Page 4 - HFA Dateline 2014 Q3 Fall
P. 4
Are you ready for Open Enrollment?
By Wendy Owens
S ummer is over and already it is time to start making your insurance policy is effective. For example, in 2015 the
list and checking it twice. No, not that list; the list of the out-of-pocket maximum for an individual is $6,600, for a
things you need to make sure your health insurance plan cov- family it is $13,200. Already, patients with chronic diseases in
ers when your open enrollment period starts. An open enroll- California are reaching their out-of-pocket maximums in one
ment period is the time when individuals can enroll themselves month and they can’t afford to pay. Legislation is in the works to
and any dependents in Qualified Health Plans for the follow- allow California residents who quickly reach their out-of-pocket
ing year. Open enrollment usually lasts about 30 days. The first max to pay down the balance over 12 to 24 months. However,
step is knowing when your open enrollment period is; the sec- patients are still at risk for financial hardship until this and
ond is finding the right plan. similar legislation is passed around the country.
The Affordable Care Act (ACA) requires insurance companies If you are not sure, now is a good time to learn when your open
to provide an easy-to-read chart of benefits for any plan it of- enrollment starts and ends. It is typical to have a 30 day window,
fers. This is great for the general benefit items, but for patients often in the fall. Check with your human resources department,
with chronic conditions, it is the details that count. For example, if you can. Some open enrollment dates to keep in mind:
bleeding disorder patients around the country have found that • Marketplace plan coverage starting in 2015:
their hemophilia treatment center (HTC) is in the network of
providers their insurance will cover only to learn that the doc- November 15, 2014- February 15, 2015
tor they see at their HTC is not. In addition, many insurance • Medicare plan coverage starting in 2015:
companies now are limiting pharmacy choice for patients, and October 15 - December 7, 2014
moving factor from major medical coverage to pharmacy cov-
erage. This allows them to charge a percentage for the cost of • Medicad and CHIP are open 365 days a year
factor (20-50%) versus a copay!
This is not all. Though the ACA capped annual out- IMPORTANT THINGS TO
of-pocket costs, some patients have to pay the full KNOW BEFORE SIGNING UP:
out-of-pocket limit in the first month that the
So what can you do? How do you find out if the policy
Necessary Benefits you are considering is the right one? How do you plan
for reaching out-of-pocket limits quickly? The checklist
on page 5 can help you determine whether the insurance
Healthcare Providers plan you have in mind has what you need to meet your
health insurance coverage needs for the coming year.
Specialty Pharmacies • Create a list of the benefits you need. List the
services you used in the past year, then think about what
Plan Options services you may need in the coming year. This includes
use of your health care providers such as doctors and
Monthly Premiums physical therapists, specialists, your HTC, your hospital,
your prescription drugs, and other treatments you feel
Yearly Deductible your family is likely to need. Don’t forget about optical
care and dental care!
4 Dateline Federation | Fall 2014
This includes use of your health care providers
such as doctors and physical therapists,
specialists, your HTC, your hospital, your
prescription drugs, and other treatments you
feel your family is likely to need. Don’t forget
about optical care and dental care!
By Wendy Owens
S ummer is over and already it is time to start making your insurance policy is effective. For example, in 2015 the
list and checking it twice. No, not that list; the list of the out-of-pocket maximum for an individual is $6,600, for a
things you need to make sure your health insurance plan cov- family it is $13,200. Already, patients with chronic diseases in
ers when your open enrollment period starts. An open enroll- California are reaching their out-of-pocket maximums in one
ment period is the time when individuals can enroll themselves month and they can’t afford to pay. Legislation is in the works to
and any dependents in Qualified Health Plans for the follow- allow California residents who quickly reach their out-of-pocket
ing year. Open enrollment usually lasts about 30 days. The first max to pay down the balance over 12 to 24 months. However,
step is knowing when your open enrollment period is; the sec- patients are still at risk for financial hardship until this and
ond is finding the right plan. similar legislation is passed around the country.
The Affordable Care Act (ACA) requires insurance companies If you are not sure, now is a good time to learn when your open
to provide an easy-to-read chart of benefits for any plan it of- enrollment starts and ends. It is typical to have a 30 day window,
fers. This is great for the general benefit items, but for patients often in the fall. Check with your human resources department,
with chronic conditions, it is the details that count. For example, if you can. Some open enrollment dates to keep in mind:
bleeding disorder patients around the country have found that • Marketplace plan coverage starting in 2015:
their hemophilia treatment center (HTC) is in the network of
providers their insurance will cover only to learn that the doc- November 15, 2014- February 15, 2015
tor they see at their HTC is not. In addition, many insurance • Medicare plan coverage starting in 2015:
companies now are limiting pharmacy choice for patients, and October 15 - December 7, 2014
moving factor from major medical coverage to pharmacy cov-
erage. This allows them to charge a percentage for the cost of • Medicad and CHIP are open 365 days a year
factor (20-50%) versus a copay!
This is not all. Though the ACA capped annual out- IMPORTANT THINGS TO
of-pocket costs, some patients have to pay the full KNOW BEFORE SIGNING UP:
out-of-pocket limit in the first month that the
So what can you do? How do you find out if the policy
Necessary Benefits you are considering is the right one? How do you plan
for reaching out-of-pocket limits quickly? The checklist
on page 5 can help you determine whether the insurance
Healthcare Providers plan you have in mind has what you need to meet your
health insurance coverage needs for the coming year.
Specialty Pharmacies • Create a list of the benefits you need. List the
services you used in the past year, then think about what
Plan Options services you may need in the coming year. This includes
use of your health care providers such as doctors and
Monthly Premiums physical therapists, specialists, your HTC, your hospital,
your prescription drugs, and other treatments you feel
Yearly Deductible your family is likely to need. Don’t forget about optical
care and dental care!
4 Dateline Federation | Fall 2014
This includes use of your health care providers
such as doctors and physical therapists,
specialists, your HTC, your hospital, your
prescription drugs, and other treatments you
feel your family is likely to need. Don’t forget
about optical care and dental care!
