How to Prepare For Open Enrollment

Posted: January 04, 2023

Open enrollment season has already begun. While the last few months of the year tend to be hectic due to the holidays, don’t neglect the importance of enrolling in your health insurance plan on time. Though signing up for a health plan through your employer or individually can often seem confusing or overwhelming, it might be easier than you think.

Whether you’re enrolling for the first time as a young adult or have an entire household of family members as dependents, waiting until the last second to update your benefits can create challenges down the line. In this open enrollment guide, we’ll discuss how to prepare for 2022 health insurance enrollment in California.

What Is Open Enrollment?

Open enrollment is a dedicated period each year when employees and individuals can enroll in health insurance and elect or adjust the benefits to an existing health plan, such as dental, vision and life insurance or other types of voluntary benefits. Unless you qualify due to a unique life circumstance, which we’ll discuss below, this is the only time you can change your health coverage or switch to a more comprehensive plan.

If you get health insurance through your employer, verify when your open enrollment plan begins and inquire about which benefits your employer or salary pays for.

If you’re self-employed, unemployed or your employer does not offer health insurance, you can sign up for a health insurance plan through California’s health care marketplace.

When Is Open Enrollment 2022?

Open enrollment for California residents applying for Covered California or Medi-Cal is from Nov. 1, 2022 to Jan. 31, 2023. However, some employers may have a specific open enrollment period and deadlines for when to turn in necessary paperwork.

Covered California and Medi-Cal use the same application, so as you fill out the form, you can see which health plan you and your dependents qualify for. Generally, if you need benefits to begin on Jan. 1, you should submit your enrollment forms early on in the process, but this will also depend on the type of plan you need and your health insurance company.

Is Open Enrollment the Only Time You Can Buy Insurance?

No. While open enrollment is the most common way to buy marketplace health insurance, there are certain circumstances, or qualifying life events, when you can apply or adjust your benefits. Outside general open enrollment, qualifying life events trigger a special enrollment period that allows individuals to apply for health insurance for exceptions, which include:

• Adopting a child
• Having a new baby
• Becoming a widow or widower
• Losing your job
• Otherwise involuntarily losing your health insurance
• Aging out of your parents’ health plan
• Getting married or divorced
• Moving to a new state

Depending on your health insurance plan, you will typically have approximately 60 days before or after the event to apply for health insurance or adjust your benefits. If you get your health insurance through your employer, some may offer as little as 30 days for you to submit the required paperwork to prove the life event occurred and select your new or updated health plan or benefits.

However, remember that you will not qualify for SEP if you lost your precious health insurance plan because you canceled the coverage or failed to pay monthly premiums.

Do I Have to Have Health Insurance?

As a California resident, you and every member of your household must have qualifying health insurance coverage to avoid facing a penalty, according to the state law passed in 2020. You can face per-person fines at a flat rate — $425 per child under 18 and $850 per adult — or at a percentage of your household income.

There are specific exceptions to this mandate, such as for members of certain Native American tribes, those whose premiums are unaffordable or people who do not make enough to pay income taxes. Be sure to determine if you or any of your dependents qualify for an exemption. To qualify for assistance on a government health insurance plan from Covered California as a California resident, you must have a specific household income based on the federal poverty level.

Information You Need to Prepare for Open Enrollment

Once you know what you need for health insurance coverage or the updates you need to make to your existing plan, it’s time to apply. To make this process as fast and straightforward as possible, you must have the following information.

• Personal information: Provide the name, address, email address, birthdate, citizenship status, Social Security number and other required information for each person you need to enroll. You may need to provide proof of citizenship and other details, so be sure to have physical copies.
• Household size: You will need to state how many people in your household need insurance.
• Financial information: Provide the income and employment information for each family member. To determine if you qualify for cost-sharing subsidies or other cost savings to reduce your monthly premium, you must calculate your modified adjusted gross income. However, even if you’re above the income limit, you may still be eligible for subsidies due to the American Rescue Plan of 2021.

Your modified adjusted gross is often the same amount as the adjusted gross income that you report on your federal Form 1040 when you file your taxes, combined with tax-exempt interest earnings, foreign-earned income, housing expenses for Americans living abroad and non-taxable Social Security benefits.

To qualify for larger subsidies, you can reduce your MAGI by contributing to a health savings account or a pretax retirement plan. To do so, you will need to verify your income with W-2 forms, tax returns, pay stubs and other documentation.

You will also need the following.

• Names and locations of your doctors: You can filter your plan options to find doctors that will accept your health insurance. Be sure to always contact your doctor’s office to verify before you enroll in a plan.
• Medications and treatments your household members require: Double-check that your insurance plan will cover all your dependents’ needs.
• Payment method: Determine how you will pay for your premiums every month. You can have payments charged to your credit card or get them automatically withdrawn from your bank account to ensure you never miss a payment.

Tips for a Smooth Open Enrollment Experience

If you’re enrolling in health insurance after a significant life change, such as getting a new job, moving states, getting married or having a baby, you may not know what to expect when it’s time to apply. Below, we’ll go through some tips to help you prepare for open enrollment and ensure it’s a hassle-free process.

1. Define Your Objectives

The first step to preparing for open enrollment is knowing what you and your family need. Before enrolling, ask yourself the following questions:

• What qualifying life events have occurred since last year?
• Do you need to adjust your benefits for more or less coverage?
• What type of benefits do your dependents need?

2. Plan

Before renewing your existing health plan, unless you’re choosing a new one during open enrollment, you will receive reminders and instructions on how to renew your health plan. Read these materials carefully and gather any documents you may need to have while filling out your forms.

Look at the plan options and determine whether you qualify for cost-sharing reduction or the advanced premium tax credit. If you’re eligible for either of these options, it might be more cost-effective to change to a different family plan or consider your deductible options.

3. Know Your Open Enrollment Deadline

This one may seem like an obvious tip, but plenty of people miss open enrollment deadlines because of their busy schedules or life events. Knowing the deadline for health insurance open enrollment through your employer or insurance company can help you avoid panicking or being unprepared when you realize last minute that you still need to apply.

For example, if you or a loved one are applying for Medicaid, the enrollment dates are from Oct. 15 to Dec. 7 each year, which is different than enrollment dates for Covered California or Affordable Care Act coverage.

4. Compare Premiums and Out-of-Pocket Costs

Whether you’re applying for a new plan for the first time, adjusting your benefits or renewing your existing health plan, it’s essential to look over your insurance company’s offered plans and compare the out-of-pocket costs, which may include:

• Premiums
• Deductibles
• Coinsurance
• Copays

You might find that one plan offers affordable upfront premiums, but may cost you more when you need to use health care services. Always consider more than the monthly premium, such as ensuring you can get all your medications covered, even if you don’t expect to switch plans.

To help you compare plans and decide the ideal one for you and your family, consider what medications you and your family take, what services you might need and the overall health of everyone in your household. Be sure to ask yourself:

• Are lower out-of-pocket costs or lower premiums more important to you?
• Do you or a family member have a chronic illness that requires regular medical care?
• Do your or a family member plan on starting an expensive prescription drug in the next year?
• Can you afford high out-of-pocket costs in an emergency?

No matter what plan you go with, take time to review your options, ask questions and consider whether your current coverage meets your needs for the upcoming year.

5. Ensure Your Doctors Are in Your Plan’s Care Provider Network

Even if you aren’t making any changes to your health insurance plan during open enrollment, it’s always wise to double-check that all providers you see regularly or plan to visit in the coming year are still in-network. If you plan to visit a provider or hospital that’s outside your network, note that these costs will likely be higher compared to a network care provider. You can also check to see if your plan offers telehealth services.

6. Don’t Forget About Additional Benefits

In addition to general health insurance coverage, you will also need to consider other add-on benefits for you and your family members, such as:

• Dental
• Vision
• Accident
• Critical illness

Having these types of insurance on your plan can protect you and your family from emergency illness or injury.

How to Choose a Plan That’s Best for Your Needs

If you have a household of dependents, you will need to consider how you health insurance plan caters to their needs. If you’re not sure what type of health plan you want for your family, here’s a short overview of some of the Covered California options you can find through Health for California.

1. Health Maintenance Organization

HMO plans generally have lower premiums and out-of-pocket costs but a small provider network. Medical facilities and health care providers within an HMO plan provide medical services for a fixed price.

These plans also provide a required primary care physician who coordinates care for you and your family members and gives referrals for specialists when needed. The PCP will also keep track of your health needs and remind you when to get tests and checkups done.

Some benefits of this plan include:

• Your premiums and out-of-pocket costs will be lower.
• You likely won’t need to file claims.
• It will cover you if you visit an out-of-network facility or provider in an emergency.

2. Preferred Provider Organization

A PPO health plan tends to be more expensive but offers a broader provider network, so you have access to more doctors and hospitals. You and your family have more flexibility when searching for a new provider, but it also means your PCP does not coordinate care for you.

With a PPO, you’re responsible for managing your care, so this can be an ideal option for those who prefer to visit specialists. This plan might also suit those who do not mind paying a bit extra to go out of network. Though in-network care is less expensive, there may be times you want to see a specific provider.

Advantages of a PPO plan include:

• You don’t need your PCP to give you a referral.
• You can go out of network.
• You and your dependents have more provider and facility options.

3. Exclusive Provider Organization

An EPO plan does not require you and your dependents to get a referral to see a specialist or receive care. This type of health plan provides a local network of doctors, providers and facilities. Though you must stay in-network with this plan, you don’t need to choose a PCP and wait for a referral.

Some benefits of this health insurance plan include:

• You and your family members will have out-of-network coverage in an emergency.
• You’ll likely have lower out-of-pocket costs.
• You don’t need to see a PCP for a referral.

4. Point-of-Service Plan

A POS health insurance plan is similar to an HMO plan because you select a PCP that will manage your health needs. However, unlike an HMO plan, a POS plan allows you to go out of network for care if necessary.

Benefits of enrolling in a POS plan include:

• Your PCP coordinates care for you and your dependents.
• You have access to more providers.
• You can go out of network for an extra cost.

5. Catastrophic Health Plan

You may qualify to purchase a catastrophic health plan if you’re under 30, relatively healthy or have a hardship and affordability exemption. This plan is ideal for individuals who don’t expect to use regular medical services such as routine doctor’s visits, but want to have emergency coverage as a safety net.

This type of plan offers free preventive care and lower premiums, but has a higher deductible that you must pay before it will cover your other care. Remember, you will not qualify for a subsidy if you have a catastrophic plan.

However, there are still some advantages to this type of health plan, such as:

• A lower monthly premium
• Coverage for emergency and preventive services

Find the Right Plan With Health for California

Health insurance is one of the most crucial things to have for you and your family. If you haven’t yet applied for health insurance or adjusted your benefits for the 2022-2023 calendar year, Health for California can make this process as seamless as possible. We offer many different Covered California family plans for your and your dependents’ needs, including dental and vision insurance.

Our knowledgeable team is ready to assist residents through the California health insurance enrollment process and answer any questions you have. Connect with us today or request an individual or family quote online to get started.