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  • Open Enrollment

    By David Gorecki, Kaplan University School of Professional and Continuing Education 

    What is an “open enrollment period?” If your answer is “I don’t know.” or “I think I might know.” You share the same sentiment  with most Americans. Many of us know very little about insurance, especially health insurance, and often find the information we need after it’s too late!

    Open enrollment is the period of time when you can sign up for health insurance and the health insurance provider has to insure you. They are not allowed to use underwriting or require evidence of insurability, both of which could make it harder for you to get health insurance. This means that individuals who are currently under their doctor’s care and are receiving treatment for an illness or disease (known as a “pre-existing condition”) qualifies for coverage when they enroll during the open enrollment period. The new insurer must now cover their ongoing treatments.

    For the Affordable Care Act, the open enrollment period is an annual event, beginning November 1, 2015, through January 31, 2016 for this year. Individuals can get coverage from any major medical plan during this time frame regardless of their health status. However, outside the open enrollment period, some health carriers can still discriminate based on the applicants health status. Insurance companies however, can’t deny coverage or charge more for people with preexisting conditions.

    Carrying health insurance is no longer optional under the Affordable Care Act, or colloquially, ObamaCare. A penalty is assessed for not providing proof of current coverage for either an individual plan purchased through the Marketplace or group coverage provided by an employer. Insurers can deny or void coverage for fraud on behalf of the applicant.

    With group health insurance, there is another open enrollment period that takes place annually; this is when plan participants or certificate holders (employees) can switch their coverage without having to prove that they are in good health.

    Here is another example of an open enrollment period. When an eligible person reaches age 65 and enrolls in the Medicare insurance plan, a 6-month open enrollment follows and they can purchase a Medicare Supplement Plan without having to prove insurability. At the time of application, the insurer they select must accept their current medical condition.

    A Medicare Supplement policy is frequently referred to as a “Medigap” plan. These policies are intended to fill most, but not all of the coverage gaps found in Medicare insurance. Examples of these gaps are out-of-pocket expenses for co-pays, co-insurance, skilled nursing care costs after 20 days, the first three pints of blood, and other personal costs. Every year from October 15 to December 7 an open enrollment period occurs and all Medicare eligible individuals can change their current supplement policy to a plan with another insurance carrier, regardless of their current health status. So with Medicare we find two open enrollment periods: when an individual first signs up for a Medicare Supplement Plan and the annual open enrollment period, when individuals can switch plans without proving insurability.

    You may wonder why you need to know about Medicare today, when you won’t be 65 years old for a long time.  Well you could be a person who suffers from “early age procrastination.” One morning you wake up only to find out that you’ve reached retirement age. This happens, and recent studies show that many older Americans fail to sign up for Medicare at the right time which could lead to higher premiums or gaps in coverage. These individuals didn’t plan to fail; they failed to plan!

    Don’t wait until it’s too late. The U.S. Government Site for Medicare offers a free booklet “Medicare & You” at medicare.gov. The site also provides helpful resources to learn more—remember when you reach age 65, Medicare will be your health insurance.

    Now that you know more about open enrollment period, you’ll have an answer the next time a co-worker asks you “What’s an Open Enrollment Period?”

    David Gorecki, is a faculty member at Kaplan University School of Professional and Continuing Education. The views expressed in this article are solely those of the author and do not represent the view of Kaplan University. Speak with a professional if you have any questions about your health care coverage or needs.  

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