How to Not be Intimidated by OE: Answering Your Open Enrollment FAQs

Open enrollment makes accessing healthcare coverage both easy and efficient for individuals today. However, many people are intimidated by the strict timing, the legal requirements, and the nuances of the process. Not only is the process confusing, but health insurance can be just as complicated, if not more so. However, while the OE period is bogged down by ample compliance regulations, with the right information, you can start the enrollment process confidently and with ease. Here’s what you need to know.

How to get Started with Open Enrollment

The first step in signing up for open enrollment is assessing your current plan. If you like the coverage you’re receiving now, this can provide a baseline for the types of benefits you’d like to receive in the new plan.

Understanding this can also help you rule out certain plans that don’t meet your needs, which can make the selection process easier. Another benefit of assessing your current plan is that it can allow you to get a feel for your price point. If you feel like your current plan is affordable, you can look for something in a similar range.

It’s also important to note any recent changes in your health, new diagnoses, or new medications. Newly developed health needs should help you identify which plans works for your lifestyle and which ones don’t offer appropriate coverage.

What is ‘out-of-pocket’ vs. a deductible?

A deductible is the amount of money you must spend on medical bills before your insurance coverage kicks in. Before that number is hit, you’ll need to pay for your bill out of your own pocket, which is where the term out-of-pocket costs come into play. This means that the higher your deductible, the more money you will personally pay before your plan starts helping you out.

As there are many exceptions and nuances, know that there are some costs that you will still need to pay out-of-pocket for even after you hit your deductible. For more terminology, such as premiums, copayment, HRAs and more, check out our glossary.

How does a deductible work?

Here’s an example to help break it down: if your deductible is $1,500, this means you’ll need to spend this amount in medical bills within a given year before your insurance starts paying their portion of the bills. However, in many cases, you’ll still be expected to help pay for a portion of these bills after the deductible is met.

How much does coinsurance cost?

When you pay for your insurance after the deductible is met, this is what’s called coinsurance. Both you and your insurance company are paying for expenses at the same time, but you’re usually responsible for paying less than half of the bill– typically 10% to 30%.

What employees should know before choosing a new plan

Employees should be certain to research information on out of pocket costs, deductibles and coinsurance. Additionally, it’s important that people review their current plan and asses if there’s anything that needs improvement. They should also be sure to research what might happen in extenuating circumstances. And, whether or not their plan is HMO or PPO, is key information to have.

What is HMO vs. PPO?

So what exactly is the difference between HMO vs. PPO plans? HMO plans provide patients with a wide network of healthcare providers. These providers have all agreed to provide their services at lower prices. These prices are negotiated by the insurance company and may vary by company and region. These plans usually require patients to choose a specific primary care physician to see for all general healthcare needs.

As for PPO plans, they also provide patients with access to providers within a network. However, patients aren’t specifically restricted to receiving care in-network. This means that patients don’t need to choose a primary care physician, and patients can make appointments with either in-network or out-of-network care team members.