Open Enrollment During COVID

The current COVID-19 Pandemic has heightened the consequences of having access to good medical care and the need for good health insurance coverage. Having good insurance means the difference between access to the providers of one’s choice or having limited access to overburdened public health clinics. Having good insurance has an impact on having access to the best available provider and getting the most value from your premium dollars. Having good insurance means keeping your out of pocket costs affordable. Having good insurance means getting your medications from your local pharmacist or delivered through the mail.

Americans who have health insurance get it through one of the following:

• Employer-Based – If you work for a large organization, your employer provides Group Coverage. 159 million Americans have employer-based coverage.
• Obamacare/Affordable Care “ACA” – You can purchase individual and dependent coverage through the marketplace, or through exchanges. About 12 million Americans are enrolled in ACA.
• Medicare – If you are 65 years and older, or permanently disabled you may be eligible for Hospital, Physician, and Prescription Drug Coverage. 59 million Americans have coverage through Medicare.
• Medicaid -A joint federal and state program that, together with the Children’s Health Insurance Program (CHIP), provides health coverage to over 72.5 million Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. Medicaid is the single largest source of health coverage in the United States

Open Enrollment Dates To Keep In Mind

If you work for an employer-based plan, your organization will communicate directly with you through your HR department to discuss your health plan options for 2025.

If you obtain your coverage from the Obamacare health insurance marketplace you can enroll in, re-enroll in or change a health insurance plan between November 1 and December 15, 2024. Your new plan coverage will become effective January 1, 2025.

If you are eligible for Medicare and are currently enrolled in a plan, The Medicare Open Enrollment Period for Medicare Advantage & Part D is between October 15, 2024, to December 7, 2024, with enrollment effective January 1, 2025. During Medicare Open Enrollment, you can:

1. Switch from Original Medicare to Medicare Advantage.
2. Switch from Medicare Advantage to Original Medicare (plus a Part D plan and possibly a Medigap plan).
3. Switch from one Medicare Advantage to another, or from one Medicare Part D (prescription drug) plan to another
4. Drop Part D coverage altogether
5. Enroll in a Part D plan – if you didn’t enroll in a Medicare Part D plan when you were first eligible.  A late enrollment penalty may apply.

Enrollment in Medicaid is based on Federal guidelines that take into account income, dependency status, and disability. Therefore, enrollment is an ongoing function.

As you can readily see, there are some steps that we as consumers must take to determine what we are eligible for and making sure we meet the deadlines to ensure that we have the coverage that we and any eligible family members need.

We will follow up and provide additional guidance and insight into successfully navigating through a seemingly complex process. But once you get the hang of it, you will find that many of the insurance plans and providers want to work closely with you to make sure that you get access to the health care you need and work hard to keep you well.

Source material for this article includes healthcare.gov., Medicaid.gov., and Kaiser Family Foundation.