Open Enrollment season can be intimidating. Let's all help each other out in the comments -- what's your biggest tip for picking the right health plan? 🤔

Because the Open Enrollment Period (OEP) begins next month, now is a good time to evaluate your needs and understand your plan heading into 2025, whether you have coverage through the ACA, an employer, or Medicare/Medicaid.

This issue, we'll focus on simplifying the Open Enrollment process and the need to understand your network options, benefits and covered prescription drugs to make an informed decision.

(And for my friends who work in healthcare, I'm sure all of us are familiar with our neighbors, friends and family asking us how to pick a "good" plan. When you're sitting around the table this Thanksgiving and you get asked this question, you'll now have a framework to share! 😄).

1. Understand your options

There are several ways to get health insurance, whether through the Health Insurance Marketplace/Affordable Care Act (ACA), Medicare/Medicaid, or employer-sponsored plans.

Regardless of your insurance coverage, you should be informed on the following going into Open Enrollment:

• Your network -- Who are your current (and potential) care providers? Are they in or out of network in the plan options available?
• Your benefits -- Which services are important to you based on current and future health needs?
• Your prescription drug needs -- What drugs are you currently taking, are they on the formulary and on what tier?

2. Remember key dates

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No matter your insurance coverage or plan, I encourage early action to avoid stress and last-minute decision-making.

For Medicare coverage, the Annual Enrollment Period (AEP) begins every year on October 15th and ends on December 7th. Information for the upcoming year's plans is always made available starting in October. You'll need to review the materials your insurance plan sends you, including both your Evidence of Coverage (EOC) and Annual Notice of Change (ANOC) to make sure they still align with your care needs. Following the AEP, Medicare Advantage plan members can make any final changes to their coverage between January 1st and March 31st. For more on this topic, check out my 2022 LinkedIn article that simplifies Medicare Open Enrollment Periods!

For Marketplace coverage, the 2025 OEP begins November 1, 2024, and ends January 15, 2025, in most states. Some states have slightly different ranges depending on if they have their own ACA exchanges. See here for a full state-by-state breakdown of OEPs.

If you miss the deadline to enroll, you can potentially be eligible for a Special Enrollment Period (SEP) if you have experienced a qualifying life event. These can include circumstances like marriage/divorce, childbirth, a family death, the loss of insurance through employment, etc. Select states also offer short-term health insurance plans for up to four months outside of OEP, although these plans don't cover pre-existing conditions.

If you're under a certain income level, you can also enroll in Medicaid or the Children's Health Insurance Program (CHIP) at any time of the year (even outside of OEP). These plans provide free or low-cost coverage to low-income families, children, pregnant women, the elderly and people with disabilities.

3. Be aware of what's changing

As we head into OEP, you should be cognizant not only of your own health needs and how they're evolving but also of changes to the broader health plan landscape.

Regardless of plan or provider, individuals should be defining (and anticipating) coverage needs for themselves, spouses and dependents, as well as thinking through total costs, provider networks and additional benefits needed (i.e., Vision, Dental, Orthodontics, etc.).

In terms of the Medicare landscape specifically, this is going to be one of the most challenging years for seniors and enrollees as they're thinking about coverage for next year. Medicare Advantage offerings are shrinking in 22 states, with Pennsylvania seeing the largest number of plan exits in 2025. More broadly, other factors to be aware of include the rise in scams and misleading information, as well as an increase in premiums which could be around 7% higher due to rising costs from increased utilization and coverage of weight management drugs. Additionally, this year's sign-up process could take longer due to increased helpline wait times. This comes after federal regulators implemented rules earlier this year to have beneficiaries authorize changes when working with new agents following consumer reports of being enrolled or switched into new plans without their consent.

Even with changes like these, I was surprised to find a majority of Medicare Beneficiaries do not compare their options nor review their plan for changes in costs or services during OEP, according to a 2022 study from KFF. This disparity was more likely to be pronounced for certain subgroups, especially the elderly, those who self-reported poor health statuses, Black and Hispanic populations and low-income individuals.

In the same study, I was even more alarmed to see Medicare's information library and resources not being taken advantage of to their fullest extent (which I'm sure is a finding that would, unfortunately, translate to other areas in healthcare). Beneficiaries are largely aware these exist but often don't take the time to use or understand them!

I know there is probably a temptation to do nothing and let existing coverage roll into the next year, but there is still a need to ensure coverage and optimize the value you're getting -- especially with the number of offerings and benefits being withdrawn from certain markets.

Not sure where to start? Check out these resources:

• The open enrollment checklist: 8 questions to ask before reviewing your plan
• State Health Insurance Assistance Program (SHIP): Local Medicare Help
• National Council on Aging (NCOA): Who is the Best Person to Talk to About Medicare?
• ACA Marketplace: Checklist PDF
• ACA Marketplace: Contact Us
• ACA Marketplace: Find Local Help
• ACA: How to estimate your expected income
• Your employer's HR department/Benefits helpline

Looking Ahead + Final Thoughts

Be informed and proactive when making choices during Open Enrollment. I'm sure we all spend hours researching things like new phones, computers and cars, so we should do the same for something as important as healthcare coverage too.

As we saw earlier in this issue, it's incredibly important to self-educate in this process as things rapidly change but aren't necessarily publicized. If you don't actively review your plan, there could be a big financial implication down the line (something not fun like a surprise out-of-network bill!).

Remember -- there is always someone there to help simplify healthcare for you. Start early, and be sure to use all the resources at your disposal!

I'd love to hear from you -- let me know your tips for Open Enrollment or any other healthcare topics you want to see discussed in the comments! My tip: Take 2 hours at minimum to review your coverage options by yourself or with a loved one, write down all questions on a piece of paper and consult those helplines ASAP.

Want a sneak peek at the November issue? I invite you to tune in next month, where I'll be "Simplifying Ruth" -- a look into my day-to-day role, my path to healthcare and the important work happening across Ayin and Providence.

Until next time.

-Ruth 🌸

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