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Open Enrollment is a valuable time to reassess your health insurance plan. Whether your health needs have changed or you’re seeking better coverage options, switching plans during this period can lead to significant benefits. Here’s a guide on what to consider when deciding to change your health insurance plan and how to navigate the process smoothly:

1. Why Consider Switching Plans

You may want to consider changing plans if any of the following situations apply to you:

• Premium Increases: If your current plan’s premium has risen, consider exploring other plans to find one that fits your budget.
• New Health Needs: Changes in health needs, like planned surgeries, starting a family, or managing a chronic condition, may mean your current plan no longer offers the best fit.
• Coverage Changes: If your plan’s benefits have changed—such as the loss of a preferred provider or reductions in prescription coverage—this might be a good time to look for a plan that better meets your needs.

What to consider when deciding on a new plan:

2. Review Key Plan Features

When selecting a health insurance plan, carefully evaluate these critical factors:

• Premiums: Your monthly payment for coverage. Lower premiums often mean higher deductibles, so find a balance that aligns with your budget and expected healthcare usage.
• Deductibles: The amount you pay out-of-pocket before insurance coverage begins. Low deductibles are beneficial if you anticipate frequent doctor visits.
• Copays/Coinsurance: Fixed fees or percentages you pay for each service. These costs can add up, so compare copays for services you use regularly.
• Out-of-Pocket Maximum: The annual limit on your out-of-pocket medical expenses. This provides financial protection in case of unexpected high-cost events like surgeries.

Most people will focus on monthly premium only, believing that this is the best way to determine savings. It makes sense to assume this because the premium is a monthly payment, so it is foremost in the consumer’s mind as the cost of their insurance. However, a more balanced and cost-effective plan will also keep other potential expenses in mind. ‍

3. Check Provider Networks

Each plan has a network of healthcare providers who accept the insurance, usually at lower rates than out-of-network providers. Make sure your preferred doctors, specialists, or facilities are covered by any new plan you’re considering.

If continuity of care is important, ensure your doctors are in-network. For families, verify coverage for each family member’s preferred providers.

4. Review Prescription Drug Coverage

Prescription coverage varies widely, especially for brand-name and specialty drugs. If you rely on specific medications, confirm they’re covered affordably under any plan you’re considering.

Review the formulary (list of covered drugs) for each plan. Many plans use tiered coverage, where generics are cheaper than brand-name drugs.

5. Assess Your Health Needs for the Upcoming Year

Predicting your healthcare needs for the coming year can help you choose a plan that provides the right balance of cost and coverage. If you anticipate needing more care than usual, a plan with lower out-of-pocket costs might be more economical, even if the premium is higher.

Think about any planned surgeries, specialist visits, or family additions (like a baby) that might impact your healthcare needs. 

6. Know the Deadlines and Process for Changing Plans

Open Enrollment generally runs from early November to mid-December, but specific dates vary by state. During this period, you can change your plan through your employer, the ACA marketplace, or your insurer’s platform. Once you select a new plan, coverage typically begins on January 1 of the following year. If you miss Open Enrollment, you’ll need a qualifying life event to make changes outside this period.

Changing health insurance plans during Open Enrollment can help you find better coverage that fits your health needs and budget. By reviewing plan options, understanding key terms, and evaluating your upcoming healthcare requirements, you can confidently switch plans and ensure a smooth transition to your new coverage. Let HealthBird guide you through the process with tools and resources to simplify your health insurance decisions.

Choosing the right health insurance plan can feel overwhelming, but it’s essential for protecting your health and finances. To help make the process smoother, here are the top 10 mistakes to avoid when selecting your health insurance coverage.

1. Only Looking at Premiums

It’s tempting to choose the plan with the lowest monthly premium, but a cheaper plan might come with higher deductibles and out-of-pocket costs. Be sure to factor in all costs, including copayments, coinsurance, and your maximum out-of-pocket limit, to get a full picture of your potential expenses.

2. Ignoring the Network of Providers

Each health insurance plan has a network of doctors, hospitals, and specialists that offer care at in-network rates. If your preferred doctor isn’t in-network, it doesn’t affect the costs of in-network providers, but it does mean you’ll likely pay higher, out-of-network prices if you choose to see that provider instead of an in-network doctor. Always check whether your preferred doctors and hospitals are part of the network before choosing a plan to avoid unexpected costs for out-of-network care.

3. Overlooking Prescription Drug Coverage

Not all health insurance plans cover the same medications, and some may charge higher copays for certain prescriptions. If you take regular medications, make sure your plan offers affordable prescription drug coverage. Review the formulary (list of covered drugs) to ensure your medications are included.

4. Choosing the Wrong Type of Plan

Health insurance comes in different forms, including HMOs, PPOs, EPOs, and POS plans. Each plan type has its own rules for accessing care. For example, an HMO typically requires you to choose a primary care doctor and get referrals for specialists, while a PPO gives you more flexibility to see out-of-network providers. Understanding the differences is key to picking the right plan for your lifestyle.

5. Underestimating Your Healthcare Needs

Many people select a plan based on their current health, without considering possible changes in the future. If you anticipate needing surgery, frequent specialist visits, or starting a family, you may want to choose a plan with lower deductibles and better overall coverage. Being proactive can save you money and stress in the long run.

6. Not Taking Advantage of Subsidies

If you’re purchasing health insurance through the Marketplace, you might qualify for subsidies or premium tax credits to lower your monthly costs. Be sure to check if you’re eligible for financial assistance by entering your income and family size during the application process. Not taking advantage of subsidies could result in paying more than necessary for coverage.

7. Failing to Account for Out-of-Pocket Maximums

The out-of-pocket maximum is the most you’ll pay for healthcare in a given year, after which your insurance covers 100% of covered services. Plans with lower premiums may have higher out-of-pocket maximums, which can lead to unexpected financial strain if you face serious health issues. Make sure the out-of-pocket maximum is something you can afford in the event of a major illness or accident.

8. Skipping Preventive Care Benefits

Many health insurance plans offer free preventive care services, like vaccinations, screenings, and annual wellness visits, but not everyone takes advantage of these. Choosing a plan that includes a wide range of preventive services can help you stay healthy and avoid costly medical bills down the road.

9. Overlooking Telehealth Services

In today’s world, telehealth has become an increasingly popular and convenient way to access medical care. However, not all plans offer telehealth services, or they may charge extra fees for them. If you prefer virtual appointments or want to avoid trips to the doctor’s office, check if your plan includes telehealth coverage.

10. Forgetting to Update Your Plan After Life Changes

Life events like getting married, having a baby, or changing jobs can affect your health insurance needs. Many people forget to adjust their plan when their circumstances change, leading to gaps in coverage or higher costs. Be sure to update your health insurance during Special Enrollment Periods if any of these changes apply to you.

Choosing health insurance doesn’t have to be stressful. By avoiding these common mistakes and carefully reviewing your plan’s details, you can find coverage that fits both your health needs and your budget.

Get started with HealthBird today to compare plans and ensure you’re making the best choice for your healthcare.

Open Enrollment is a critical time to choose or renew health insurance coverage, but it can be confusing with all the industry-specific terms. Understanding these key terms can help you make informed decisions about your healthcare and select the best plan for your needs. Here’s a glossary of essential health insurance terms to guide you through Open Enrollment.

Premium

The amount you pay monthly for your health insurance plan. Think of it as your subscription fee to keep your coverage active.

Example: If your monthly premium is $300, you’ll pay that amount each month regardless of whether you use any healthcare services.

Deductible

The amount you need to pay out of pocket for covered healthcare services before your insurance plan begins to share costs.

Example: If your deductible is $1,500, you’ll pay all medical expenses up to $1,500 before your insurer covers a portion of additional costs.

Copayment (Copay)

A fixed amount you pay for specific services, like doctor visits or prescriptions, as part of your cost-sharing with the insurer.

Example: Your plan may have a $25 copay for primary care visits, meaning you’ll pay that amount for each visit.

Coinsurance

The percentage of costs you share with your insurer after meeting your deductible. Coinsurance applies until you reach your out-of-pocket maximum.

Example: With 20% coinsurance, you’ll pay 20% of covered services, and your insurer will cover the remaining 80% after your deductible is met.

Out-of-Pocket Maximum

The maximum amount you’ll pay in a year for covered services, including deductibles, copays, and coinsurance. After reaching this limit, your insurer covers 100% of costs for covered services.

Example: If your out-of-pocket maximum is $6,000, you won’t pay more than that amount in a year for covered care.

Network

A group of doctors, hospitals, and other providers that your insurer contracts with to offer services at a discounted rate. Staying in-network usually costs less than seeing out-of-network providers.

Always confirm that your preferred providers are in-network to avoid higher out-of-pocket expenses.

In-Network and Out-of-Network

In-network providers are part of your insurer’s network, and their services typically cost less. Out-of-network providers are not contracted with your insurer, often resulting in higher costs or no coverage.

Example: An in-network primary care visit may have a $25 copay, while an out-of-network visit could cost significantly more.

Health Maintenance Organization (HMO)

A type of health insurance plan that requires you to use in-network providers for care, except in emergencies. HMOs usually require a primary care physician (PCP) referral to see specialists.

HMOs can be more affordable but have limited provider options. Make sure your preferred doctors are within the HMO network.

Preferred Provider Organization (PPO)

A plan that offers more flexibility in choosing providers, allowing you to see both in-network and out-of-network providers without a referral. PPOs typically have higher premiums but offer broader provider access.

If you prefer more provider options, a PPO plan may be a better fit, even with higher premiums.

Exclusive Provider Organization (EPO)

An EPO plan combines features of HMOs and PPOs, requiring you to use in-network providers without referrals but offering no coverage for out-of-network care (except in emergencies).

EPOs are ideal for those who want more freedom than an HMO but don’t need out-of-network access.

High Deductible Health Plan (HDHP)

A plan with a higher deductible and lower premium, often paired with a Health Savings Account (HSA). HDHPs are designed for those who want lower monthly premiums and are prepared for higher out-of-pocket costs.

HDHPs are best for those who expect low medical expenses and want to save on premiums.

Health Savings Account (HSA)

A tax-advantaged savings account available with HDHPs, allowing you to set aside money for medical expenses. Funds in an HSA are tax-free and roll over year to year. Read about how to maximize your HSA.

 HSAs are a great option for saving pre-tax dollars for future healthcare costs, and contributions can even be invested.

Special Enrollment Period (SEP)

A time outside of Open Enrollment when you can enroll in or change your health insurance plan, triggered by certain life events such as marriage, childbirth, or job loss.

If you experience a qualifying event, you may be eligible for an SEP to adjust your coverage.

Preventive Care

Services intended to prevent illness or detect health issues early, such as vaccinations, screenings, and annual check-ups. Most preventive care is covered at no cost to you.

Take advantage of preventive care benefits as they’re often fully covered under most health plans.

Formulary

A list of prescription drugs covered by your insurance plan. Drugs are often divided into tiers, with higher costs for brand-name or specialty medications.

Check your plan’s formulary if you rely on specific medications to ensure they’re covered affordably.

Premium Tax Credit

A subsidy that lowers your monthly premium cost for ACA marketplace plans, based on your income and household size.

Update your income and household information to see if you qualify for financial assistance through the ACA.

For a more comprehensive guide to health insurance terminology, visit our Insurance Terminology section. This resource provides clear definitions and explanations to help you navigate your healthcare options with confidence to select the right plan during Open Enrollment. With this knowledge, you’ll be better equipped to evaluate your options, compare costs, and make choices that align with your healthcare needs and budget. Let HealthBird help guide you through the process with personalized recommendations to make Open Enrollment a stress-free experience.