Open enrollment is a period of time that opens up once a year for individuals and families to either review or switch their health insurance plans, and is active now. Individuals who have employer-sponsored health insurance or Medicare may not be eligible for open enrollment – only those who have or are getting private or individual health insurance.
Open enrollment is important because you may change your health plan without answering any health questions. This allows you to be eligible for a health plan you may not be outside of the open enrollment period. Open enrollment could be a good time to review different health insurance options if your family is changing or growing.
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Individual vs. Family Health Plans
Both individual and family health plans are similar in that they have only one primary insured listed on the plan. However, family health plans have dependents listed under them and may receive the same care as the primary insured, if hospitalized.
For families, it may be more cost-effective to be on a health plan together instead of each family member having their own individual health plan. The average cost for an individual health plan is $7,739 per year and averages about $22,221 per year for family plans. If, for example, a family of 6 would have their own individual plans, it could be more costly.
There may be possible exceptions to a family member having their own individual plans, such as both parents having their own individual employer-sponsored plans. In this case, the children may only be listed as dependents on one or the other’s health plans. Continuing on, here are tips for those looking to enroll their family into a family health plan.
Remember Your Open Enrollment Dates
For the majority of states, the Open Enrollment Period runs from November 1 until January 15. Bear in mind, deadlines may be different in some states, so it may be important to check your state’s Open Enrollment deadlines.
If you enroll by December 15, your health coverage may begin immediately on January 1. For those who enroll after December 15, your health coverage may begin on February 1.
If you’re on an employer-sponsored health plan, dates to change or review your plan may vary by employer. You may contact your employer on when those dates are.
Is Health Insurance Mandatory for Families?
Health insurance is no longer mandatory, but it may still be a good idea to have, as it protects you and your family from unexpected medical costs. Having health insurance allows you to get free preventative care, such as annual checkups, medical screenings, and vaccines. Most importantly, health insurance may help financially with prescription drugs, pediatric care for those with young children, and hospitalization.
Determine What Type of Health Insurance Your Family Needs
To determine the type of health insurance policy your family needs, here are some factors to consider:
- Your and your family’s medical history: If a family member has a higher risk for diseases, you may have to consider how much health coverage your family needs.
- Anticipated health costs: The amount of your health coverage may affect your monthly health insurance premiums. When choosing how much coverage you’d like for you and your family, it may be important to keep your budget in mind.
- Preferred physicians: Before deciding on a health insurance plan, make sure your preferred physician is in-network. This may be important if you have young children, as you may have to pay more to see your physician if they’re out of network.
Common Health Insurance Types
PPO | HMO | EPO | POS | |
|---|---|---|---|---|
Primary care physician | No | Yes | No | Yes |
Out-of-network care | Yes, partially covered | No | Medical emergencies only | Yes, with limitations |
Pre-approval for medical services | Yes | Yes | Yes | Yes |
A health insurance network, also known as a provider network, is when a hospital, doctor, or other healthcare provider is in a contract with a health insurance company to provide care for its members. This allows you to have lower healthcare costs when you go to a doctor that’s in-network.
By law, insurance companies must cover certain preventative care services at no cost to you. Preventive care services include, but are not limited to:
- Annual check-ups
- Flu shots
- Mammograms
- Colonoscopy screenings
There are different types of health insurance plans that have different characteristics that suit different individuals and families. The plans are:
- Preferred Provider Organization (PPO): PPO plans are one of the most popular and common types of health insurance plan types. This plan allows you to see any doctor or specialist within your network without a referral. You may also go out of network for healthcare, but it may cost you more. Due to its flexibility, this plan may be more expensive than HMO and EPO plans.
- Health Maintenance Organization (HMO): HMO plans are one of the most popular and common types of health insurance plan types. They are less expensive than PPOs but require you to stay in-network and require a referral to see a specialist.
- Exclusive Provider Organization (EPO): EPO plans require individuals to stay in-network for care and may or may not require a referral for a specialist. Premiums may be higher than PPOs but lower than HMOs.
- Point-of-service (POS): POS plans may be more expensive than HMOs but this plan provides out-of-network care. Bear in mind, you may be paying more for in-network doctors with a POS plan. This plan may be beneficial for those who have a serious health condition and may need to see multiple doctors that are out-of-network.
- High-deductible Plans: High-deductible health plans have low premiums but have high out-of-pocket costs. High-deductible plans are commonly found in employer-sponsored health plans that are paired with a Health Savings Account (HSA) to help with your deductibles. This plan may be beneficial for those who are on a tight budget but may still need health insurance.
Look at the Health Insurance Marketplace to Shop For Different Insurers and Plans
You may choose to get your health insurance through ACA-approved plans for families, your employer, or your spouse’s employer, or if you are eligible, Medicaid.
There may be more health insurance options to choose from by finding ACA-approved plans on the Health Insurance Marketplace. The Health Insurance Marketplace, also known as the “marketplace” or “exchange”, is a place (online and in-person) for individuals to purchase private health insurance for themselves and their families. The marketplace may offer income-based subsidies to make an individual’s health coverage more affordable. In the marketplace, you may compare plans with various health insurance companies to see which is the most suitable and affordable for you and your family.
When enrolling, you may choose a metal tier level from bronze, silver, gold, or platinum.
- Bronze: Low monthly premiums with high deductibles and cost of care.
- Silver: Moderate monthly premiums with moderate deductibles and cost of care.
- Gold: High monthly premiums with low deductibles and cost of care.
- Platinum: Highest monthly premiums with low deductibles and cost of care.
Note, when searching for a new plan on the health insurance marketplace, you may exclude plans that do not include your preferred healthcare providers.
After seeing a plan that interests you, you may get a health insurance quote from them. Generally, you may click on the plan and apply for a quote directly from the website. Should you sign up, the quote may provide you with the premiums, deductibles, copays, and your out-of-pocket maximum for the new year. Bear in mind, a quote is not a guarantee of the exact prices and numbers. After signing up, the health underwriters may contact you if there are any changes to your plan.
What to Compare
When comparing different health insurance plans, while it is important, premium costs should not be the only factor in your decision.
You may have to consider how big your health insurance network size is and if the doctors and specialists are easy to access. If you like your physician now, you may have to make sure that your physician is in-network for your new health coverage.
Some questions that you may have to consider when comparing plans could be:
- How often do you and your family members go to the doctor?
- Does anyone in your family take expensive medications?
- Is vision and dental coverage important for you and your family?
- In the case of a medical emergency, can you afford unexpected out-of-pocket costs?
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Check Your Eligibility for Health Insurance Subsidies
Open enrollment may be a good time to check if your family is qualified for subsidy eligibility. Families may be eligible for discounts on their health plans such as the Advanced Premium Tax Credit and Cost-Sharing Reductions.
- Advanced Premium Tax Credit (APTIC): When you apply for health insurance on the marketplace, you may be expected to report your expected annual income for the next year. If qualified, you may use any amount of the credit to lower your monthly premiums. If you’re unsure if you’re eligible for this credit, you may check available resources to determine eligibility.
- Cost-Sharing Reductions (CSR): Much like the APTIC, eligibility depends on your expected annual income for next year. If eligible, you may receive a discount that lowers your deductibles, copays, and coinsurance. Bear in mind, this discount is only eligible with silver metal tier plans.
What Can You Do If Your Family Missed Open Enrollment?
If you and your family missed the Open Enrollment Period to change your health insurance, you may be able to still change it if qualified for a qualifying life event. Qualifying events are events that allow a special enrollment period for you to purchase health insurance outside of the annual enrollment period.
With qualifying life events happening outside of the normal enrollment period, insurers may allow you to change your health plan to ensure that you’re protected. Certain changes may lead you to be disqualified from your current health plan. You may qualify for a special enrollment period and can apply within 30-to-60 days of the event if you experience:
- Changes to your household
- Changes to your employment and finances
- Changes in location
- Changes in Age
- Changes to your current health insurance