Open enrollment: Signing up for health insurance

Confused? Take a look at these tips and FAQs.
Health insurance pamphlet

如果你对公开注册过程感到有点不知所措——每年你都可以更新或更改你的医疗保险范围——你不是一个人. Selecting insurance can be confusing and time-consuming.

但是,花时间和精力仔细审查你的健康保险选择可能会为你节省一些钱, 当突发健康事件发生时,给你带来内心的平静,保护你免受意想不到的经济负担.

Regina D. Green, director of managed care operations for UCLA Medical Group, 解释在公开注册过程中需要考虑的事项,以使过程更加用户友好.

While it may be tempting to base your insurance choice on monthly premiums alone, 在确定明年的保险范围之前,详细了解你的个人和家庭健康需求以及不同的计划细节是值得的.

First, the vocabulary

It’s helpful to understand these terms before you begin:

  • 共同保险:你负责的服务和治疗费用的百分比.
  • 共同支付:你的保险公司向你收取的看医生费用,通常是固定费用. 门诊费用可能是10- 30美元(或更多),住院费用可能高达数百美元.
  • 免赔额:在保险公司付款前的日历年内,您必须支付的医疗服务金额.
  • HMO: Health Maintenance Organization. 有了这个计划,你可以选择一个初级保健医生,你所有的医疗服务都要通过他. Visits to doctors outside the HMO network typically aren’t covered by these plans.
  • Network: The set of providers — physicians, specialists, clinics and hospitals — that accept your insurance plan’s coverage.
  • 自付最高限额:在计划支付100%覆盖费用之前,您必须在日历年内支付的金额. However, what counts toward this annual maximum varies by plan.
  • PPO: Preferred Provider Organization. More flexible than an HMO, PPO计划不需要初级保健医生,并且覆盖网络内外的医生, though staying in network generally means lower copays and out-of-pocket costs.
  • 保险费:雇主或保险公司每月收取的保险费用.

Factors to consider based on age

20s to 30s

Once you age out of your parents’ insurance plan at 26, you’re responsible for your own medical coverage. Provided you’re generally healthy, 你在这个年龄的重点可能是预防保健和治疗常见疾病.

格林建议找一位让你感觉舒服的初级保健医生,并记下保险计划所涵盖的医院和诊所的位置:它们离你家或工作地点近吗?

你需要考虑在哪里和什么时候寻求医疗保健,”她说. Are you the kind of person who’s proactive and schedules appointments? Or are you more the 11th-hour type who’s going to show up at urgent care?”

有孩子的年轻人应该考虑他们计划中每个人的需求. Is there a pediatrician nearby? 孩子们是否有健康问题需要专科医生或处方药治疗?

您可以通过雇主提供的HMO和PPO计划或Covered California计划获得UCLA的医疗服务. Go to dftractor.com/health-plans#ppo for more information. To find out if your insurance is accepted at UCLA Health, call 310-301-8700 (Monday-Friday, 8 am-5 pm).

40s to 60s

People in this age range require more preventive exams, such as mammograms and colonoscopies, 因此,在查看套餐网络中可用的服务时,请考虑提供这些服务的地点. Because most of this population is still working, often while raising families and caring for older relatives, convenience is key. Green advises taking geography into account so services can be easily coordinated.

An unexpected health event could end up costing thousands, 因此,以较高的月保费换取较低的免赔额和自付限额可能是值得的. 仔细观察各种计划的细节,以避免昂贵的医疗账单.

It’s no different than buying anything else,” Green says. When you buy a car, when you buy a refrigerator, 当你买洗衣机和烘干机时:有些东西包括在内,有些东西不包括在内.”

您可以通过雇主提供的HMO和PPO计划或Covered California计划获得UCLA的医疗服务. Go to dftractor.com/health-plans#ppo for more information.

Older than 65

在选择健康计划时,老年人可能是最需要考虑的. While some older adults continue to work and have coverage through their employer, 有些人已经退休,有固定收入,可能更有可能出现需要经常护理的健康状况.

格林建议这个年龄段的人根据他们知道自己使用的服务来比较福利计划. 他们可能会盘点过去一年所需要的护理,以帮助评估未来一年的潜在需求.

There are multiple types of medical plans available to seniors through Medicare. Original Medicare and Medicare Advantage are the two largest. Also think about prescription medication needs. Medicare covers prescriptions through its pharmacy drug plans known as Part D,但你要确保你选择的药物计划涵盖了你服用的药物.

Knowing your health conditions and prescription requirements are key, as out-of-pocket costs can vary greatly between plans. For instance, 如果你经常出现在急诊科,或者过去需要长期住院, you want to be sure to factor these concerns into your coverage selection. 不同的计划对急诊科就诊有不同的自付费用,有些计划只覆盖部分住院时间.

Added perks are another potentially important consideration. Some plans include travel vouchers for rides to medical offices; others might cover acupuncture or chiropractic care. 这就是为什么了解自己的需求并仔细阅读每个计划所提供的内容是很重要的.

皇冠hga025大学洛杉矶分校接受多种医疗保险计划,包括原始医疗保险和医疗保险优势. Visit eHealthMedicare.com/UCLAhealth for more information.

More questions? Check out these FAQs

(Important information here about access to UCLA Health via Anthem Blue Cross plans.)

When exactly is open enrollment?

Open enrollment dates vary by employer and insurance provider, 但这段时间通常是在秋季,从明年开始覆盖. 对于那些通过Covered California购买保险的人,开放注册期从 Nov. 1 to Jan. 31Medicare's open enrollment window began Oct. 15 and runs until Dec. 7. Nationally, the open enrollment period goes from Nov. 1 to Jan. 15.

I’m still stumped. Who can help me make sense of all this?

If you get your insurance coverage through your employer, your Human Resources department should be able to help. You can also call your insurance company directly to ask questions.

如果你通过市场购买保险并且住在皇冠hga025,起价为 coveredca.com.

Outside California, go to healthcare.gov and click on find local help” for information about coverage in your state.

How can I find out exactly what’s covered under my plan?

不要只看你可能收到的传单,要看一个提供简单计划比较的网格. For detailed information about what is and isn’t covered by your insurance plan, read the Evidence of Coverage. This detailed document is lengthy – usually about 100 pages – but worth the time, both when choosing coverage and as a reference when needs arise. Green advises: Take notes like you were in class.”

If I miss the open enrollment period, am I stuck with my current coverage?

Yes, 除非你经历了一个符合资格的生活事件,使你有资格获得一个特殊的注册期. These events are: loss of existing health coverage through loss of job or aging out of a parent’s plan; change in household such as marriage, divorce or having a child; change in residence, such as moving to a different county; change in income that affects the coverage you qualify for; becoming a U.S. citizen; or leaving incarceration.

Take the Next Step

Still more questions? Visit the UCLA Health Open Enrollment page.

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