Open Enrollment is a fixed window every year where you can sign up for new health insurance, adjust your current plan, or cancel your existing plan. This year, Open Enrollment in Maine starts November 1, 2022 and runs until January 15, 2023.
Each year, new plans are offered or existing plans will change, some of which may offer a better balance of coverage and cost. For example, we’re Taro Health, and we’ll be available for the first time for Mainers during this year’s Open Enrollment.
It is crucial that you prepare for Open Enrollment, so you can make the best choice for your healthcare! Here’s a few tips to help you navigate an already hectic time of year.
1. Know the Dates
In Maine, this year’s Open Enrollment will follow the following schedule:
- To receive coverage starting January 1, 2023, you will need to enroll in a plan between November 1, 2022 and December 15, 2022
- If you miss the previous window, you can receive coverage starting February 1, 2023, by enrolling in a plan between December 15, 2022 and January 15, 2023
If you miss the Open Enrollment period outlined above, you will unfortunately miss your chance to pick a better health plan for you, except for a few situations (see the “What happens when I don’t sign up for Taro Health during Open Enrollment?” section below)
2. Confirm the plan is ACA-Compliant
The last thing you want to do is end up with a healthcare plan that is not a legitimate healthcare plan. You want to make sure that the plan you choose is ACA-compliant, meaning that it covers the ten essential health benefits with no annual or lifetime coverage maximums.
The easiest way to check for a plan’s legitimacy is to use your state’s official healthcare insurance exchange shopping tool to shop for your healthcare plan. These official exchanges all have a rigorous vetting process for new plans before listing them on the exchange. For example, in the state of Maine, you should use coverme.gov.
You can also ensure that the healthcare plan you choose has a regulatory license from the state of operation. Each state will have a website for regulatory licensing and permitting, where you can check under “insurance” for the appropriate license. For Maine, that website is located at pfr.maine.gov.
3. Check and apply for government subsidies
Depending on your income, a subsidy can save you hundreds – even thousands – in monthly premiums.
You can check if you qualify for a subsidy and estimate the amount you can expect to receive by using Taro Health’s tool here.
4. Thoroughly understand the plan
Your health insurance plan is one of the biggest purchases you make each year. You owe it to yourself to understand what healthcare benefits you will receive and the costs associated with them.
- Consider all cost factors. All plans have deductibles, co-pays and/or coinsurance, premiums, formulary tiers and out-of-pocket maximums. You should examine which of these costs have historically been most meaningful to you and compare plans based on such costs.
- Know the network. Most plans have a network of preferred providers. Which providers you can see, as well as the cost for such providers, can change each year, even within a plan. You should never assume that your personal preferred providers are still in network with your current healthcare plan.
- Review coverage details carefully. Even if you stay with the same healthcare plan, there may be new restrictions, new copay and coinsurance amounts, and new formulary tiers.
- Understand insurer processes. There are often insurer rules that affect which healthcare services are covered and your share of the cost. Be sure to look into your plan’s position on medical necessity, prior authorization, benefit verification, step therapy and restrictions on using copay cards for drug deductibles.
We know there are a lot of terms there that you may not be familiar with. Here’s a glossary from healthcare.gov where you can look up terms that seem foreign to you!
Have any more questions about Taro Health plans? Sign up for a free information session with one of our Taro Health team members to learn more.
5. Gather all the required information to sign up
In order to sign up for a Taro Health plan, make sure you have all of the following to make the process much easier to go through. CoverME.gov has a list of necessary documents and information you’ll need to have handy.
What happens when I don’t sign up for Taro Health during Open Enrollment?
If you have a life change, such as but not limited to getting married, having a baby or losing your employer-sponsored insurance, you may be able to get health insurance coverage outside of the annual open enrollment period, or make changes to your plan during the year. This is called a special enrollment period, or “SEP”.
If you qualify for a life event as described on healthcare.gov here, you may be eligible for a Special Enrollment Period, which allows you to enroll in health insurance outside the yearly Open Enrollment Period. If you are unsure, you can use the screener tool here.