kinds of options are available to you, as your employer may pay for some or all of your health care premiums.
Personal Health Insurance Plans
If you are not employed or eligible for a company-sponsored group plan, you can enroll for personal health insurance coverage through the Open Marketplace made available by the Affordable Care Act. Even if your employer provides a group plan, you have the option to substitute or supplement this coverage with private health insurance from the Open Marketplace.
Important Dates to Remember
Important dates to remember when considering enrolling in private health coverage from the Open Marketplace for 2021:
November 1, 2020: Open Enrollment begins.
December 15, 2020: Open Enrollment ends. After December 15, you can still buy a health plan if you qualify for a Special Enrollment Period.
January 1, 2021: Coverage purchased during Open Enrollment begins.
Now that you have the big picture, let’s take a look at some common questions you may have regarding health care coverage in the upcoming year, whether you choose private insurance or employer-sponsored insurance.
What is “Open Enrollment”?
Open Enrollment refers to a specified period of time when you are given a chance to elect or make changes to your health care coverage for the coming year.
The open enrollment timeframe for your company’s employer-provided insurance plan may differ from the enrollment period for the Open Marketplace. Ask your HR benefits representative if you haven’t received information about your company’s enrollment period. Some companies will schedule employee meetings for HR and/or insurance representatives to answer questions before enrollment starts. Either way, you’ll want to allow plenty of time to gather information so you can make the most informed decisions when it’s enrollment time.
Whatever you do, don’t miss the enrollment deadline! Speak with your employer or HR representative to learn when your deadline is. Remember, if you are shopping in the Open Marketplace for your health insurance, the deadline is December 15.
What can I do to make sure I pick the best plan for my family and me?
First, you should always look at more than just costs. What may look like the lowest-priced plan, for example, may ultimately cost you more in terms of copays, higher drug costs or other fees. In particular, take time to compare premiums, deductibles, in- and out-of-network doctors and health systems, and other out-of-pocket costs before you make your decision.
You may also want to consider your prior health care history to determine the best plan for you. For example, if you or your family tend to see a doctor more often, you may want to pick a lower-deductible option. Conversely, if you’re rarely sick, a higher-deductible option may be the better choice.
Can I enroll in Marketplace insurance if I currently have Medicare? What if I already have job-based insurance?
If you have Medicare, unfortunately, you cannot switch to Marketplace insurance, supplement your coverage with a Marketplace plan or buy a Marketplace dental plan.
If you have employer-based coverage, you may be able to change to a Marketplace plan, but keep in mind that you probably won’t qualify for a premium tax credit or other savings. However, if you do not currently have employer-based insurance and enroll in a Marketplace plan only to get an offer of employer health insurance later in 2021, you can cancel your Marketplace plan.
Are there plans that can help me with mental health, stress or other personal issues?
Many employer-based insurance plans include coverage for mental health services, but you’ll want to check on the specific provisions of the policies available to you, as well as the potential out-of-pocket costs involved with care.
Many companies now offer or include coverage for programs that can help their employees navigate personal challenges that pop up in their daily lives. These include programs that help combat stress or provide counseling to help with sleep issues, among others.
All Marketplace health insurance plans include coverage for mental health and substance use disorder services. This includes behavioral health treatment such as counseling, psychotherapy or inpatient services.
How much will I pay toward my medical costs?
If you opt for employer-based coverage, your monthly premiums likely will be deducted — all or in part — from your paycheck. In some cases, employers contribute to the cost of their employees’ monthly premiums, but in other cases, employees pay the entire premium. If you’re unsure, take the time to speak with your HR benefits representative for clarification.
If you opt for a Marketplace plan, your monthly premiums will go directly to the insurance company of the plan you enrolled in, not the Marketplace. Many insurance companies who offer coverage in the Marketplace will provide an option to pay your premiums online, whereby they will deduct the cost of your premiums directly from your bank account or charge the premium to a debit or credit card. If your insurance company does not accept online payment, they will contact you with the next steps after enrollment.
What are my options for handling expenses not covered by insurance?
Both employer-based plans and Marketplace plans place the responsibility for paying most, if not all, uncovered health care expenses on the plan holder. But the good news is that many plans include options for you to set aside pre-tax funds to pay for those out-of-pocket costs.
Flexible Spending Accounts
One option is a flexible spending account (FSA), which allows you to use pre-tax wages — usually a monthly deduction — to pay for eligible health care expenses like prescription drugs or eyeglasses. It’s important to remember that FSAs typically are ‘use it or lose it’ funds, so you’ll want to carefully calculate your expected expenses for the next year so that you don’t leave unused funds in the account at the end of the year. Ask your HR department or insurance company for a worksheet to help you with your FSA deduction calculation.
Health Savings Accounts
Another option for paying out-of-pocket medical costs is a Health Savings Account (HSA), typically made available for people enrolled in high-deductible insurance plans. Much like a 401(k), HSA contributions are pre-tax and can grow and accumulate interest tax-free. Unlike FSA plans, funds left in an HSA at the end of the year can be rolled over to the next year and can be used for any future eligible medical expenses. In 2021, the limits on contributions to an HSA are $3,600 for individuals and $7,200 for families. Those over the age of 55 can also contribute an extra $1,000 per year to their HSA account.
How do I find out if my doctor or hospital participates in my health plan option? What if they do not?
Your HR representative, benefits broker or insurance company will provide you with a list of providers included in your plan. If your preferred providers are not included in the plans you’re considering, ask your HR representative if there’s an option to pay an additional premium to include non-network providers or explore the other plan options available to you.
What else should I consider when I’m making my health care decision?
Although it may seem obvious, it can sometimes be easy to forget to talk to your spouse about anticipated health care needs and expenses in the coming year. Without consulting your partner, you may neglect to fully consider the scope of your family health care needs. If your spouse is employed, also take a look at the options provided by his or her employer, being careful to compare coverages, premiums, deductibles and out-of-pocket expenses. Your spouse’s employer may provide better options than the ones you’re considering.
An investment of your time can make all the difference in making the best choices for your health. Before selecting your choices during open enrollment, arm yourself with all the knowledge you can gather. Use these questions as a guide to thinking about what you need to know, and spend time with your HR benefits representative. You’ll be healthier for it!