What Every Woman Should Know About Insurance Open Enrollment Before It Starts 

The fall is a busy time for many women, what with back-to-school preparations, Halloween and Thanksgiving festivities, and the disruptive end of daylight saving time. In the midst of all these seasonal events, it’s important not to overlook your health. Fall is also the time to review health coverage. 

For most insurance plans, Open Enrollment occurs between October and November. This is the time period when individuals and families can enroll in, renew, change, or cancel their health insurance. Missing this period may mean losing coverage. 

For women with specific health needs, coverage is essential. Navigating the world of health insurance, whether employer-sponsored, subsidized, or private, however, can be complicated.  

Before Open Enrollment begins, here are three key things you need to know:

To know WHEN you can enroll, you must first know WHAT you’re enrolling for. The first thing to determine is what type of insurance you qualify for. To do so, ask yourself the following: 

• Does my employer provide coverage? If so, you may qualify for employer-sponsored health insurance. WHEN: Open Enrollment varies from company to company. Most companies have designated time periods for employees to enroll and/or make changes. Contact your organization’s benefits manager for more information about yours. 
• Am I a senior and/or do I have a disability? If you are 65 or older and/or have a qualifying disability, you may be eligible for Medicare. WHEN: The Initial Enrollment Period for Medicare (i.e., when you can first apply) differs from individual to individual as it includes the three months before your 65th birthday, the month of your 65th birthday, and the three months after. After initial enrollment, the annual enrollment period to make changes is from October 15th to December 7th.
  
• Am I low-income? If your income falls below your state’s specific Medicaid limits (which differ from state to state), you may qualify for Medicaid. WHEN: Medicaid open enrollment is year-round. 
• What if I don’t have employer coverage and don’t qualify for Medicare or Medicaid? If this is the case, you may apply for insurance through the Affordable Care Act Marketplace. WHEN: Each state has their own “marketplace” and guidelines. Open enrollment is generally November 1st through January 15th. 

Now, what if I miss Open Enrollment altogether?

If you were unable to apply for health insurance during open enrollment, you may still apply outside of this time if you have a qualifying circumstance. This is known as a Special Enrollment Period. Qualifying circumstances can include losing previous health coverage, moving to a different state, and changes in household composition such as getting married, getting divorced, and/or having a baby. 

There are many costs associated with health insurance, the main ones being: 

• Premiums: What you pay each month to keep your insurance. 
• Copays: The fixed dollar amount you pay as your share for covered services. 
• Coinsurance: The percentage amount you pay as your share for covered services. 
• Deductible: What you pay BEFORE the plan begins to pay for covered services. 
• Out-of-pocket maximum: The most you can pay for covered services in a plan year. 

These figures are determined by the plan and subject to the plan’s terms; however, it is up to you to familiarize yourself with them. You must consider all these costs together (not just the monthly cost), and if there are any applicable subsidies to help you pay for them, when selecting the best plan for you.

Each type of health insurance has a plethora of plans to choose from, but not all plans are created equal. The plan that’s best for you is not always the cheapest or even the same plan you had the year prior. The plan that’s best for you is the plan that best meets your current medical needs. 

Consider: 

• How often do I visit doctors?
• How often do I visit specialists?
• Do I take medications regularly?
• Do I have dependents (children, spouse, etc.) who also need coverage?
• Do I have other special needs: fertility treatments, pregnancies, anticipated surgeries or procedures, or mental health needs?

The plan you choose should depend on the answers to these questions. If you are generally healthy and don’t require too many medical services, then yes, perhaps the plan with the lowest monthly premium is your best option. However, if you have frequent doctor visits, take regular medication, and anticipate other needs, then it likely makes more sense to choose a plan that has more coverage and lower out-of-pocket costs. 

For example, if you are planning a pregnancy, you may want to ensure your new plan covers OB-GYN visits, delivery, ultrasounds, labs, and newborn care, and has low copays/coinsurances for these services. These plans may not be the cheapest at face value, but they may end up being a lot more economical in the long run.

If you see specialists, then you may want a plan that doesn’t have complicated referral processes. And whether you require many medical services or few, keep in mind that most insurance plans offer preventive services, such as screenings, at no additional cost. It’s important to take advantage of these benefits and use them before the plan year ends to get ahead of any potential health risks. 

All of this information should be available for you to review before selecting a plan. Do your research, compare your options, and choose the coverage that best meets your needs for a healthy year ahead!