Now that the leaves are starting to fall, it’s not just pumpkin spice lattes making their annual return—Open Enrollment is here again, too. If your care recipient’s insurance is through an employer, they should expect notification from HR about Open Enrollment and when changes can be made to their insurance plan. Alternatively, if your care recipient participates in a government-sponsored plan or doesn't have insurance, they may not receive notice. Whatever your circumstances, we’re here to help you navigate the challenge.
For coverage in 2025, Open Enrollment runs from November 1, 2024, through January 31, 2025 (depending on the state). Once Open Enrollment is over, your care recipient won’t be able to enroll in a health care plan without a qualifying life event such as starting a new job, moving to a new state, or getting married.
Open Enrollment might seem like a maze of paperwork and fine print, but it’s your opportunity to help secure the most beneficial coverage for your care recipient. From checking for changes in their current plan to exploring new options, asking the right questions now can help you avoid surprises later.
Below are 5 key questions to ask, whether your care recipient already has insurance or you’re getting them covered for the first time. Asking these questions now will help you and your care recipient minimize unexpected costs and maximize healthcare benefits next year.
If your care recipient already has insurance coverage:
- What changes have been made to their health plan since last year?
Health insurance plans often change from year to year. These changes can include everything from costs, such as premiums and deductibles, to covered services and prescription drug coverage. Review the plan’s Summary of Benefits and Coverage to find any updates that could impact your care recipient. For example, if a certain treatment or medication they need will no longer covered, it’s better to know now—and change plans—than to be caught off guard later.
- Are their current healthcare providers still in-network?
One of the most important things to do during Open Enrollment is to make sure your care recipient’s doctors, specialists, and healthcare facilities are still in-network under next year’s plan. In-network providers have a contract with the insurance company to provide services for lower costs, while out-of-network providers do not. A change in network status could lead to higher out-of-pocket costs (see question 3 for more information) or force your care recipient to switch providers.
- Will the deductible, co-pay, and out-of-pocket maximum amounts be different than last year?
Understanding how much your care recipient may need to pay for their health care can help you avoid surprises. Co-pays are the fixed amounts you pay for services, like doctor's visits, while deductibles are the total amount you must pay before your insurance starts covering more costs. The out-of-pocket maximum is the most you’ll have to pay during a policy period before the insurance covers all medical expenses. Compare next year’s figures with this year’s to see if the proposed plan provides enough financial coverage for your care recipient’s healthcare needs.
- What benefits relevant to long-term care or specialized services does the plan offer?
For care recipients with chronic conditions, determine if the plan covers long-term services like home health care or rehabilitation. If these benefits aren’t included, it might be time to consider other plans.
- Are there any new plans that could better meet your care recipient's needs?
Even if your care recipient’s current coverage is acceptable, take a moment to evaluate other options. Make a list of the healthcare needs your care recipient might have over the coming year (including regular check-ups, surgeries, and medications) and compare associated benefits as offered in their existing plan to those available through alternatives. Different plans might offer new benefits, better coverage for specific treatments, or lower costs.
If your care recipient doesn’t currently have insurance coverage:
- What are your care recipient’s healthcare needs for the coming year?
If this is your first time signing up for insurance, make a list of anticipated healthcare needs such as doctor’s visits, medications, potential surgeries, or treatments. Understanding what types of care to expect will help you choose the best possible plan.
- What type of health coverage does your care recipient qualify for?
If your care recipient isn’t currently covered, start by exploring their eligibility for programs like Medicare, Medicaid, or the Affordable Care Act (ACA) Marketplace plans. Each program has specific criteria based on age, income, and medical needs.
- Will the monthly premium fit their budget?
Once you’ve found a few insurance options, consider the cost of monthly premiums. If your care recipient is on a fixed income, you’ll want to balance affordability with necessary coverage. Subsidies and financial assistance may be available depending on the plan and eligibility; HealthCare.gov is a good place to start your search.
- How do deductibles and co-pays impact overall costs?
Lower premiums can sometimes mean higher deductibles and co-pays. Be sure to understand how much you’ll pay upfront for services, doctor’s visits, or prescriptions.
- Does the plan cover prescription medications?
Some plans offer excellent medical coverage but limited or expensive prescription drug benefits. If your care recipient regularly takes medications, check the plan to make sure their prescriptions are covered and affordable.
Looking Ahead
Open Enrollment can feel like a whirlwind of choices and paperwork, especially when you’re already juggling caregiving duties. It’s a lot to take in, and it’s easy to feel overwhelmed trying to figure out what’s best for your care recipient. But remember, you’re not alone in this process. Asking the right questions and taking time to understand available options will reduce potential stress for you and your care recipient.