Open Enrollment, Alternative Care, and Health Plans, Oh My!

T’is the season for new healthcare benefit plans!

If you haven’t heard already, open enrollment began on November 1 and runs through Jan 31. In response to requests for some guidance about things to look for in a healthcare plan for coverage in our office, we have put together some tips and helpful information for you! But first, Some basics:

Important dates for 2016 enrollment

  • November 1, 2015: Open Enrollment started — first day you can enroll in a 2016 insurance plan through the Health Insurance Marketplace. Coverage can start as soon as January 1, 2016.
  • December 15, 2015: Last day to enroll in or change plans for new coverage to start January 1, 2016
  • January 1, 2016: 2016 coverage starts for those who enroll or change plans by December 15.
  • January 15, 2016: Last day to enroll in or change plans for new coverage to start February 1, 2016
  • January 31, 2016: 2016 Open Enrollment ends. Enrollments or changes between January 16 and January 31 take effect March 1, 2016.

If you don’t enroll in a 2016 health insurance plan by January 31, 2016, you can’t enroll in a health insurance plan for 2016 unless you qualify for a Special Enrollment Period.

See if you qualify for savings right now

Before you apply, you can quickly see if you’ll qualify for savings based on your income. Most people who apply do qualify — this year, about 8 in 10 of the uninsured eligible for Marketplace coverage qualify for savings that lower the cost of their monthly premiums.

Medicaid & CHIP – apply any time

City Fit Tips:

  1. The first thing you want to do is consider what kind of healthcare consumer you are: You’ll want to keep in mind the type of providers you see most regularly (Chiropractor, Physical Therapist, Osteopathic Doctor, Medical Doctor, Counselor etc.), as well as how frequently you have appointments barring emergencies or unexpected injuries. This information will provide you with a basis for the kind of coverage you’re looking for beyond catastrophic coverage.
  2. As you are comparing plans, make sure you take note if your deductible applies to the services you use most frequently: for our office, make sure you check your chiropractic benefit, physical therapy benefit (massage is often covered under this benefit in the absence of a specific massage benefit) and massage therapy (if available).
  3. Many plans impose annual limits for chiropractic coverage. Sometimes this is in the form of visits per year, and sometimes it will be a dollar amount per year. Dollar benefit limits refer to the amount the plan will pay for those services. Typical routine visits are between $35-120, depending on the services you receive. 1-Hour massage visits run between $75-135. *These are estimate only, and will vary depending on your treatment history and the specifics of each visit; please contact the office for personalized information.
  4. Some plans also require authorizations for certain services, which  means that the benefit will be listed, and may list a visit limit, but will be subject to authorization. This means that while your plan provides coverage for up to, say, 60 physical therapy visits, you will need approval from your insurance carrier and they may deny authorization after 18 visits based on their medical necessity criteria.
  5. This form may help in comparing benefit plan options!

In addition to premium costs, you’ll want to understand which services are applied to your deductible and factor in co-payments and co-insurance costs. For a visual explanation of how these costs accumulate, see the short video below:

If you would like more details on insurance companies or specific treatment history information, please contact Sophia here!