Open Enrollment: What it is and FAQs about it

What is Open Enrollment?

Open enrollment is the designated time each year when individuals can enroll in, change, or cancel their health insurance plans. This period typically occurs in the fall and usually lasts a few weeks. During open enrollment, you can review and select the best coverage options for the upcoming year. Outside of this window, changes to health insurance plans are generally limited to special circumstances like a major life event (e.g., marriage or job loss).

Exceptions to the Open Enrollment Period

If you’ve experienced a qualifying life event you may be eligible for a Special Enrollment Period which is when you can make changes to your health plan outside the typical open enrollment period specifically if a qualifying life event occurred. Qualifying life events include things such as loss of essential coverage, marriage, birth of a child, permanent relocation, divorce, adoption, new foster child, etc.

Which types of insurance use open enrollment?

Health insurance through employers, Medicare, or the Affordable Care Act (ACA) marketplace all have open enrollment periods.

Selecting an Insurance Plan

Before selecting a health insurance plan or making any adjustments to your current plan, consider these factors:

  • Review last year’s healthcare expenses, including premiums, deductibles, and out-of-pocket costs.
  • Assess whether your spending matched your healthcare needs
  • Check if your doctor or clinic is in-network (including Behavioral Innovations)
  • Ensure that your medications are covered by the plan

By thoroughly reviewing your current or potential new healthcare plan, you can be proactive in making sure that your child receives their necessary services without disruptions. You can also make the most educated decision about your child and your family’s healthcare coverage needs.

Components of a Health Plan

Many people select health plans based primarily on the monthly premium, but this can lead to overlooking key factors. There are other components of a health plan including the following:

  • Deductible
    • The amount you pay before insurance starts paying for services
  • Coinsurance
    • Your share of costs after meeting the deductible
  • Copayments (copays)
    • Fixed fees you pay for care after the deductible
  • Out-of-pocket maximum
    • The most you’ll pay in a year for covered services

It is helpful to consider these components when choosing a plan. For instance, if a high deductible is unaffordable, a plan with a lower one, though more expensive monthly, may be more manageable.

Next Steps for You

  • If your insurance remains the same, confirm that ABA therapy is still covered and that Behavioral Innovations is in-network.
  • If your insurance changes, verify ABA therapy coverage with the new provider. If ABA therapy is not covered, you should work with your insurance provider to find a plan that will cover ABA therapy.

Once you’ve selected a plan, verify ABA therapy coverage directly with your carrier, as Behavioral Innovations can only confirm coverage with an active plan number.

Questions for Open Enrollment

By reviewing your health plan and renewing your current plan or selecting a new plan, you can help to ensure that your next year’s health coverage meets your needs.

Some questions that you can ask to help you through the open enrollment process include:

  1. What is my deadline for picking a new health plan?
  2. Will anything with my current health plan change?
  3. What is the best health plan for my financial circumstances (such as the premium, deductible, coinsurance, copayments, and your out-of-pocket maximum)?
  4. Are my doctors and service providers in network with my plan?
  5. Will I need the same, more, or less healthcare services next year as compared to this year?
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