Dear Addy: Open Enrollment for New Users

Dear Addy,
I’m applying for health insurance for the first time this open enrollment period. With a bleeding disorder, what should I look for in an insurance plan?
First-time Subscriber
Dear Subscriber,
First, an Open Enrollment Period is the time during the year when health insurance companies or HMOs (health maintenance organizations) are required by law to accept applications from new plan enrollees regardless of their health history. This also is the time when you can choose to stay with the health plan you have if it is the right one for you. Generally, open enrollment is held once a year.
When reviewing potential health insurance plans, you need to review all provisions carefully but someone with a bleeding disorder needs to look carefully at the sections on the “general provisions” (length of policy, types of providers you can see, term definitions), the “drug provision” (is your factor product, and any other drugs you need, covered by the plan), and the provision that discusses claims and the payment of claims. All of these items plus many others are required by law to be spelled out in an easily understood format.
After reviewing any potential plan, you should be able to answer the following questions. If you can’t, contact your company’s human resources department or a Marketplace navigator if you are selecting a plan via the Marketplace.

  • What is the overall deductible?
  • Are there other deductibles for specific services?
  • Is there an out-of-pocket limit on my expenses?
  • What is not included in the out-of-pocket limit?
  • Is there an overall annual limit on what the plan pays?
  • Does the plan use a network of providers?
  • Do I need a referral to see a specialist?
  • Are there any services this plan doesn’t cover?
  • Does the plan use a preferred drug list and if so, will my product of choice be covered?

For more information on how to read an insurance policy and what you need to know prior to selecting a plan, see HFA’s webinar “How to Reader Your Health Insurance Policy“.
Check with your human resources department to find out when your company’s open enrollment period begins and ends. For people who have health insurance through the Marketplace, the open enrollment period runs from November 1, 2016 to January 31, 2017. For people with Medicare, open enrollment runs from October 15-December 7 annually. The open enrollment period for Medicaid is 365 days a year, available to those that need it, whenever that occurs.
Remember, whether you keep your current health insurance or enroll in a new plan, READ YOUR POLICY. This is critical because the health insurance plan you choose, will be yours for 12 months unless you have a qualifying life event.
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HFA frequently receives questions from the bleeding disorders community related to advocacy issues. The questions often impact the entire community. In an effort to reach the largest audience possible with our responses to these widely applicable questions, HFA developed “Dear Addy.” Questions submitted to this column are edited in order to protect privacy and should be considered educational only, not individual guidance.