Gifts aren’t the only things being opened this time of year. While everyone else may be unwrapping their brand-new phones, water bottles, clothes, and five-pack of Domino’s gift cards from Costco (thank you, Grandma), you might be thinking about whether to change your health insurance coverage level, contribute more or less to your health spending account, or enroll in a new benefit. Not only must you weigh the pros and cons of all these questions, you’ll also need to figure out how to actually go about doing any of those things. After all, you just saw the email from the head of HR and started thinking about it, but where do you even begin?
We get it. At Payday HCM, we’ve had numerous potential clients approach us with all sorts of questions about open enrollment. As a company that offers benefits services to our clients, we’re familiar with the ins and outs of open enrollment and the common questions employers and employees alike might ask during this time.
In this article, we’ll go over everything you need to know about open enrollment. We’ll start by going over a broad outline of what open enrollment is. From there, we’ll dive deeper into the kinds of things that you can change during an open enrollment period, such as important dates and deadlines, as well as answer any other questions you might have. By the end of this article, you’ll be so well-versed in open enrollment that you might just have to stop yourself from unwrapping those benefits before Christmas (or the open enrollment deadline) morning.
In this article, you will learn:
What Is Open Enrollment?
While the world of health insurance contains many unnecessarily confusing concepts, open enrollment is one that is relatively easy to parse out.
Time To Enroll In Benefits
When you start a new job, one of the onboarding tasks that you will often have is to enroll in the company’s benefits. These benefits can be a variety of things, but often, you’ll have the choice to enroll in certain benefits and not enroll in others.
Open enrollment is essentially the same thing: each year, either through your employer, Medicare, or an Affordable Care Act Marketplace provider, you’ll be able to go back in and make changes to the benefits that you initially signed up for the better fit your needs for the upcoming year. These changes can vary from the level of coverage of health insurance to signing up for a company-sponsored gym membership.
Who Is Eligible To Make Changes During An Open Enrollment Period?
Technically, anyone is eligible to make changes to their benefits during an open enrollment period. Eligibility is really more about whether or not you are already enrolled in benefits or not, although open enrollment periods are good times for those not currently enrolled in benefits to do so.
For businesses with full-time and part-time employees, eligibility will depend on whether certain employees qualify for benefits in the first place. This will depend on the benefits policy that you’re organization has already outlined.
How Does Open Enrollment Work?
Now that we understand a bit more about what open enrollment is, we’ll dive deeper into how open enrollment works and the kinds of things you can do during an open enrollment period.
What Changes Can You Make During Open Enrollment?
Open enrollment is a good time to review your current health insurance plan and see what sorts of things you might or might not need heading into the new year. Some common things to look at are:
- Adjusting coverage levels
- Adding or removing dependents or a spouse
- Enrolling in new benefits
- Switching between plan types, like a HMO, PPO, or HDHP
- Signing up for a health savings account or flexible spending account
You’ll want to work with your benefits administrator to figure out how you’ll go about making changes to your benefits. Payday, for example, is partnered with isolved, which has benefits administration features built in. In some cases, you may need to go through a portal through your insurance provider to make certain changes.
How Do I Make The Most Of Open Enrollment?
As we discussed above, open enrollment is a great time to make any changes to your benefits that you’ve been considering. For those who haven’t thought much about it, open enrollment is also a great time to consider the benefits you have and how much you make use of them, regardless of whether you end up making any changes.
Some important questions to ask yourself during an open enrollment period include:
- What healthcare costs can I anticipate in the new year?
- Do I have any chronic illnesses that require regular doctor visits?
- Would I like the flexibility of out-of-network care?
- Will I start a family in the next year?
These questions can help you decide what actions to take during an open enrollment period.
When Does Open Enrollment End?
While there are deadlines for open enrollment, they aren’t universal. There are a few factors that would determine when your open enrollment period will end.
Open Enrollment Deadlines
Deadlines for open enrollment periods can vary based on several factors. The deadline to enroll in an insurance plan through the Affordable Care Act is January 15. Medicare’s open enrollment period ends on December 7.
Beyond that, though, any deadline will most likely vary. In some states that offer their own health insurance marketplaces beyond the one offered by the ACA, they will set their own open enrollment deadlines. For those with insurance plans provided through their employer, they will also set their own open enrollment deadline.
What Happens If I Miss Open Enrollment?
If you miss open enrollment, it doesn’t mean you’ll be without health insurance for the rest of the year in most cases. If this happens, the only way you’ll be able to enroll in any health insurance benefits is following a Qualifying Life Event.
A Qualifying Life Event can take a few different forms, including:
- Loss of health coverage
- Changes in your household, such as having a baby or getting a divorce
- Changes in residence
A QLE will allow you to enroll in either your employer’s benefits plan or in an ACA Marketplace-provided plan outside of the open enrollment period.
Enrolling In Beneficial Benefits
It’s hard to emphasize just how stressful the end of the year can be. Between all the last-minute sales calls and last-minute gift shopping, it’s hard to find a moment to sit back, relax, and think about the year ahead. When it comes to an open enrollment period, though, thinking ahead is exactly what you need to do, but without the proper knowledge of what an open enrollment period is and what it means for you, it can make this a challenge. With the knowledge provided in this article, you’ll have no problem taking charge of this year’s open enrollment period and entering the new year in stride.
Of course, open enrollment is only one step in a much larger puzzle. Now that you’ve got a better understanding for what open enrollment is, check out our article on five tips for ensuring successful benefits enrollment.
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