Since the beginning of the Affordable Care Act, the term Open Enrollment refers to the specific period of time each year when an individual can enroll in, or switch, their health insurance plan without the need to qualify for a special enrollment period. This is also when additional eligible members can be added to an existing plan.
Open enrollment only occurs once per year, so keeping an eye on the Open Enrollment deadlines is important in order to avoid losing coverage. This year the Open Enrollment window has been shortened and begins November 1st with a December 15th deadline.
We know that Open Enrollment can seem stressful and completely overwhelming — but it doesn’t need to be! One of the best things you can do to make the Open Enrollment process easier is to know the most frequently used terms:
- Coinsurance: Coinsurance is your share of the costs of a covered healthcare service calculated as a percent (for example, 20 percent) of the allowed amount for the service. You pay coinsurance plus any deductibles you still owe for a covered health service.
- Premium: A premium is the amount of money charged by an insurance company for coverage. The cost of premiums may be determined by several factors, including age, geographic area, tobacco use, and number of dependents.
- Copayment: A copayment, or copay, is a fixed amount you pay for a covered healthcare service, usually at the time of service. The amount can vary by the type of covered healthcare service.
- Deductible: A deductible is the amount you owe for healthcare services each year before the insurance company begins to pay.
- Out-of-pocket Maximum (OOPM): An out-of-pocket maximum is the most you should have to pay for your healthcare during a year, excluding the monthly premium. It protects you from very high medical expenses. After you reach the annual out-of-pocket maximum, your health insurance or plan begins to pay 100 percent of the allowed amount for covered healthcare services for the rest of the year. The deductible, coinsurance, copays and prescription drug copays are included in the out-of-pocket maximum.
- Preventive Care: Rather than waiting for a patient to become sick, preventive care aims to keep people healthy, or at least catch illnesses at their earliest and most treatable stages. Preventive care includes preventive services performed by providers, such as annual physicals or mammograms. Under the provisions of the Affordable Care Act (ACA), policies must cover various preventive services for men, women, and children without sharing the cost for these services through coinsurance, deductibles or copayments. Certain Preventive care services are subject to frequency limitations.
- Annual Limit and Lifetime Limit: In the past, health insurance carriers imposed Annual and Lifetime limits on the benefits you receive. You are no longer subject to these limitations and there is no maximum to the benefits you may receive.
Asking For Help
Our team of licensed Benefits Counselors are here to help! Schedule an appointment so you can get your questions answered —And don’t forget, Open Enrollment only runs through December 15th for the 2018 season!