Open Enrollment For Insurance Plans

Open enrollment — the annual period when you can renew or adjust your health insurance coverage — can feel overwhelming. The process can feel confusing and time-confusing, and it might be tempting to go with the first insurance options you come across. However, taking the time to review your choices carefully could save you money and spare you unnecessary stress down the road.

To make the process more user-friendly, we’ve created this guide that provides:

• Open Enrollment Terminology that help you make informed decisions
• Age-based information and things to consider
• Frequently asked questions

Investing a bit of effort in reviewing your options can lead to savings, provide peace of mind, and protect you from unexpected financial stress in case of a health emergency. While it might be tempting to choose an insurance plan based solely on its monthly premium, it’s beneficial to consider the details of each option and assess both your personal and family health needs before making a final choice.

Open enrollment terminology

Before you begin, it’s helpful to understand the following terms:

• Coinsurance: The percentage of the cost for services and treatments that you’re responsible for.
• Copay: A flat fee you pay for doctor visits, which can range from $10 to $30 (or more) for office visits and be higher for hospital admissions.
• Deductible: The amount you must pay for medical services during the calendar year before the insurance starts paying.
• HMO (Health Maintenance Organization): Requires choosing a primary care physician who coordinates your care within a network; generally doesn’t cover out-of-network visits.
• Network: The set of providers (physicians, specialists, clinics, hospitals) that accept your insurance plan.
• Out-of-pocket maximum: The limit you’ll pay for covered services in a year before the plan covers 100%. The specifics vary by plan.
• PPO (Preferred Provider Organization): Offers more flexibility than an HMO, allowing you to see both in-network and out-of-network providers, though costs are generally lower in-network.
• Premium: The monthly fee your employer or insurance provider charges for coverage.

Learn more about the Differences between PPO & HMO Insurances

What to Consider Based on Your Age

20s to 30s
Once you reach 26 and are no longer covered under a parent’s plan, you’ll be responsible for your own health insurance. If you’re generally healthy, your focus may be on preventive care and occasional treatments for common illnesses.

Consider finding a primary care provider you trust and noting the locations of hospitals and clinics included in a plan: Are they close to your home or work?

It’s helpful to think about when and where you’re likely to need care. Do you tend to plan and schedule appointments, or are you more likely to rely on urgent care?

If you have children, consider their healthcare needs as well, such as the availability of a nearby pediatrician or any required specialists.
Visit the List Of Health Insurance Plans We Accept at RRH.

40s to 60s
At this stage, regular preventive exams like mammograms and colonoscopies become essential. When evaluating plans, consider the convenience of locations for these services. People in this age group often balance work, family care, and sometimes elder care, making accessibility a key factor.

Since unexpected health events can lead to high costs, it may be worth considering a plan with a higher premium but lower deductible and out-of-pocket limits. Examining the details of each plan can help you avoid surprises.
Visit the List Of Health Insurance Plans We Accept at RRH.

Adults 65+
Older adults may have specific needs when choosing a health plan. Some are still working with employer coverage, while others are retired and may have ongoing medical needs. For those on a fixed income or with chronic health conditions, it’s important to assess plans based on anticipated medical services.

Medicare offers multiple plan options, including Original Medicare and Medicare Advantage, both of which have different coverage levels for hospital stays and prescription medications. Reviewing your past year’s healthcare needs can help anticipate the next year’s requirements.

Added benefits like travel assistance to medical appointments or coverage for acupuncture and chiropractic care are also available in some plans.
Visit the List Of Health Insurance Plans We Accept at RRH.

Useful Information

List Of Health Insurance Plans We Accept
How Health Insurance Works
Differences between PPO & HMO Insurances

For inquiries about health insurance plans, email admitting@rrh.org or call (760) 499-3750

Frequently Asked Questions

When is open enrollment?
Open enrollment typically takes place in the fall for coverage starting the following year. For insurance through Covered California, open enrollment runs from Nov. 1 to Jan. 31. Medicare’s enrollment period is from Oct. 15 to Dec. 7, and the federal enrollment period spans Nov. 1 to Jan. 15.

Where can I get help?
If your coverage is through your employer, the HR department can answer questions. You may also contact your insurance provider for specific inquiries. For those in California buying insurance through the marketplace, visit Covered California. Outside of California, go to Healthcare.gov and click “find local help” to explore coverage in your state.

How do I find out what’s covered?
Don’t rely solely on a simple plan summary. For complete details, review your Evidence of Coverage document, which outlines all covered and non-covered services. It’s lengthy but valuable, both when choosing and using your plan.

What if I miss open enrollment?
If you miss the period, you’re generally locked into your current plan unless you experience a Qualifying Life Event, such as losing existing coverage, moving, changing income, or having a change in household (e.g., marriage, birth of a child).