Maximizing Your Benefits During Open Enrollment

A lot can happen over the course of a year. Your income can change, you may welcome a new family member, or there may be a new health issue that you’re dealing with. Whatever life events come your way, the annual open enrollment period is your opportunity to adjust your health coverage for the upcoming year, so that it’s best suited to meet your needs.

The open enrollment period is when our members can decide to either keep their existing health plan or change to another plan of ours. If you are happy with your current coverage, you don’t have to do anything – your plan will automatically be renewed. However, if you want to consider making changes, we have some tips for how to do it, so that your health plan benefits will be maximized for your individual situation.

Tip #1: Know Your Deadline

Open enrollment for qualified health plans (QHPs), which meet all requirements of the federal Affordable Care Act, happens each year beginning November 1. You should find out when your open enrollment period begins and ends, so that you’ll be ready and don’t miss the deadline. 

• Open enrollment for our QHP plans starts November 1. For 2024, it continues until January 15. If you want your new coverage to start January 1, you’ll need to let us know which plan you want to enroll in by December 15. Otherwise, your new plan will go into effect in February.
• If you enroll through Vermont Health Connect, open enrollment begins November 1 and ends January 15.

Tip #2: Check Your Subsidy Eligibility

Financial assistance can change each year. It’s a good idea to check during open enrollment if you may qualify for financial help to lower your premiums for the upcoming year.
Check out our plan comparison tool or visit Vermont Health Connect to see an estimate of how much of a premium subsidy you may be eligible for. If you do qualify for a subsidy, you’ll need to enroll through Vermont Health Connect to receive it.

Tip #3: Review Your Health Care Spending

Take a look at what you’ve spent on doctor’s office visits, hospital services, and other health care expenses during the last year or two. Has it been too high -- putting a squeeze on your budget -- or are you comfortable with what you’ve typically been spending? 

Tip #4: Look Ahead

In addition to looking back at your past spending, take a look forward at what you might need for health care in the year ahead. Ask yourself:

• Is there a change in my and my family members’ medical needs, such as taking different prescribed medications?
• Are there any major surgeries or other procedures that will be necessary?
• Do I or a family member have a new medical condition that will need treatment?
• What other medical expenses might we be facing in the next year? 

Tip #5: Determine Your Priorities

Once you’ve reviewed your past and potential future use of medical services, it’s time to set a few priorities for what you’d like to see covered in next year’s health plan. For example, if you visit your primary care physician often, you might prioritize low-cost coverage for doctor’s office visits. If you take a lot of prescription medications, then better drug coverage may be your top priority. Ask yourself, “what would make the most difference in our health care budget?” 

Tip #6: Review Your Options and Compare

Now that you’ve got a good idea of what your needs will be, and what your priorities are, take a look at our available plans. The Find and Compare Plans tool on our website is a great way to see what we offer. 

• You can filter plans by the level of expected health expenses (low, medium, and high).
• Plans can be filtered by premium level, deductible amount, or deductible type.
• If you are interested in plans that can be paired with a health savings account (HSA), you can filter to find our plans that are HSA compatible.

Our tool will show you each plan’s monthly premium, deductible, and out-of-pocket limits. You’ll also see the plan’s benefits for prescription drugs, primary care visits, specialist visits, and hospital care (outpatient and inpatient). If you want to see the details of a particular plan, that’s all available with one click.

If you would like to compare plans, you can view up to three plans side-by-side. Compare premiums, deductibles, and other benefit information. That makes it easy to see which plan will be a better match for the priorities you’ve set. If you want to compare all plans available, we’ve compiled all our individual and family plans into one chart that you can download.

Tip #7: Leave Time to Make a Good Choice

It’s important to leave plenty of time during the open enrollment period to review your situation and look for the health plan that will be the best fit. You don’t want to make a hasty decision by leaving it to the last minute. Once you’ve chosen a plan, be sure to sign up for it by the deadline – either through Vermont Health Connect or by contacting us directly at (800) 255-4550. 

Help is Available

We know that shopping for a health plan or choosing a new plan can be confusing, so we have published several other articles on our blog to help you better understand how health insurance works. You can find a listing of additional articles by choosing the Understanding Insurance category in our blog filters.  

If you have questions, or would like help in finding a plan, our local plan experts will be glad to talk with you and provide assistance. You can give us a call at (800) 255-4550. We’re available Monday through Friday from 8 a.m. to 4:30 p.m., with extended hours during open enrollment.