Our Choose Smart Checklist is back to help you through Open Enrollment

November 18, 2020

Mark Your Calendars: Open Enrollment typically runs from November 1 through December 15, 2020. Coverage starts January 1, 2021. (Click here to view Open Enrollment dates by state)

Every year, the Open Enrollment period gives consumers, like you, the opportunity to review your health plan and make sure it meets your needs. Choosing the right plan can be difficult and this year, many Americans will spend even more time evaluating their benefits and with good reason: the financial and health care challenges created by the COVID-19 pandemic make health benefit decisions particularly important. These are unprecedented times and many individual and family needs have changed – moving into 2021, many patients may want more telehealth programs or mental health options included in their health plans. Even if you’re happy with the plan you already have, we encourage you to gather and compare all of your options.

So, where can you start looking for plans when you’re ready to begin your search?

1. Online, visit the federal marketplace or a state exchange
2. On the phone, call the marketplace call center at 1-800-318-2596
3. Directly on an insurer’s website
4. Via a local health insurance broker

Looking online can be especially helpful, as healthcare.gov and coveredca.com offer tools to compare plans. Once you have a better idea of available plans, you can use other resources, like an insurer’s website or the marketplace call center, to help answer any remaining questions.

When you’re ready to compare plans, use our checklist to ensure you’re choosing the plan that best fits your health needs. Here are some terms you should be familiar with as you shop around during Open Enrollment:

• Copayment:A fee you pay each time you see a doctor or fill a prescription. Looking to see how high your copayment is for certain services will give you an idea of out-of-pocket costs you may accumulate when seeking care.
• Deductible:The amount you must pay for health services before your insurance starts to pay. Plans may offer you a lower copayment, but higher deductible, or vice versa. Considering your health needs for the upcoming year can help you choose which type of plan may work best for you, and where your costs come from.
• Out-of-pocket maximum:The most you have to pay for health services. Once you have paid this amount, your insurance pays 100% of your remaining health care costs for the rest of the plan year.
• Prior authorization:Your health plan’s approval process before you receive services, which lets a provider know if the health plan will cover a needed service. Prior authorizations can be required on medications, services and treatments. Checking what might require prior authorization will help you avoid delayed care in the future.
• Copay Accumulator: A copay accumulator – or accumulator adjustment program – is a strategy used by insurance companies and Pharmacy Benefits Managers (PBMs) that stop manufacturer copay assistance coupons from counting towards two things: 1) the deductible and 2) the maximum out-of-pocket spending. (Learn more about copay accumulator here)

Beyond considering the terms above, when comparing plans, here are a few questions to ask yourself:

• Does this plan allow me to continue seeing my current doctor?
• Is there a specific hospital that I must use?
• Will this plan cover my current prescriptions?
• Does this plan restrict which pharmacy I can use?

Remember, when choosing a health plan – start early, take your time, and ask questions. Once you’re confident you’ve chosen the best plan for you, you’re ready to sign up!

My Patient Rights is here to help during Open Enrollment! (Click here to download the Open Enrollment Checklist)

---

Open Enrollment typically runs from November 1 through December 15, 2020. Coverage starts January 1, 2021. (Click here to view Open Enrollment dates by state)

If you don’t enroll in a plan by December 15, you can only get 2021 Marketplace coverage if you qualify for a Special Enrollment Period. **Covered California 2020-2021 Open Enrollment Period: November 1, 2020 – January 31, 2020**

If you’ve lost your job or experienced a reduction of hours due to the COVID-19 pandemic, you may qualify for a Special Enrollment Period. For more information please visit: https://www.healthcare.gov/coronavirus/