Understanding HealthcareHealth Insurance 101
Jan 9, 2023
8 Minute Read

Buying your own insurance? Open Enrollment is here and you need to take action

Open enrollment is nearing its close for 2023 plan options – and it’s important to enroll as soon as possible to secure health coverage in the new year.

What Is Open Enrollment?

Open enrollment is the period when you can sign up for, make changes to, or cancel a health insurance plan through the Affordable Care Act (ACA). The ACA marketplace offers affordable plans to Americans who do not receive health insurance through their employer. It can be accessed at healthcare.gov beginning on Nov. 1, 2022, through Jan. 15, 2023. There are benefits to signing up early – those who enroll before Dec. 15 will have coverage effective Jan. 1, 2023.  

It’s important to take action during this timeframe because if you miss the open enrollment period, federal policy mandates you can’t get coverage until the following year, unless you qualify for a special enrollment period.

Some Types of Insurance Do Not Use an Enrollment Period

Most health insurers in the United States use open enrollment programs that restrict enrollments to a specific time of year, but exceptions exist. For example:

  • Medicaid. Medicaid enrollment is not restricted to an open enrollment period. If you are eligible for Medicaid, you can apply at any time.
  • Short-term health insurance. Short-term insurance is not regulated by the Affordable Care Act, and plans are available year-round in states that permit them.
  • Supplemental insurance products. Supplemental insurance options are available in some cases. Individual supplemental insurance plans are available all year.

Why Is Buying Insurance Limited to Once Per Year?

Open enrollment periods encourage people with varying health needs to sign up for insurance. This diverse pool of enrollees – both healthy and those requiring medical attention – reduces copays and premiums, which ultimately benefits everyone who is covered under an insurance plan.

Think of health insurance like car or homeowners’ insurance. Enrollees must buy into the insurance before an accident occurs. The system would simply be unstainable if everyone only bought insurance when something needed to be covered.   

Types of Enrollment Plans

While there are many kinds of enrollment plans, there are three main types of healthcare plans: preferred provider organizations (PPOs), health maintenance organizations (HMOs), and high deductible health plans (HDHPs).

Preferred provider organization plans typically have higher amounts that you pay to your health plan each month, but they tend to be more flexible. PPOs allow you to see any doctor or specialist in the network of your plan. You can also seek care outside of your network. To see a specialist, PPOs do not require a referral from your primary care physician (PCP), but you will likely have to pay more for the service.

Health maintenance organization plans have lower monthly payments than PPOs but require members to use specific in-network providers. Additionally, you must obtain referrals from your doctor to see specialists. Like HMOs, exclusive provider organizations (EPOs) also require you to stay within the network of your health plan.

high deductible health plan is another low-cost option. HDHPs have low monthly payments and a higher amount you pay for healthcare services (such as a doctor’s visit) before your plan starts to pay for services. With HDHPs, you may not pay much monthly, but you’ll have to pay more for healthcare when it’s utilized. HDHPs are usually paired with a health savings account (HSA) to help offset healthcare costs.

Why It’s Important

The open enrollment period is crucial because it is one of the few times you can change many of your benefits. The health plan decisions you make during open enrollment can have a major impact on your finances, so it’s critical that you not only enroll before the period ends, but that you also carefully consider your options.

When enrolling for healthcare through the ACA at healthcare.gov, you will enter details about your living situation and income, and the system will offer a range of plans for which you qualify. The list of options may stretch over several pages – but they are searchable, and comparison shopping is highly encouraged. We recommend searching within your results for Blue KC health plans, which offer competitive rates and excellent care. For more information about open enrollment and Blue KC health plan options, visit https://www.bluekcforyou.com/

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