It's the time of year that health insurance companies refer to as open enrollment, a term that only employers used to think about until the Affordable Care Act made the business of buying and understanding health insurance a national mandate for everyday people.
Now each year, we enter a period called open enrollment; when commercials hit the airwaves and billboards popup in our communities and on our highways, encouraging us to "sign-up!", "be well" or "get covered. Still, even with all of this advertisement, figuring out what we are supposed to do can be complicated. So here's a basic guide to help you navigate open enrollment. I hope it helps you approach this year’s open enrollment period with more grace and, most importantly, more power.
1. Open Enrollment refers to health insurance plans that you can buy. This year’s Open Enrollment period in New Mexico and the rest of the country runs from November 1, 2015-January 31, 2016. If you qualify for Medicaid, you do not have to purchase insurance. If your employer provides health insurance for you, you may want to skip to number 5 on this list.
2. Medicaid is health insurance that is not for sale; so you don't have to buy it! You qualify for Medicaid based on your household income and size. It is absolutely worth checking out! You can sign up for Medicaid anytime of year not just during the health insurance open enrollment period.
3. If you are 65 or older, your health insurance is Medicare. Medicare has an open enrollment period- meaning a time when you can sign up- versus a period throughout the rest of the year when you can't. Please check guidelines that are specific to Medicare to learn more. Currently, Medicare’s open enrollment period is a different time of the year than the one mentioned above.
4. If you are self employed, not covered by your spouse’s insurance, don’t qualify for Medicaid, don’t have a job that provides you health insurance and aren’t older than 65, you are fully responsible now, by law, for purchasing your own health insurance. It's not an option anymore, it's a mandate. For more information on your situation, skip to number 7.
5. If you have a job that provides health insurance, you are one lucky son of a gun! In all likelihood, the amount you pay through your employer is the lowest fee option you have. Although open enrollment advertisements may make you want to shop around and compare prices, unless you are paying above 9.5% of your annual salary for health insurance, it's almost impossible for you to get a lower rate and equal product by going outside of your job to buy your own insurance. As a result, my advice is to stay put and watch the trends. Jumping ship into the tremulous waters of open enrollment is unnecessary and, in my opinion, ill advised.
6. If you think you might qualify for Medicaid there are some amazing places that will help you sign up and you can even sign yourself up online. Some local entities that can help you get enrolled are La Familia, Centro Savila, La Casa and almost any federally qualified health clinic in the state. In Santa Fe, I also recommend St. Vincent's hospital as a reliable place for enrollment assistance.
7. If you must purchase insurance because you are self employed, or have a job that does not provide you with health coverage, you’ll need to figure out how to navigate the purchasing process. In short you'll need to:
-pick a plan-pick a place to sign up-prepare to start paying a monthly amount to cover your health care-get used to an imperfect and often expensive health insurance system
To sign up you will need to provide specific documents. To view a list of what paperwork you need to complete the process of buying health insurance visit: bewell.nm.com, click on “how to enroll” and look at the list under the “be prepared” tab. If you don’t have the internet call 877-958-4556 between 9am-5pm to find out what documents, you’ll need.
If purchasing insurance, I recommend you give some thought to what you can afford to pay each moth for your coverage. Do your best to pick an insurance plan that comes as close to meeting your health and budget needs as possible. Plans can range anywhere from approximately $60 to $450 a month and the cost depends on a lot of things, including but not limited to, what kind of plan you pick; how high your deductible is; your age; whether or not you smoke cigarettes; how much you earn; whether or not you receive a subsidy (a subsidy is kind of like a health insurance partial scholarship) and other things.
8. Health enrollment staff and brokers are awesome people who care and want to help you get health insurance during the open enrollment period. However, the quality of their services may vary and even when working with the most knowledgeable staff your emotions and satisfaction may be tested and you can end up picking a plan that isn't really right for you. The entire country is still figuring out how to implement this new way of buying, selling, using and managing health insurance and sometimes the information that we need isn’t readily available. Even this guide is just a start. Please work with your local enrollment personnel because they know about the enrollment process, but keep in mind that 99% of them don't know everything.
9. In New Mexico, this year, there are four insurance companies and numerous plans for you to choose from. The following companies are offering health plans in New Mexico during the open enrollment period through the exchange: Christus Health, Molina Market Place, Presbyterian and New Mexico Health Connections.
10. Whether you are buying insurance or applying for Medicaid, don't wait till you get sick or the open enrollment period ends. You can't buy car insurance to pay for an accident after it happens and you can't buy health insurance to pay for your medical treatment after you get sick or have an accident. Having health coverage in America is now a right and responsibility and the system that delivers it is ours to navigate, change and master.