How to Prepare for Open Enrollment: Best Practices for Health Insurance

Last Updated on November 11, 2024 by VantagePoint

Since the open enrollment period for 2024-2025 began on November 1, employees, individuals, and HR teams now have the opportunity to review and choose health insurance plans that best meet their needs. This annual opportunity is essential for securing the right coverage and avoiding costly gaps in care. 

At Vantage Point Benefit, we understand that navigating the complexities of health insurance can be overwhelming, which is why we’re here to simplify the process with tools, insights, and guidance. So, please do get in touch with our team of professionals.

Below, we outline key steps and best practices to make the most of the enrollment season.

Why Open Enrollment Matters

Open enrollment is the designated period when individuals can enroll in or make changes to their health insurance plans. Missing this window could mean going without coverage until the next cycle or experiencing higher costs. For 2024-2025, the open enrollment period for most states runs from November 1, 2024, through January 15, 2025. This timeframe is critical for both employees and HR teams in managing benefits.

VantagePoint offers up-to-date resources and support for our clients, ensuring you’re aware of these key dates and providing reminders to help you stay on track.

Review Your Current Health Coverage and Needs

Reviewing your existing health insurance coverage is one of the most critical steps in preparing for open enrollment. Taking a close look at your current plan’s benefits and limitations can help you determine if your coverage meets your needs or if it’s time to explore other options.

Analyze Your Past Year’s Healthcare Utilization

• Start by reviewing the healthcare services you used over the past year. This includes doctor visits, specialist consultations, medications, and any major treatments or hospital stays. Were your expenses in line with your plan’s coverage? Did you find yourself paying significant out-of-pocket costs? If you’ve spent a lot on uncovered services, you might benefit from a plan with broader coverage.

• Did your plan cover the majority of your healthcare expenses, or were there areas where coverage fell short? For example, if your current plan has high copays for specialist visits and you anticipate needing more specialized care, consider exploring a plan with lower copays or one that doesn’t require referrals.
  

Identify Any Anticipated Healthcare Needs

• Plan for Major Life Changes: Are you expecting any major life changes in the coming year? For example, if you’re planning to start a family, need regular physical therapy, or are approaching an age milestone that may require more frequent screenings, your insurance needs may increase. Plans with lower deductibles or higher premiums could save you money if you foresee increased medical expenses.

• Long-Term Health Management: If you have a chronic condition like diabetes, asthma, or heart disease, you may need more consistent and predictable coverage. Plans with low out-of-pocket maximums can be beneficial, as they help limit your total annual spending. Review how well your current plan supports chronic condition management, including medication costs, specialist visits, and preventive care.

Assess the Value of Additional Benefits

• Mental Health and Wellness: Many health insurance plans now offer wellness benefits and mental health services, which are essential to consider. If these services are important to you, review whether your plan covers therapy, counseling, or wellness programs. Additionally, some plans offer gym memberships, wellness incentives, or access to virtual care, which can add value.

• Telehealth Options: Telehealth has become a popular option for convenient healthcare access. If you regularly use telemedicine or anticipate needing virtual visits, ensure your current plan includes this service or consider plans that offer more comprehensive telehealth support.

Examine Your Plan’s Network and Provider Flexibility

• Provider Access: Does your plan cover the providers you currently use? Insurance plans often have network limitations, and switching to a different provider network could mean higher out-of-pocket costs. If you’re attached to a particular healthcare provider or facility, confirm they’re included in your network. If your current plan restricts you from accessing preferred providers, a PPO or EPO plan with broader access might be worth considering.

• Specialist Access and Referral Requirements: Certain plans, like HMOs, require referrals to see specialists, which can add steps to getting care. If you prefer direct access to specialists, a plan with fewer restrictions might be a better fit for you.

Health insurance plans come in different types—PPO, HMO, HDHP—and each has unique advantages.

Differences between PPO, HMO, HDHP

A PPO plan ((Preferred Provider Organization) might offer more flexibility in choosing providers, allowing both in-network and out-of-network care at higher premiums and potential out-of-pocket costs.

Example Scenario PPO plan:

If you visit a specialist under a PPO plan without needing a referral, you could go directly to that specialist. If the specialist is in-network, you would pay a lower copay or coinsurance. If the specialist is out-of-network, you might pay a higher share of the cost but still have partial coverage from your plan.

An HMO ((Health Maintenance Organization) plan is a type of health insurance plan that requires members to receive care from a network of designated healthcare providers and typically mandates selecting a primary care physician (PCP) who coordinates all care and provides referrals to specialists when needed. HMO plans generally have lower premiums and out-of-pocket costs but less flexibility in choosing providers compared to PPO plans.

Example Scenario HMO plan:

Imagine you have a health issue that requires a specialist’s attention, such as persistent joint pain. Under your HMO plan, you first need to visit your primary care physician (PCP), who assesses your condition. Your PCP decides that seeing an orthopedic specialist is necessary and provides a referral. You then visit the specialist within your HMO’s network, ensuring that your care is covered at a lower cost. If you choose to see a specialist without obtaining a referral or outside of the HMO network, you might have to pay the full cost out of pocket, as most HMO plans do not cover out-of-network services except in emergencies.

An HDHP (High Deductible Health Plan) is a type of health insurance plan characterized by higher deductibles and lower monthly premiums compared to traditional insurance plans. HDHPs are designed to cover serious health issues and major medical expenses, but they require the insured to pay more out-of-pocket costs before the insurance coverage starts. These plans are often paired with a Health Savings Account (HSA), which allows individuals to save pre-tax money to use for qualified medical expenses, helping offset the higher deductible.

Example Scenario HDHP plan:

If you are enrolled in an HDHP and visit the doctor for a routine check-up, preventive care might be fully covered without needing to meet the deductible. However, if you require surgery or specialized care, you would need to pay out-of-pocket until the deductible is met. Once you reach your deductible, the plan starts covering a significant portion of your healthcare expenses, often with coinsurance until you hit the out-of-pocket maximum.

Comparing these options involves examining premium costs, deductibles, and out-of-pocket maximums.

Vantage Point Insight: Through our personalized benefits review and our comprehensive comparison tools, we help clients analyze their current plans, identify any gaps, and explore options that could provide better coverage or savings, allowing clients to weigh plan options side by side, empowering you to make informed, confident decisions.

Get Familiar with Key Insurance Terms

Understanding terms like deductible, copay, and out-of-pocket maximum can make a big difference in your decision-making. A lower premium might be appealing, but if it comes with a high deductible, it could lead to unexpected costs if healthcare needs increase. For a more detailed list of health insurance terms, check this glossary.

Leverage Employer-Provided Resources

Employers often offer resources to help employees understand their health benefits, from HR consultations to informational webinars. Taking advantage of these resources can provide insight into your plan’s full range of benefits.

Consider Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs)

HSAs and FSAs are tax-advantaged accounts that can help cover healthcare costs. HSAs (health savings accounts) are available to those enrolled in high-deductible health plans, and the funds can be rolled over year to year, while FSAs (flexible spending accounts) typically require you to use funds within the year. Both options offer significant tax savings and can ease out-of-pocket expenses. We’ve covered these topics on our blog, so make sure you check them out.

Vantage Point Benefit Tip: Our advisors can walk you through the eligibility and benefits of these accounts, helping you make the most of tax-advantaged savings options.

Gather Essential Documents Early

To expedite the enrollment process, have the necessary documents ready. This may include your current insurance details, dependent information, and records of recent medical expenses. Being organized can save you time and prevent errors during enrollment.

Vantage Point Checklist: We provide a pre-enrollment checklist to ensure you have everything you need to make your enrollment process smooth and hassle-free.

Set a Reminder for Open Enrollment Deadlines

It’s easy to lose track of deadlines during the busy holiday season, but failing to enroll on time can lead to costly coverage gaps. Set up a digital calendar reminder or an alarm on your phone to stay on top of deadlines.

Vantage Point Service: Our clients benefit from timely reminders and alerts to keep important deadlines front and center.

Double-check and Confirm Your Enrollment Details

Once you’ve chosen your plan, review all coverage and cost details before submitting your enrollment form. This final step can prevent surprises later and ensures that the plan you chose will be effective in the new year.

Vantage Point Assistance: Our support team is available to help you double-check and confirm all enrollment information, offering peace of mind that your coverage is correctly set up.

Conclusion

The open enrollment period is an invaluable opportunity to secure the right health insurance coverage for the coming year. With preparation, careful review, and the support of a trusted benefits partner, you can navigate this process confidently. At VantagePoint Benefit, we’re dedicated to guiding you through each step—from understanding plan options to setting reminders for critical deadlines—ensuring that you and your team are prepared for a successful enrollment season.

If you’re looking for personalized guidance on navigating open enrollment or need additional support, please contact our team or request a demo! Our experts are here to answer questions, provide resources, and help you make informed choices for your health and financial well-being.