What is Open Enrollment?  It is an annual window (usually in the fall) when employers and the government (Medicare & ACA) allow employees/consumers to elect or change their benefit options.  This can include health, dental, life insurance, and possibly other ancillary benefits ranging from legal services to pet insurance.

Typically, you can only enroll in benefit plans outside the open enrollment window IF you are either a new employee or experience a qualifying life event.  Qualifying life events generally include:

• Changes in household (marriage, death, divorce)
• Loss of insurance
• Changing residence
• Having a baby or adopting a child
• Turning 65 for Medicare

Most Common Open Enrollment Mistakes 

Sometimes it may feel like open enrollment is just another thing on your to-do list.  However, you are making a big investment in your benefits package, so it is worth your time to make sure you are making the best choices for yourself and possibly your family.  Common mistakes include:

• Missing the deadline
• Defaulting to the prior year’s benefits
• Over or underinsuring
• Passing up tax-free savings
• Assuming everyone should be on one plan
• Ignoring added benefits
• Forgetting to add your newborn.  You are required to add your newborn to your health insurance within 30 days of his/her birth in order to be covered by your plan.

Preparation for Open Enrollment

The good news is that most of the information you need is available online through your insurance portal.  Your prior claims also provide an abundance of information.  Our suggestions for getting ready:

• Calculate your cost of care for the current year including co-pays, deductibles, monthly payroll deductions, prescriptions, and any other out-of-pocket expenses related to health, dental or vision care to calculate your total health care expenses.  Then you can compare plans with accurate information.  Obviously, you won’t know what the future will bring, but you can make an educated decision.
• If you are married and you both have employer-sponsored health insurance, use the exercise above to compare your plans.  Determine if it makes sense to be covered on the same plan or to enroll individually on each of your employer’s plan.
• Make a list of prescriptions, providers and pharmacies to determine whether your needs were met.
• Jot down questions to research for the new year.  How have your needs changed this year?
• Do the same for childcare if you have the option to fund an FSA.
• Determine whether you are eligible for 401K or other retirement plan catch-ups.
• Make sure you take advantage of all employer matches.
• Check out this list.

Review your Options

It may be that your employer is offering an HDHP (high deductible health plan) in addition to or in lieu of a more traditional health plan.  If you are in good health, it is a good idea to seriously consider switching to such a plan. They allow you to fund an HSA (health savings account), which is the most tax-advantaged way to put money away for medical expenses for now and for the future. Read our blog on HSAs.

Medicare Open Enrollment

Even Medicare has open enrollment for existing Medicare enrollees who want to change their coverage.  We recommend speaking with a Medicare expert if you are thinking about changing your current coverage.  Some important points are:

• The open enrollment period is October 15-December 7 (every year).  The new plans are effective January 1 of the following year.
• It allows for switching from Medicare Advantage (Part C) to Original Medicare (Part A & B).
  • If you do this, you may also enroll in a stand-alone prescription drug (Part D) plan as well as a Supplemental plan.
• The reverse is also true.  You can switch from Original Medicare to Medicare Advantage and drop Part D.

Open Enrollment for the ACA

​Open enrollment in Illinois is November 1-January 15, 2024.  The ACA website does a great job of explaining and comparing plans.  The 2023 eligibility for ACA subsidies is available if you earn between $13,590 and $54,360 as an individual, or between $27,750 and $111,000 for a family of four.
Qualifying life events to enroll in an ACA plan:

• Loss of a job/health insurance
• Loss of a spouse
• Medicare eligibility
• Birth or adoption of a child
• Marriage or divorce

For help with open enrollment, please contact your company representative or a designated specialist.