Need Individual/Family Health Insurance? Now is the Time to Find (and enroll in) the Right Plan for Your Needs
Posted December 02, 2024 by Matt Baker, Director of Sales
‘Tis the season for the Open Enrollment Period (OEP). If you recently lost your health insurance, need to bridge the gap before qualifying for Medicare, your employer doesn’t offer group coverage, or you’re simply looking to switch plans, this season is for you.
This is the time when individuals and families can sign up for private health insurance, adjust their current plan or cancel.
Even if you have health insurance and are happy with your coverage, it’s a good idea to review it to make sure it’s still meeting your and your family’s needs. And if it isn’t, this is the time to make changes.
During Open Enrollment, common adjustments made include:
- Enrolling in or switching to a new benefit plan
- Selecting different coverage levels, such as individual or family plans
- Adding or removing dependents
OEP runs at the same time every year, from November 1 through January 15. However, to ensure continuous coverage, you’ll need to enroll by December 15 for coverage effective January 1, 2025. If you enroll December 16 through January 15, 2025, your coverage will be effective February 1, 2025. If you miss this enrollment period, you will need to wait until the following year unless you qualify for a special enrollment period.
How to prepare for the Open Enrollment Period
Insurance companies review and refine their benefit plans annually, so it’s important to be prepared even if you’re happy with the coverage. Plus, your and your family’s needs can change from year to year. If you don’t do anything to your existing plan, you could end up locked into a plan with a much higher premium or holes in coverage.
SummaCare recommends 4 ways to prepare for this season’s OEP:
- Review your current coverage. Evaluate whether your health plan includes the benefits you need and want and identify any gaps in coverage. Weigh the pros and cons of your current plan and estimate your total out-of-pocket costs (including monthly premium, deductibles and copays) to compare.
- Consider plan changes. Review your plan documents for any revisions made for the following year, such as benefits being added or removed, changes to providers and hospitals in-network, drug formulary or plan cost changes.
- Evaluate your current healthcare needs. Was a family member recently diagnosed with a chronic disease? Do you have a major procedure coming up? Determine whether expanded benefits and services are needed, more drug coverage, or possibly less coverage with a lower premium.
- Assess changes in your family’s status. Did you get married, have a baby or will your child age off your plan next year? Now is the time to add or remove dependents on your family plan.
How to find a plan that’s right for you
Choosing the right health insurance involves many key considerations, such as cost, healthcare needs and prescription coverage.
To find a plan that offers the best value and coverage for you and your family’s specific needs and circumstances:
Research and compare plan options.
You can find individual and family plans to cover you, your spouse and your children through the Affordable Care Act’s health insurance marketplace/exchange (healthcare.gov) or directly from health insurance companies, such as SummaCare.
You can work with a licensed insurance agent or use online tools and resources to compare coverage, estimate out-of-pocket costs and get your questions answered.
Select the plan that best aligns with your healthcare needs and budget. For example, individuals and families that access care frequently may choose a plan with higher premiums but cover more healthcare costs when they receive medical treatment. On the flip side, other plans may offer low premiums, but individuals and families will have to pay for more routine care.
Evaluate additional benefits.
Many plans include additional health and wellness benefits, such as discounts on gym memberships, health coaching, preventative care like flu shots and more. Taking advantage of these extras can help you be proactive about your health.
Estimate out-of-pocket costs.
You’ll pay many types of costs for health insurance, so when comparing plans be sure you understand the out-of-pocket costs, such as premiums, deductibles, copayments and out-of-pocket maximums. You also can find out if you’re eligible for a subsidy from the federal government to help cover some of the plan costs.
Consult with an insurance plan expert.
Contact a licensed insurance agent to help you compare plans, review plan documents and even enroll. If you’re keeping your current plan, an agent also can help you maximize your coverage by using your benefits to their fullest potential.
About SummaCare’s Individual and Family plans
SummaCare offers insurance options for individuals and families who do not have access to group coverage, don’t yet qualify for Medicare or make too much money for Medicaid. Our health plans offer access to quality providers and top hospitals, comprehensive pharmacy benefits, certain preventative services for free, value-added health and wellness programs and more.
SummaCare’s Individual & Family plans received a 5 out of 5 overall quality star Health Insurance Marketplace rating, demonstrating how our plans rank among the best in the nation for outstanding service and clinical quality. Marketplace star ratings are calculated based on three categories (member experience, medical care and plan administration) and are a great way to compare plans on HealthCare.gov.
Check out our 2025
individual and family health insurance plans that offer great
benefits designed to meet your needs, plus
health and wellness services to help you feel your best.
The Open Enrollment Period for Individual & Family plans runs from November 1st through January 15th. If you enroll before December 15, your coverage will begin on January 1, 2025. If you enroll between December 16 and January 15, 2025, your coverage will begin on February 1, 2025.
Finding the right plan can feel overwhelming. SummaCare’s Licensed Insurance Representatives are here to answer your questions and help you enroll in the plan that’s right for you and your family. Call 888.251.7957 to schedule your one-on-one health plan review.
For more information, compare plans or enroll, visit summacare.com/individual. Most plans can be purchased using financial assistance in the form of an advanced premium tax credit and/or cost-sharing subsidy, if applicable.
