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Open enrollment true and false

Think you understand open enrollment? Think again.

Think you understand all of your options during open enrollment? Check out these common assumptions and see which ones are true, false and somewhere in between.

If one of my employer plans includes MultiCare, they all will.

FALSE. If your job offers more than one health plan option, those plans often vary in the amount and type of coverage options they offer. So, while they may very well all include MultiCare providers and services, they may not. Don’t make assumptions! The only way to know for usre is to check each plan offered to see if your preferred doctors and hospitals are in-network. 

If I get my insurance through my job, I don’t have choices. 

MAYBE. Most larger employers offer more than one option for coverage. But sometimes, especially with smaller companies, there is only one choice. If that’s the case where you work, it’s take it or leave it.

But wait. I can’t leave it. If it’s offered, I have to enroll in my employer-sponsored health insurance.

FALSE. And there are reasons to turn it down. 

Usually you’ll find the plans offered through your job are the most affordable options because employers subsidize some of the monthly premium costs. But you can always to buy your own through the Washington State Healthcare Exchange (as long as you enroll during the Exchange’s own open enrollment period). You may also have the option to opt in to coverage through your spouse’s job.

In fact, if the premiums aren’t too high, you can often get coverage through both your employer and your spouse’s employer (Not all employers allow this. Make sure you read your job’s and your spouse’s job’s rules for this kind of double coverage). Your spouse’s insurance would be deemed as “secondary” coverage to pick up whatever your plan doesn’t pay. Whether this makes sense for you depends on how much it costs you and how much you anticipate using your insurance.

If I don’t sign up during open enrollment I’m out of luck for the year.

This is mostly TRUE. But not always. You can add health coverage outside of normal open enrollment windows if you experience a “qualifying life event.” If that happens, you have a window of time — usually 60 days — to get new coverage. QLEs come in four basic flavors:

  1. Loss of coverage. Anything that makes you lose coverage that’s outside of your control, whether it’s a change in job/job loss or turning 26 and getting automatically dropped from your parents’ coverage, is a qualifying life event. Losing coverage because you didn’t pay your premiums is NOT a qualifying event.
  2. Change in family size. Having a child (whether through birth, marriage or adoption), getting married, getting divorced or a death of a family member are qualifying life events if it affects your insurance needs.
  3. Moving. If you move to a new zip code or county, you might be able to change coverage. Same if you’re a seasonal worker or a college student going out of the area. 
  4. Other. If your finances change and you become eligible for Medicaid, you can sign up outside of open enrollment. Likewise, turning 65 allows you to apply for Medicare coverage, even if your birthday happens outside of Medicare’s annual open enrollment period. Getting out of jail or prison or becoming a U.S. Citizen are also qualifying life events that may allow you to sign up for health insurance.

I already have insurance so I don’t have to do anything during open enrollment.

MAYBE? Here’s the deal. Plans change — and not just your plans, but your insurance plans. What was covered this year may be excluded next year. In-network providers might have changed along with deductibles and premiums Look at the plan description for the coming year and make sure any changes are acceptable to you.