Each year, usually in the fall, you have the chance to change or sign up for health insurance coverage. Here is a review of what you need to know in order to enroll in a plan, whether you are getting insured for the first time, or are switching plans.
What Are Open Enrollment Terms I Need to Know?
When you review your options for health insurance, there are some terms you need to know so you can make the best decision for you and your family.
A Health Care Provider is a person who is trained and licensed to provide health care, such as a doctor or nurse.
Open enrollment refers to the time period when you can add or change your health insurance. Outside of that time frame, you can only make changes if you have a certain change in your circumstances.
A Special Enrollment Period is a time outside the yearly open enrollment period when you can sign up for health insurance through the marketplace. Certain life events will qualify you for this enrollment period, like getting married, having a baby, adopting a child, moving, or losing health coverage.
Your monthly premium is what you pay each month for the cost of your health insurance plan.
There are also costs you pay each time you need care. These are called out-of-pocket costs.
Out-of-pocket pocket costs include:
- A Deductible is what you pay each year for health care services or medicines before your insurance begins paying.
- Copayments are what you pay to see a health care provider. For example, it may cost $15 to see your primary care doctor and a visit to your asthma specialist might cost $30.
- Coinsurance is the percentage of your your medical expenses you must pay, including medicines, hospital stays, office visits, etc.
- Covered services means what your health plan will pay for. This includes medical treatments and prescription medicine.
Finally, know which doctors, specialists and other health care providers are in-network or out-of-network.
- In-network means that your health plan has an agreement with that a group of specific providers for your health care. Copayments and other costs generally cost less if you use in-network providers.
- Out-of-network means there is no agreement between the health insurance company and the provider. Your costs will be higher to see a health care provider out of network.
For more insurance definitions, see this list of common terms.
The Asthma and Allergy Foundation of America (AAFA) has a Support Center for general inquiries to help you better understand health insurance.
Where Can I get Health Insurance?
Millions of Americans get health insurance through their jobs. If your employer does not offer health insurance benefits, you have other options.
You can buy insurance through the Health Insurance Marketplace, created by the Affordable Care Act.
Open enrollment for these plans ends on Dec. 15, 2022 for coverage that starts on Jan. 1, 2023. You can apply until Jan. 15, 2023, for coverage that starts Feb. 1, 2023.
If you don’t act by Jan. 15, 2023, you can’t get coverage for 2023 unless you qualify for a Special Enrollment Period.
When you apply for insurance, you'll find out if you qualify for financial help to pay your monthly premiums.
Updated November 2022