Open Enrollment: What You Need to Know

Fall marks an especially exciting time for those of us that work in the healthcare industry: the open enrollment period! The end of another year offers people the perfect chance to plan for the future (or more specifically, the coming year), offering the opportunity to review their medical expenses from the previous 12 months and use that information to make informed decisions regarding their insurance needs going forward.

Wait a minute: that’s what the open enrollment is for? Like most, you may simply elect to remain enrolled in your current coverage year-after-year. You can certainly do that, but know that not taking this time to truly research your options could end up costing you. Thus, we’ve prepared a comprehensive guide to help get you ready for this year’s period, addressing important questions such as “What is open enrollment?” and “When does open enrollment take place?”. We will also explain important details regarding group health, private and Medicare open enrollment.

open enrollment 2018

What is Open Enrollment?

Few truly understand what happens during open enrollment. Simply put, it’s the time of year reserved to make modifications to your health insurance plan, whether that be to enroll in coverage, modify your plan or switch carriers completely. Your employer may have scheduled a benefits fair to go over these details, or you may be noticing increased correspondence from your insurance provider in your mailbox. It’s all being done to help you know what your options are for the coming year.

When is Open Enrollment?

The exact dates depend on that type of insurance coverage you have. Medicare open enrollment runs from October 15, 2020 through December 7, 2020 for coverage effective in 2021. Marketplace plans available through or state exchanges have varying enrollment dates. Group health plans sponsored by individual employers set their own open enrollment dates, yet they usually follow the same time frame as government and private plans.

Why This All Matters

Why should you care about open enrollment? According to the Internal Revenue Service, the individual mandate introduced by the Affordable Care Act is still in effect, which means you could have to pay a tax penalty if you don’t have healthcare coverage. Plus, planning accordingly during your private, group health plan or medical open enrollment period can help you stay in control of your healthcare costs in the coming year.

How, you ask? Take a look at your healthcare expenses from recent years. Use that information to answer the following questions:

How many times do you (or your family members) go to the doctor?

What types of problems are needing to be treated?

How much have you been spending out of your own pocket on healthcare?

Once you have that information, consider what life events you might be facing in the coming year. Are you expecting a baby? Do you need surgery? Do you have a family member that has a chronic condition? All of these are factors that will influence how often you’ll need to utilize your health insurance next year. Then, take a look at the plan options available to you. Add up the cost of premiums, the deductibles, and the out-of-pocket maximums. Those numbers will tell you the total costs of each plan.

The total cost of each plan is great information to have, but how does it help you control your healthcare spending? Knowing the total amount you’d have to pay before you reach a plan’s out-of-pocket maximum allows you to allocate added pre-tax funds to resources such as a health savings or flexible spending account. That money helps you afford care throughout the year without putting added strain on your household budget. Plus, your research will also show how providers offer added resources to help promote wellness and understand your rights as a policyholder, further helping you to manage the need and cost for care.

meritage medical network open enrollment

Things to Consider This Year

With the issues of explaining what and when is open enrollment now put to bed, here are a few things to consider as you head into this year’s period:

Marketplace open enrollment: The Affordable Care Act coverage is still available through the online insurance marketplace. is estimating a 34 percent increase in premiums for private plans, yet if your income is below 400 percent of the federal poverty level, you could qualify for subsidized premiums.

Employer plan open enrollment: High deductible plans are becoming more popular as employers attempt to expand cost sharing. The Kaiser Family Foundation reports that the average deductible for group health plans has risen over $1,200 in the last 10 years. If you don’t anticipate many visits to the doctor, a high-deductible plan can save you money through lower monthly premiums.

Medicare open enrollment: If you’re looking for added benefits and are willing to deal with a limited provider network, you may want to consider switching to a Medicare Advantage plan. Consider your potential prescription costs, as well. While Advantage plans require higher monthly premiums for Part D coverage than the $33.50 premium that the Centers for Medicare and Medicaid Services reports is required for traditional Medicare drug benefits, you may find that such coverage gives you access to more medications.

Now that you have better understanding of when is open enrollment, don’t allow it to sneak up on you again this year. Knowing what is open enrollment allows you to better prepare to select the right type of coverage for you and your family. Of course, you’re not alone in this process; our experts here at Meritage Medical Network are prepared to answer any questions that you may have, from complex details regarding Medicare Open enrollment to simple inquiries about whether or not a doctor is a member of our network. Click here to learn more about how to choose Meritage during open enrollment.