Preparing for Open Enrollment: Answers to Common Questions

(BPT) - If you're getting ready for open enrollment, a few basics can help you choose and enroll in a health plan with more confidence, from key deadlines to what to compare before signing up.

What is open enrollment?

Open enrollment is the annual period when you can buy health insurance, renew your current coverage or switch to a different plan. If you miss the window, you may have to wait until the next enrollment period unless you qualify for special enrollment because of a life change such as losing coverage, having a baby or getting married.

When does open enrollment start, and what deadlines matter?

The dates vary depending on where you get coverage. Employer-sponsored plans may follow a different schedule. For people enrolling through Covered California, open enrollment starts Nov. 1 and runs through Jan. 31. Enrollment is available online, by phone or in person.

If you enroll in November or December, coverage begins on Jan. 1. If you enroll in January, coverage begins on Feb. 1.

What should I collect before I apply or renew?

Before you apply or renew, it helps to have the following information ready:

• Social Security numbers for everyone applying
• Federal tax information
• Immigration documents, if applicable, such as a Green Card, I-94 or EAD
• Employer information and an estimate of household income
  • You should also know how to calculate your income

Having these details on hand can make the process easier. You may not need to upload documents when you first apply. If additional verification is needed, Covered California will contact you with instructions on what to submit.

How do I choose the right health plan?

Whether this is your first time enrolling or you're shopping for a new plan, it helps to ask a few practical questions:

• Who needs coverage?
• How often do you see a doctor?
• What kinds of care do you expect to use?
• Are your preferred doctors and hospitals in the network?
• Are your prescription drugs covered?
• What will you pay each month and when you receive care?

Your answers can make it easier to compare plans and choose one that fits both your health needs and your budget.

What do premium, deductible and copay mean?

Health insurance includes several types of costs. Here are a few common terms:

• Premium: The amount you pay each month to keep your health plan.
• Deductible: The amount you pay for covered services before your plan starts paying its share, similar to a car insurance deductible.
• Copay, or copayment: A fixed amount you pay for a covered service such as a doctor visit or prescription.

Many plans include both deductibles and copays. In general, plans with higher premiums tend to have lower deductibles and copays, while plans with lower premiums often have higher out-of-pocket costs when you use care. Because insurers offer a range of plan designs, consumers can choose the option that best matches their needs.

Other useful terms include:

• Coinsurance: The percentage of the cost you pay for a covered service after you meet your deductible.
• Out-of-pocket costs: What you pay for care yourself, including deductibles, copays and coinsurance.
• Out-of-pocket maximum: The most you will pay in a year for covered services. After you reach that limit, your plan pays 100% of covered costs.

What does coverage include, and how do I know which level to choose?

Every Covered California plan covers the same essential health services, regardless of tier or type:

• Outpatient care
• Emergency services
• Hospital care, including surgery and overnight stays
• Pregnancy, maternity and newborn care
• Mental health and substance use services, including behavioral health treatment
• Prescription drugs
• Rehabilitation and habilitation services and devices
• Lab services
• Preventive care, wellness services and chronic disease management
• Pediatric services, including children's dental and vision care

Plans are offered in four metal levels: Bronze, Silver, Gold and Platinum. They all cover the same basic categories of services, such as doctor visits, emergency care, hospital stays, prescription drugs, mental health care and preventive care. The main difference is how costs are split between you and the plan.

For example, plans with higher monthly premiums generally have lower costs when you get care. There is no single correct choice. Think about your budget, how often you expect to use care and which doctors or medications you want covered. You can learn more about Covered California's coverage levels and use the Shop and Compare tool on CoveredCA.com to estimate costs based on your situation.

How can I find out whether I qualify for financial help?

Covered California is the only place where you can get financial help to lower the cost of health insurance through state and federal tax credits. In fact, four out of five people who enroll through Covered California qualify for assistance.

Californians may be eligible for more help than ever before. That includes premium tax credits that reduce your monthly bill and cost-sharing reductions that lower what you pay when you receive care. You can get a quick estimate to see how much help you may qualify for.

What if my income or household changes?

If your income or household changes, update your Covered California account as soon as possible. For coverage that applies in the coming year, use your best estimate of the income you expect to earn rather than what you earned previously. If your income is difficult to predict, make your best estimate and report changes as they happen during the year. That helps ensure your financial assistance amount is as accurate as possible.

Where can I get free, confidential help?

Free, confidential help from Covered California is available by phone, online and in person. Certified enrollers can answer questions about plans, explain possible financial help and guide you through enrollment. Help is available in multiple languages.

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• By phone: Call 800-300-1506 to speak with a Covered California representative.
• Help on demand: Request a free callback from a certified enroller if you're applying for the first time.
• In-person help: Find a certified enroller or agent near you through CoveredCA.com.
• Online: Visit CoveredCA.com for live chat and other support options.

Open enrollment is coming up soon. Start preparing now at CoveredCA.com.