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Residents prepare for open enrollment season


Last updated 11/30/2017 at Noon

Greg Wright

Special to Village News

More than 22.5 million Californians, including more than 500,000 who are Medicare eligible in San Diego County, are in the process of selecting or switching their health benefits plans during open enrollment. So now is the time to prepare for that important decision that usually happens once a year.

More than 70 percent of Americans said they are prepared for open enrollment yet most people struggle to understand basic health insurance terms, according to a recent UnitedHealthcare survey. Only nine percent of survey respondents could successfully define all four basic health insurance concepts: plan premium, deductible, co-insurance and out-of-pocket maximum.

Here are five tips that can help make the most out of any health benefits and better understand how to use health care dollars.

First and foremost, know the open enrollment dates. Open enrollment isn’t the same or at the same time for everyone, so there are key dates to keep in mind depending on individual situations.

For the more than 177 million Americans with employer-provided coverage, many companies set aside a two-week period between now and December when employees can select health benefits for the following year.

For the more than 58 million seniors and other people enrolled in Medicare, their open enrollment runs from now to Dec. 7 each year.

Health insurance marketplace or individual state exchange open enrollment runs from now to Dec. 15. For most people, changes made to coverage during open enrollment take effect Jan. 1, 2018.

Next, take time to review every option. Every person or family has unique health and budget needs, so there is no one-size-fits-all approach to selecting a health plan. Take the time to explore the options, to understand the benefits and costs of each plan and to find the coverage that works best for each individual and the whole family.

Check to see if the current coverage still meets needs and if the benefits will change in the next year. Determine if the plan is a good fit for the budget and pay attention to more than just the monthly premium. Understand the other out-of-pocket costs, including deductibles, copays and coinsurance.

Make sure any medications are covered. Even without expected plan changes, it’s important to ensure specific medications will still be covered next year.

Check the doctors who are in the plan’s network to ensure that any doctor that is seen regularly is in the benefit plan’s care provider network. If a patient is planning to visit a doctor or hospital outside of the network, be sure to understand how the costs will differ from a network care provider because those costs will most likely be higher.

Also, check if the plan includes 24/7 telehealth services for consultations on minor health issues. Often, telehealth – defined as online, or virtual, visits with a doctor over a computer, tablet or mobile phone – is available to people enrolled in employer-sponsored health plans and group Medicare Advantage plans, as well as select individual Medicare Advantage plans. Virtual visits may provide convenient and affordable access to care for minor medical issues, including allergies, bronchitis and seasonal flu.

Lastly, don’t forget about additional benefits, such as dental, vision, accident or critical-illness insurance, which are often affordable options. For people enrolled in Medicare, many are surprised to find that Original Medicare doesn’t cover prescription drugs and most dental, vision and hearing services. But many Medicare Advantage plans do, often at a $0 monthly premium beyond the premium for Original Medicare.

Take advantage of wellness programs. Some health plans offer discounts on gym memberships and provide financial incentives for completing health assessments, signing up for health coaching programs, lowering cholesterol levels, losing weight, meeting walking goals or stopping smoking. Programs are designed to reward people for making healthy choices and being more engaged in improving their health.

For help navigating open enrollment, visit for articles and videos with easy-to-understand information about health benefits and health insurance terms.

Greg Wright is the CEO of UnitedHealthcare Medicare and Retirement in Southern California.


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