What to consider when switching health insurance plans

When is open enrollment season?

Employee benefit enrollment can vary, but it generally takes place during the fall, beginning in October and lasting around a month. You'll want to pay attention to any communications from your human resources (HR) department about open enrollment to ensure you're ready to make your choice on coverage.

As of 2021, health insurance purchased through state exchanges or the federal marketplace has an open enrollment period that begins in November and ends in January.

Know your plan options

You can start the process of switching health insurance plans by requesting the Summary of Benefits and Coverage to get an idea of what each plan entails, including deductible amounts, coverage for common health needs, and the copays you can expect. You can use this information in combination with the premium amounts to see what option will help you optimize the quality of care you can receive for the most effective cost.

Even if you're happy with your current plan and anticipate no changes, it's still good practice to participate in open enrollment by reviewing your options before finalizing your selection.

Consider your costs

The two most important things to consider when evaluating your health insurance options are the care your plan will provide and how much it costs to receive the care. This is where doing a little cost-comparison math can go a long way. When you think about the most commonly used features of your current plan, your diabetes management supplies, and any substantial potential healthcare costs for the upcoming year, you can use this information to help you determine what plan will be most effective for you.

There are federal subsidies and cost-sharing reductions available to help make premiums more affordable when purchased through the marketplace. Some states also offer subsidies and additional cost-sharing options. Eligibility for these savings is dependent on income, which can be evaluated when shopping for insurance online or with a broker. If your income changes throughout the year, you can reevaluate your situation and potentially become eligible for cost-sharing at that point.

Qualifying life events and special enrollment periods

Open enrollment season is typically the one time in the year when you can make changes to your benefit elections at work or change insurance through the healthcare exchange. The exception to this is when you experience a qualifying life event (QLE) that triggers a special enrollment period (SEP). The SEP is usually a 60-day time period after the QLE when you can make changes to your coverage or enroll in new coverage. Employer-based coverage requires a minimum SEP length of 30 days.

There are many scenarios that can open up the ability to gain new coverage or make changes to existing coverage, including common QLEs like losing healthcare coverage, moving, getting married, or the birth or adoption of a child. It's important to note that you do not need a QLE to enroll in Medicaid or the Children's Health Insurance Program (CHIP), which is available for qualifying individuals year-round.

Ready, set, elect!

Now that you know what to look for when switching health insurance plans, you're ready to navigate open enrollment season for the year ahead. If you have questions about the options available and how they could impact your diabetes care, you can reach out to the plan administrator, insurance broker, or a trusted friend who can help guide you through the process. The open enrollment process can be stressful, but when you're done, you'll feel relieved to know you're covered for whatever diabetes and life may throw your way.

Have you noticed the impact on your health plan as a result of the COVID-19 pandemic? Read more about COVID-19 and medical policy changes.