INDIANAPOLIS — Open enrollment season is back for many Hoosiers, with the window opening for everyone on Nov. 1.
Experts in Indianapolis say if you are feeling overwhelmed by your health care coverage options, you're not alone.
"Forbes did a study recently, and they determined that 77% of people had trouble with basic health care coverage terms," said Managed Health Services Plan President and CEO Kevin O'Toole.
Every year, O'Toole said, employers will offer open enrollment through commercial plans. Hoosiers can also access health care coverage through Medicare, Medicaid and the Health Insurance Marketplace.
Medicare is health insurance for people 65 or older, as well as some people under 65 with certain disabilities or conditions.
Medicaid provides coverage to people who meet certain income or resource criteria.
"Then there's the Marketplace," O'Toole said. "In the Marketplace, open enrollment is starting November 1 and goes through January 15."
The Health Insurance Marketplace allows anyone, regardless of income level, to shop for and compare plans.
"It is a really important time to make sure you've got health care coverage, so that you can get the preventative care that you need to stay healthy and live your best life," O'Toole said.
Selecting the appropriate plan can be confusing, O'Toole admitted. He said it is important to consider a few key questions when making your selection this fall.
For one, do you have a specific health care provider, and do you wish to continue seeing that physician?
"It can be troublesome if you pick and plan, and then your provider is not part of that plan," O'Toole said. "Some plans will let you see any provider or have a wide variety of hospitals and providers in their network, and others have a very narrow network, and not all hospitals or providers are in that plan."
Next, O'Toole said it's important to understand the total cost – both the monthly cost and the out-of-pocket costs.
Depending on your individual health care needs, it may or may not be best to choose a plan with a higher premium.
"It's about understanding the impact of these decisions to you and your family," O'Toole said.
O'Toole said there are a few key terms to know when it comes to the overall cost:
- Monthly Premium: the amount you pay to your insurance each month to have health insurance.
- Deductible: the amount you spend for covered health services before your insurance company pays anything.
- Copayments: payments you make to your health care provider each time you get care.
- Out-of-pocket maximum: the most you have to spend for covered services in one year. After you reach this amount, the insurance company pays for 100% of covered services.
The tricky part, O'Toole said, it making sure you select a plan that will protect you and your family from the unexpected.
"From a peace of mind standpoint, I recommend getting coverage and protecting your financial situation for yourself and your family, but again it's individual," O'Toole said. "It depends on what your financial situation is, what services you expect to use, and how you feel about particular hospitals or doctors."
The good news is, according to O'Toole, there are free resources to help Hoosiers decide which options are best.
One of the best tools, O'Toole said, is healthcare.gov. Hoosiers can start for free by simply entering a zip code.
"For many people, actually the majority of people, you can qualify for health care coverage through the Marketplace program at healthcare.gov for little to no cost to yourself," O'Toole said.