Open Enrollment: Q&A to Help You Get Ready

Hi! I’m Tara, and I’m a social worker for the Arthritis Foundation Helpline. When I’m not at work, you can usually find me in the garden. Over more than 20 years as a social worker, I’ve had many roles helping people. At the Arthritis Foundation. I’ve answered thousands of questions about arthritis, how to manage it and the best ways to get and pay for care.

You may start to notice a lot of commercials and billboards touting “open enrollment” health insurance coverage benefits. With all the dates, benefits, costs and abundance of other information, it can feel overwhelming. Chances are you have questions.

I’ve rounded up some of the most popular questions patients have about open enrollment – along with answers that can help you secure the best plan for your care. I hope this information will benefit you or someone you know with arthritis. If you have individual questions, reach out to me directly at 1 (844) 571-HELP(4357) or helpline@arthritis.org.

What is open enrollment?
Open enrollment is an opportunity to get or change your health insurance. Enrollment dates vary by the type of plan you are applying for:

  • The enrollment period for Medicare opens Oct. 15 and continues until Dec. 7.
  • Enrollment for Affordable Care Act State Insurance Exchanges lasts from Nov. 1 to Dec. 15.
  • Many workplaces that offer insurance provide a yearly opportunity to opt-in, review and change plans – dates vary.

Where do I even start?
The Arthritis Foundation’s Your Coverage, Your Care toolkit is the best place to review insurance terms and learn strategies for choosing and managing a health care plan. Plus, it includes additional resources on paying for care.

Both Medicare and Affordable Care Act options offer a menu of plans. In general, Medicare is available when you turn 65 or if you qualify due to a disability. Affordable Care Act Exchange plans are available to all U.S. citizens. However, if you have insurance through an employer, it’s typically offered at a lower cost than exchange plans. If you have question about an employer plan, it’s best to contact your human resources department.

I like my current plan. Should I re-enroll or make a switch?
Maybe. Even if you love your current health plan, it’s smart to review your plan, your budget and any upcoming medical changes or expenses. There are some handy budget tools in the Your Coverage, Your Care toolkit.

What factors does my arthritis have on my insurance choices?
Let’s face it, arthritis can be pretty expensive. All of the primary care visits, specialists, medications, surgeries, equipment and physical therapy can add up! Consider your current and upcoming treatment needs, too. Will you need X-rays or an MRI? Are you considering surgery? If you’re taking a biologic medication, be sure your medication is on the formulary list. Plus, if you’ve used a copay card, know that it will not be available with a Medicare plan.

Are my doctor and medicines covered?
You’ll need to check every year. New online tools allow you to search for doctors, medications and services that are covered or in-network (lower priced). If you have trouble with the tools, there are phone numbers and in-person help available. If you want your medications covered, be sure to opt into a Part D plan.

What do all these insurance terms mean?
Reading through insurance plans isn’t anyone’s idea of fun. But with a little help and patience, you can really boost your insurance IQ. The Your Coverage, Your Care toolkit has a great glossary you can use as a guide and reference.

Where can I find local help?
Local resources are available in communities all around the country, which can be helpful as you navigate your care.

Medicare: Each state has a free Senior Health Insurance Information Program (SHIIP) https://www.shiptacenter.org/.

Affordable Care Act: Find a local navigator at https://localhelp.healthcare.gov/#/.

Live Yes Connect Group leaders may plan a meeting featuring insurance and coverage topics. Find local meeting info at https://liveyes.arthritis.org/.

Need to talk right now?
Call the Helpline at 1 (844) 571-HELP(4357) or email helpline@arthritis.org.

Take a quick quiz to see how well you understand your open enrollment options.

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