Do you smell that? It’s not just pumpkin spice. Every fall, health insurance open enrollment rolls around. This year, open enrollment starts Tuesday, November 1 and ends on Sunday, January 15, 2023. After that 45-day window, you can only enroll under special circumstances, like having a new baby or losing health coverage from your employer. Since it’s not easy to switch plans on a whim, it’s worth planning ahead to make sure the plan you select fits your family’s needs the first time around.
We’re going to level with you: All that complicated insurance jargon is confusing, and making sense of it is a royal pain. We get it. To help, the following is a comprehensive guide to help you make an informed decision. If you sign up for insurance this November on the HealthBird website, our ingenious algorithm will make it so much easier to narrow down your options. Plus, if you enroll by Thursday, December 15, 2022, you can get coverage that starts on the first of the year. What better way to kick off New Year’s than by taking care of yourself?
It’s wise to understand the basics of health coverage before you enroll. Take a deep breath, pour yourself a glass of wine and relax. You’ve got this. Just keep these seven factors in mind, and the next plan you pick will fit like a glove.
There are two main types of health insurance plans: HMOs and PPOs. The short version? If you’re a creature of habit who’s gone to the same doctor for years and has no serious health issues, an HMO is just fine. If you’d prefer to be able to go try that physical therapist you’ve been meaning to see without getting a referral, a PPO is where it’s at.
With an HMO, patients can only see care providers within a certain network for services to be covered. They also need a referral from their primary care physician to see a specialist. With a PPO, patients can see any doctor they want, including specialists. Even with a PPO, it’s cheaper to see a doctor within your network. PPOs typically have higher premiums than HMOs, but for members who need specialized care, it’s often worth the upgrade.
Already have a favorite doctor or dentist? Before you sign up for a new plan, make sure that your preferred health care providers, pharmacies and hospitals fall within the plan’s network. Even with a PPO, out-of-network services are pricier, so it’s best to choose a plan that includes the doctors you already see. HealthBird makes it easy to find plans that cover your preferred doctors. Just specify your favorite care providers, and our algorithm will make sure any recommended plans include them.
A plan’s premium is the amount you’ll pay every month for your insurance plan. This amount is billed regardless of whether or not you use any healthcare services. It works like an AppleCare membership: You pay a little every month, but if you drop your phone, you’ll be glad you signed up.
Even if your health plan’s premium is higher than you’d like, it’s much less expensive than paying out of pocket if you need a trip to the E.R. If you choose a plan with a lower premium, there’s a tradeoff. It’ll be cheaper every month, but you’ll pay more when you see your doctor or fill a prescription.
Most preventative services, like annual checkups, vaccines and cancer screenings, are covered at no additional cost. For specialist visits, procedures and certain prescriptions, you’ll have to pay a certain amount out-of-pocket until your coverage kicks in. If you choose a plan with, say, a $1,000 deductible, your insurance provider won’t pay for most expenses until you’ve paid $1,000 yourself. The higher a plan’s deductible, the lower the premium, and the lower the plan’s deductible, the higher the premium.
Check if the plans you’re looking at have a combined deductible for both medical and pharmacy services, or if the deductible for prescription medications is separate. That way, you’ll have a clear idea of how much you’ll have to pay for medications before they’re covered.
Wait, you might wonder. I have to pay hundreds every month, and everything’s still not covered? Yep. In a perfect world, everyone would get complete health coverage without worrying that falling ill might lead them to financial ruin. Sadly, the cost of getting an IV in the U.S. can be up to $500. $500 for a bag of salt water. It’s nuts, but it’s also the reason why having to pay a deductible and monthly premium is still way better than going without insurance at all.
Even after you meet your plan’s deductible, you may be required to contribute a certain amount to access care. A co-pay is a flat fee you pay for prescriptions and services even after your deductible has been met. The amount is usually listed on the back of your insurance card. For example, you might pay a flat fee of $35 for every visit to urgent care, and $50 to visit the ER.
Instead of charging co-pays, some plans charge coinsurance. It works similarly, except instead of a flat fee, you’ll have to pay a percentage of the cost of each service or medication. Many people prefer plans that rely on co-pays rather than coinsurance since you know exactly how much you’ll spend for each visit even if your healthcare needs change.
Do you take certain medications that would be crazy expensive without coverage? Check out your potential insurer’s list of covered medications to make sure your prescriptions are covered. If they’re not, you’d have to appeal to obtain coverage. The process can take months, so it’s better to choose a plan that already covers your meds.
Medications are typically divided into tiers. Each tier has a different out-of-pocket cost. To get a clear idea of how much you’ll have to pay for your current medications, write down all your prescriptions and compare them to the plan’s list. It’s like keeping track of your Netflix, Hulu and Amazon Prime subscriptions, only way less fun. (Pro-tip: Making popcorn while you do it helps.)
With each additional family member on your insurance policy, your monthly premium will go up. That’s because the head of household is charged for each individual covered by the plan: More people = a higher premium. Some insurance plans offer discounts for family health plans, but most do not. Still, having your immediate family on a single health plan is much more convenient than trying to keep track of separate plans for each family member.
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