Open Enrollment Begins November 15

By Michelle Putnam, Associate Director of Research and Advocacy

Thanksgiving is right around the corner. For those planning a family dinner, this can be a harried and stressful time. Who is coming to dinner? Do you need a whole turkey? What if you roast a whole turkey and end up with a ton of leftovers? Can you roll those leftovers into next week, or next year? Should you just pay more out of pocket and have someone else cook your turkey for you? What about extras, like cranberry sauce? Should you go with the generic brand, or does someone in your family need the really expensive specialty cranberry sauce?

You may not put this much thought into Thanksgiving dinner, but when it comes to choosing a health plan, you can’t help but think about these questions. And in some cruel twist of fate, someone decided to hold Open Enrollment right at the onset of the holidays. If you’re choosing a plan through Medicare, the Health Marketplace, or the State Health Benefit Plan, now is the time to revisit your health insurance coverage.

Here are a few Open Enrollment dates to remember:

• Health Marketplace: November 15 to February 15 (www.healthcare.gov or 1-800-318-2596)
• Medicare: October 15 to December 7 (www.medicare.gov or 1-800-MEDICARE)
• State Health Benefit Plan: October 27 to November 14 (www.dch.georgia.gov/state-health-benefit-plan-shbp)

If you get insurance through your employer, this may be the time of year that you are asked to review your plan and re-enroll. Even if you have the option of automatically renewing your current health plan, you will want to double check the details – insurers can change premiums, copays, and provider networks, and you don’t want to be surprised when you get your first bill!

Fortunately, as a member of the Hemophilia of Georgia family, this enrollment process is a bit easier. We have social workers ready to answer questions you have about enrolling in a new plan or keeping the one you already have. But, at the end of the open enrollment season, it’s worth remembering that there are some questions that only you can answer. For instance, do you use factor or other medications? If so, you want to see how drugs are covered under your insurance plan. Are they covered under a prescription drug benefit? Does the money you spend on prescription drugs, whether through copays or coinsurance, count towards your overall deductible and out-of-pocket expenses? Remember, under the Affordable Care Act, the amount you spend out-of-pocket is limited to $6,600 for an individual and $13,200 for a family plan.

Another important question to ask is whether your insurance plan’s provider network includes your doctor and pharmacist. Is your Hemophilia Treatment Center in network? The best way to figure this out is by visiting the health insurer’s website (many of them have a “Find a Provider” link that will let you search for your doctor). Or, check with your social worker, who can help you find this information. Some plans may charge you more if you see a doctor who is not in network.

If you are enrolling in a plan through the Health Marketplace, has your income changed this year? If so, your social worker can help you update your information on www.healthcare.gov. Any changes may change the price of your monthly premiums and tax credits, so you want to make sure your information is accurate.

There are many things to consider when choosing a health plan, and none of us have a crystal ball that can predict what the plan year ahead will look like. Still, you can make an educated decision on what will be best for you and your family. It’s best to tackle the choice early instead of waiting until the end of the enrollment period, so that you have enough time to explore plans and choose one that is best for you. The sooner you do, the sooner you can jump back into the controlled chaos of holiday dinners!