Enrollment periods vary depending on how you get health insurance and where you live, you should check when your respective period starts and ends.
What is Open Enrollment?
The open enrollment period refers to a yearly window of time when you can sign up for health insurance or adjust your current plan. This period does not last long, typically a few weeks, and if you miss it, you might have to wait until the next enrollment period to make any changes.
What types of insurance use open enrollment?
You will have an open enrollment period if you get your health insurance through your employer, through Medicare, or through the Affordable Care Act marketplace.
Common Terms to Know
When it comes to selecting health insurance, it can feel like you must speak another language. This process is even more daunting for those new to the U.S. healthcare system. To help navigate the open enrollment waters, here are some of the more common terms that will come up and what they mean.
- Affordable Care Act (ACA) Marketplace: A platform where eligible people can find and buy health insurance that meets ACA standards.
- Copay: This is a specified dollar amount you will need to pay for a certain covered medical expense.
- Coinsurance: The percentage of the total medical bill you are responsible for paying.
- Deductible: Think car insurance. This is the amount of money you must pay before the insurance company starts paying. Some insurance policies have an annual deductible; others will have a deductible per illness or injury.
- Flexible Spending Account (FSA): A type of savings account set up by employers for their employees. Basically, employees contribute some of their pre-tax earnings into an FSA to cover qualified expenses. These funds cannot be used to pay for your premiums, but they can cover a deductible, copay, and coinsurance.
- Health Maintenance Organization (HMO): This is the entity that provides health services to its subscribers. An HMO will contract with a network of primary care physicians, specialists, and facilities that its subscribers can use by paying a monthly or annual premium. The upside is that by staying in this network, medical costs decrease. The downside is that subscribers are limited to receiving care from the medical providers in the network.
- Health Savings Account (HSA): An HSA works a lot like an FSA. HSAs offer a higher contribution limit than FSAs and are normally owned by the individual who sets it up rather than the employer.
- Out of Pocket Limit: The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100 percent of the allowed amount.
- Preexisting Condition: A medical condition determined to have been in existence before the policy went into effect.
- Preferred Provider Organization (PPO): An alternative to an HMO. Under a PPO, medical professionals and medical facilities contract with an insurance provider to offer their services to subscribers at a reduced rate. PPO rates tend to be higher than HMO rates, but in return, subscribers can access a much larger network of providers.
- Premium: The amount you must pay to purchase the insurance coverage.
- Primary Care Provider: A physician, nurse practitioner, clinical nurse specialist or physician assistant who coordinates or helps a patient access a range of health care services.
- Provider Network: The facilities, providers, and suppliers your health insurer or plan has contracted with to provide health care services.
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