What is Open Enrollment?
Open enrollment is the one time of year when you can enroll or change insurance plans through the Health Insurance Marketplace. Open enrollment is only for people who get their insurance through the Health Insurance Marketplace.
“I don’t need insurance now, but what if my situation changes in a few months?”
Under special circumstances, you can enroll or change health plans outside of open enrollment. These are called qualifying events. Qualifying events include things such as loss of health coverage through an employer, a change in marital status, or a new child in the family. If you do not have an approved qualifying event, you will need to wait until the next open enrollment period to enroll in coverage.
All plans are different. Originally under the ACA, plans were required to cover ten essential benefits. These essential benefits fall into the following categories:
- Outpatient services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services
- Prescription medications
- Rehabilitative services
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
Beyond the essentials.
Most plans cover the essential health benefits that we mentioned. Once a plan meets the essential health benefits, they have the flexibility to offer different levels of coverage for different pricing. Carefully consider your circumstances when selecting a plan, keeping in mind:
- Premium costs – the amount you pay each month.
- Services – what the insurance company will cover and what will they exclude.
- Co-pays – how much you pay at each visit.
- Deductibles – how much you pay out of pocket before insurance coverage begins.
A word of caution:
In 2019, rule changes allowed insurers to offer short-term, limited-duration coverage. Even though they are called short-term plans, they can last for periods of up to three years, leading many to believe they are purchasing a traditional insurance plan. These plans are not required to cover the ten essential benefits, and while they can offer significantly reduced costs upfront, patients often find very little is covered.
We encourage all patients to carefully review the covered benefits section and ask for assistance if you are not clear on the coverage. What seems like a good deal could end up costing you more if the plan doesn’t cover medications or services you are likely to use.
How do I enroll?
NH residents use the federal marketplace at www.healthcare.gov. If you live in another state, check with your State Insurance Bureau for guidance. Small businesses can also use the marketplace through the Small Business Health Options Program (SHOP) to provide coverage for employees.
Open enrollment for the Healthcare Marketplace is from November 1 to December 15. This is the only time you can enroll in a plan without a qualifying event.
If you need are looking for assistance in understanding your options, or with the enrollment, Lamprey Health Care can help. Our three health centers all have Certified Application Counselors who can meet with you individually and assist you through the process. To make an appointment call any Lamprey Health Care office and ask for an appointment with the Certified Application Counselor. Marketplace counseling is available to all. You don’t need to be a patient of the health center to access this free service.
We recommend making your appointment early in the enrollment period. Many people wait until after Thanksgiving, and appointments will fill up.
What if I already have a plan through the Marketplace; how do I renew?
You should have received an email or letter from your insurance carrier. Please read it! It has important renewal information specific to your plan. If you aren’t happy with your plan and want to make a switch, now is the time. If you are unsure how to proceed, our Certified Application Counselors are happy to meet with you.
What about Medicare?
Medicare is the federal health insurance program for people over the age of 65. It is also available for some people under 65 with disabilities. Most people are eligible to enroll in Medicare Part A (hospital expenses) and Part B (outpatient health expenses) during the initial enrollment period. This starts three months before turning 65 and ends three months after turning 65. You can also opt to enroll in Part C (Medicare Advantage), Part D (prescription drug plan), and supplemental plans (Medigap) during the initial enrollment period.
Except during your initial enrollment period, open enrollment is the only time of year that you can enroll, change, or un-enroll your Part C or Part D plan.
Open enrollment for Medicare is from October 15 to December 7. Information on Medicare Open Enrollment is available by contacting the Social Security Office at (800) 772-1213 (TTY users 1-800-0778) Monday through Friday from 7 AM to 7 PM. New Hampshire residents can also contact Service Link for assistance on Medicare Open Enrollment.
How about Medicaid?
Medicaid provides health coverage to qualifying low-income adults, children, pregnant women, elderly adults, and people with disabilities. To enroll, you will have to meet enrollment guidelines. Enrollment in Medicaid can happen any time a person meets the enrollment guidelines, and coverage can begin immediately.
In NH, the Medicaid Program is called Granite Advantage. Currently, three Managed Care Organizations administer care under the Granite Advantage Program; AmeriHealth Caritas New Hampshire, NH Healthy Families, and Wellsense.
Annually, people enrolled in these plans will be offered an open enrollment period when they can switch plan coverage. The 2019 open enrollment period for Granite Advantage has already passed.
Yeah, we get it. Health coverage can be confusing. It’s normal to feel a bit overwhelmed by all the information. It’s also why we offer Certified Application Counselors to help you understand your options. They receive comprehensive training each year and can help you through the process. Meeting with a counselor is FREE, and you do not need to be our patient to use this service. To speak with a counselor or schedule a one on one appointment call (603) 292-7278 in the Seacoast/Rockingham county region, or (603) 816-7165 in the Nashua area.
|NH Medicaid||https://nheasy.nh.gov/#/||(800) 852-3345 ext. 9700
|NH Dept. Health & Human Services||www.dhhs.nh.gov||(800) 852-3345
|Healthcare Marketplace||www.healthcare.gov||(800) 318-2596
TTY (855) 889-4325
|Social Security Administration||www.ssa.gov||Manchester office (866) 814-5408
Nashua office (877) 444-0134
Portsmouth office (888) 397-9796
|Service Link||www.servicelink.nh.gov||Atkinson office (603) 892-9769
Manchester office (603) 644-2240
Nashua office (603) 598-4709
Rochester office (603) 332-7398
Stratham office (603) 334-6594