Your 2019-2020 Open Enrollment FAQ

November 01, 2019

We’re dedicated to helping everyone get the care they need to grow healthy—and that means empowering you to make the best decisions about you and your family’s health care needs.

This open enrollment FAQ can help you better understand your choices. If you need additional information, we’re here to help, and we can walk you through your options for free.

Get help in English: 833-444-5560
Get help in Spanish: 833-444-5570

 

Q: What is Open Enrollment?

Man reading

A: Open Enrollment is the period when you can make decisions about your health care and your insurance coverage for the next calendar year. You can choose to stay with your current plan or select a new plan that works better for your budget or your health needs.

The plan you pick can affect:

  • The price of your premiums, or the amount you pay every month for your plan
  • Which doctors and hospitals you can visit
  • How much you pay for office visits, prescriptions, and other services
  • How much you will have to pay out of your own pocket for the entire year
  • If you can get certain kinds of care (for example, dental or optometry visits)

 

Q: When is Open Enrollment?

Calendar and a heart

A: It depends on what kind of insurance or medical coverage you have. If you get your benefits through Medicare, your Open Enrollment period runs from October 15 to December 7. If you get your care through Covered California, your Open Enrollment period runs from October 15 to January 31.

 

Q: If I’m Offered Coverage at My Job, Should I Take It?

A health test

A: Many people believe that if your job offers you an insurance plan, you should take it. That’s not always your best move. Even if your employer pays for part of your plan, it can still be expensive and not offer you the right kind of coverage.

Our advice is to research available plans. Depending on how much you make, you may still be eligible for coverage through Medi-Cal. You may also qualify for discounts through the Covered California marketplace. Just because your employer selected it doesn’t mean it’s the best plan for you.

 

Q: What Happens If I Don’t Choose?

Pen over a table

A: If you’re covered through Medicare, you will likely continue with the same plan you were already on. If you are on a plan through Covered California or your employer, and your plan goes away, you will automatically get assigned to a plan that offers similar coverage at a similar price.

 

Q: What Happens If I Don’t Have Coverage and Miss the Deadline?

Hand holding a pen and writing

A: If you are at a job that offers coverage but miss the deadline, you won’t be able to enroll until the following year unless you have what’s called a Qualifying Life Event (see below). You may be able to get a short-term plan, or you may be eligible for Medi-Cal or Children’s Health Insurance Program (CHIP). The same is true for Covered California. If you miss your deadline to sign up for Medicare, you can enroll during the General Enrollment Period that runs from January 1 to March 31 every year. Unfortunately, your coverage won’t start until July 1.

 

Q: What’s a Qualifying Life Event?

Doctor and her patient

A: Most people need to pick their insurance plan during Open Enrollment. However, if you experience certain events (called a Qualifying Life Event, or QLE) you may be able to change, cancel, or enroll in new coverage. QLEs include:

  • Getting married
  • Having baby
  • Losing a job or experiencing a change to your income that affects your eligibility for certain plans
  • A death in the family
  • Moving to a different ZIP code
  • Becoming a U.S. citizen

 

Q: How Can I Save Money on Coverage?

Phonendoscope over dollar bills

A: If you are purchasing a plan through Covered California, make sure you apply for tax credits or cost-sharing reductions that can reduce the amount you will have to pay.

Some health insurance plans provide discounts based on your health and activities – for example, if you maintain a healthy weight, enroll in an exercise program, or participate in other activities the company requests.

If your plan doesn’t offer those discounts, there are many ways to save money on your health expenses:

  • Choose in-network doctors
  • Only visit the emergency room for true emergencies
  • Take advantage of covered health screenings: you may qualify to get preventive cancer screenings, diabetes screenings, HIV and STI tests, and many others at no cost
  • If you are given a prescription, ask if a generic version is available

 

Phone in the open enrollment app

Learn more about getting the most out of your coverage, no matter what plan you’re on. And don’t forget, we’re here for you. Call us with your questions about selecting coverage that can help your whole family grow healthy – in 2020 and for years to come.

Get help in English: 833-444-5560
Get help in Spanish: 833-444-5570

 

Sign Up for Articles

Sign up to receive email updates on the information that matters to you and those you love.

Open Enrollment: How to Get the Most Out of Your Benefits

October 15, 2018

Your health care plan is about much more than simply going to the doctor and getting medication when you get sick. Medicare and most commercial plans offer a number of benefits that can help you stay healthy and save money.

Not every plan offers all of these benefits, so you should contact the number on the back of your health care ID card or visit your plan’s website before you schedule an appointment.
 

Preventive services
mom and daughter at doctor

Did you know there are a number of services that you can get that will keep you and your entire family healthier – and they’re at no cost to you? Under the Affordable Care Act, health care companies cover what are called preventive services. They’re called preventive services because they can help prevent illness and disease. All in all, there are 15 covered services for children and adults, and they include:

  •  Blood pressure screening
  • Cholesterol screening
  • Type 2 diabetes screening (for adults with high blood pressure)
  • Age-appropriate immunizations for hepatitis A & B; HPV; measles, mumps, and rubella; and many others 
  • Tobacco use screenings and cessations interventions for tobacco users

You should always check coverage with your plan. You’ll still have to see a doctor that is in your network to get these services, but it’s well worth your time.
 

No-cost wellness services
yoga mat

Many plans offer free programs to help members achieve important health goals, such as losing weight, becoming more active, cooking and eating healthier, or reducing stress. For example, your plan might offer you a weight loss program that allows you to log your weight and get easy-to-use tips, recipes, exercise videos, and words of encouragement. 

These health and wellness programs are designed to be fun and easy to use, even for those who may be new to healthy habits. 
 

Mental health care
man smiling

We all know how important your mental health is, and the affect it has on your body and your family. Many insurance plans, including Medicare Part B, provide coverage for members to see a specialist, such as a psychiatrist or someone who specializes in substance abuse. 

And FYI, a depression screening with your primary care doctor is considered a preventive screening. See them first and get recommendations for next steps.


Special screenings for moms-to-be
mom and baby

You and your health plan both win when you have a happy, healthy baby. That’s why plans are required to cover special preventive services for women who are either currently pregnant or trying to get there. Besides health screenings for conditions like anemia and gestational diabetes, you should be covered for lactation support and breast pumps.
 

Nurse Line
call center nurse

It’s 3 am and your six-year-old just woke you up with a cough and a temperature of 99 degrees. Maybe it’s nothing, but you’d sleep better if you could get some advice. Call the nurse advice line. It’s a great way to avoid an expensive trip to the emergency room, and you can get help right when you need it. 

Your health plan’s nurse advice line is available 24/7. Call them anytime to talk to a licensed, registered nurse to find out more about common health issues. You can also call the AltaMed nurse advice line at (866) 266-5092.

If you’re experiencing a true medical emergency, call 9-1-1 or go to your nearest emergency room.
 

Save on your medication
meds


If you have prescription coverage, you can save even more with generic drugs. In most cases, they are totally identical to the “name brand,” at a fraction of the cost. Be sure to ask your doctor or pharmacist about them.

Many health care plans also offer mail order services. In some cases, you could pay less for your prescriptions. Even if you don’t, you’re still saving several trips to the pharmacy. 

Still need some help for Open Enrollment?
AltaMed is here to walk you through your Open Enrollment options for free. Let us help you make smart choices to help you and your family grow healthy.

Get help in English: 833-444-5560
Get help in Spanish: 833-444-5570

 

 

Take Care with Your Health Care

October 08, 2018

We’ve all heard the saying, “If you don’t use it, you lose it,” and the same sentiment can be applied to your health plan. Thanks to the Affordable Care Act (ACA), an additional estimated 20 million Americans now have health coverage. It’s up to you to make sure you take advantage of everything your insurance has to offer. 

Beyond taking a closer look at the details of your specific plan, here are a few easy and basic ways to make the most of the benefits included in your health coverage. 

  • Wellness Visit: These provide an overall picture of your health and how you can make improvements by checking stats like blood pressure, cholesterol, body mass index (BMI) and weight.
  • Preventive Services: Keeping you healthy is just as important to your provider as it is to you. So be sure to use any and all free services they offer, which can include immunizations, colonoscopies, diabetes checks, contraceptives, osteoporosis and anemia screenings, prenatal care and mammograms, just to name a few.
  • Education: Many plans include classes on fitness, nutrition, overall healthy living and chronic disease management. 
  • Annual Physical: Preventive exams are key to catching any serious health issues like cancer and diabetes early, before they start, or early enough to be properly treated. It’s also a great time to talk to your doctor about any health concerns you may have, and to get important shots and vaccinations. 
  • Discounts: You’d be surprised what kind of health and wellness products and services may be available through your insurance. Think discounts on gym memberships, eye exams, and chiropractic or acupuncture visits, as well as programs and support groups to help quit smoking. 
  • Nurse Advice Line: Typically available 24/7, you can save yourself and your family a trip to the emergency room or urgent care by calling these helplines , which have registered nurses on hand to answer your questions and point you in the right direction. 
  • Prescriptions: Not only is medication more affordable if your doctor prescribes you the generic version, but if your plan has a mail service pharmacy option, you’ll be able to save a trip to the pharmacy.