Late fall traditionally marks Open Enrollment, the time when many of us need to select our health insurance plans for the new year.
This article was updated on October 1, 2019.
Whether you receive your health care coverage on your own through a place such as HealthCare.gov, through your employer, or even through Medicare, Open Enrollment is the time of year when you can enroll, reenroll, or make changes in your insurance plan for the coming year.
Selecting the best health insurance plan for your needs is the first step in good health for you and your family, but it can be confusing. Here are tips to help with your decisions.
Know when YOUR Open Enrollment is scheduled
Insurance on your own: If you buy your own insurance through HealthCare.gov or a licensed insurance agent, your Open Enrollment dates run from Nov. 1 to Dec. 15.
Insurance through your employer: In November, many employers inform their workforce of which health insurance options will be available for the next year and set a specific period in which employees must choose a plan. Not every employer does this during November, so check with your human resources department or manager for your workplace Open Enrollment window.
Medicare: If you are over age 65 or older and qualify, you may be eligible for Medicare. Open Enrollment runs from Oct. 15 to Dec. 7, when you can change your coverage or supplemental plan.
Please note that there is no limited enrollment period for those who qualify for Pennsylvania’s Medical Assistance Program, Medicaid, or Pennsylvania’s Children’s Health Insurance Program (CHIP). You can apply any time.
Balancing your health and your budget
You’ll need to consider what your health care needs will be in 2020 and what you can spend. This can be a time-consuming process because the plan that seems affordable on the surface might not adequately cover your health care needs, or its deductibles and copayments might be more than you can handle.
Keep these factors in mind when choosing:
- Are your favorite doctors and hospitals in the health plan’s provider network?
- Are the medications you take included in the plan’s prescription drug coverage?
- What are the costs you will have to pay for, such as premiums, deductibles, copays, and coinsurance?
Confused by some of that terminology? You can consult these short videos developed by the Pennsylvania Insurance Department to explain these items. To learn more about:
- How to choose a health insurance plan, watch this video
- Health care costs you should know, watch this video
- Provider networks, watch this video
- Prescription drug coverage, watch this video
Keep these considerations in mind as you weigh your options:
- What are your medical needs for the next year—are you preparing for a child? Will you require knee surgery?
- Are the medications, services, and providers you want covered by the plan?
- How often do you think you will use your insurance?
- How do you balance upfront costs, such as your premium, against what you pay at the time of care, such as deductibles and copays?
It’s worth spending the time and effort now to carefully select the health plan that will best protect your health and your financial security in the coming year.
If you need personal assistance applying for health insurance coverage or have more questions, there is help available close to home. These individuals are known by different names, depending on who provides the service and where they are located, but all can help you with your choices and application.
- Your Local Hospital—Your local hospital is taking an active role in helping individuals enroll in health insurance coverage. Contact your local hospital or find a hospital in your community through the online directory.
- In Person Help and Enrollment Events—You can find free, in-person assistance and enrollment events near you via Healthcare.gov or contact your local library
- Phone Assistance—You can call (800) 318-2596 (TTY: 1-855-889-4325), 24 hours-a-day, 7 days-a-week for assistance.
The Pennsylvania Department of Insurance—The department’s website has a lot of helpful information. If you still have questions, you can call the department’s Customer Service Line at (877) 881-6388 (TTY/TDD: 717-783-3898).