Getting Ready for Open Enrollment: Your Questions, Answered

(BPT) - Have questions about this year's open enrollment? From important dates to choosing a health plan, here's what you need to know to prepare and enroll with confidence.

What is open enrollment?

Open enrollment is the time of year when you can sign up for health insurance, renew your existing plan or shop for a new one. If you miss this period, you may need to wait until next open enrollment to sign up, unless you have a qualifying life event, such as losing coverage, having a baby or getting married, which qualifies you for special enrollment.

When does open enrollment begin, and what dates should I know?

Open enrollment dates depend on where you get your health insurance. If you get coverage through your employer, your enrollment dates may be different. For those getting health coverage through Covered California — open enrollment begins Nov. 1 and ends Jan. 31. You can sign up online, by phone or in person.

If you enroll in November and December, your coverage begins on Jan. 1. If you enroll in January, your coverage begins Feb. 1.

What information should I gather before I apply or renew my coverage?

When you apply or renew coverage, you'll need to have the following information ready:

• Social Security numbers for everyone applying
• Federal tax information
• Immigration documents, if applicable (Green Card, I-94, EAD)
• Employer information and estimated household income
  • You will also need to know how to calculate your income
• The number of people in your household, including their ages and incomes

Having this information can make the process easier. You may not need to submit documents when you first apply. If anything else is needed to confirm your eligibility, Covered California will contact you with the specific documents to provide.

What should I consider when choosing a health plan?

Whether you're getting health insurance for the first time or looking for a new plan, consider these questions:

• Who needs coverage?
• How often do you visit the doctor?
• What health services do you expect to need?
• Are your preferred doctors and hospitals included in the plan?
• Are your prescription medications covered?
• How much would you pay each month and when you get care?

Your answers can help you compare plans and find one that fits your health needs and budget.

What do terms such as premium, deductible and copay mean?

Health insurance comes with different types of costs. Here are a few common terms to know:

• Premium: The amount you pay each month to have a health plan.
• Deductible: The amount you pay for covered services before your plan starts paying its share — similar to car insurance where you might need to pay a deductible to cover part of a repair.
• Copay (or copayment): A fixed amount you pay for a covered service, like a doctor visit or prescription.

Many insurance plans include both deductibles and copays. A general rule is that policies with higher premiums have lower deductibles and copays, while those with lower premiums have higher deductibles and copays. By offering a diversity of plan options, health insurance companies provide consumers the opportunity to choose a plan that best suits their needs.

Here are some other terms that are useful to know when enrolling:

• Coinsurance: The percentage of the cost you pay for a covered service, after you meet your deductible.
• Out-of-pocket costs: What you pay yourself for care. This includes deductibles, copays and coinsurance.
• Out-of-pocket maximum: The most you'll pay in a year for covered services. After that, your plan pays 100% of covered costs.

What does coverage include, and how do I know which level is right for me?

Every Covered California plan covers the same core set of health services — no matter its level or type:

• Outpatient care (care without a hospital stay)
• Emergency services
• Hospital care, including surgery and overnight stays
• Pregnancy, maternity and newborn care
• Mental health and substance use services, including behavioral health treatment
• Prescription drugs
• Rehabilitation and habilitation services and devices
• Lab services
• Preventive care, wellness services and chronic disease management
• Pediatric services, including children's dental and vision care

Each plan has four levels of coverage: Bronze, Silver, Gold and Platinum. Plans cover the same core categories of health services, including doctor visits, emergency care, hospital stays, prescription drugs, mental health care and preventive services. The main difference is how you and your health plan share the costs.

For example, plans with higher monthly premiums generally have lower costs when you receive care. There's no single right choice. Consider your budget, how often you expect to need care and the doctors or medications you want covered. You can learn more about Covered California's coverage levels here, and use the Shop and Compare tool on CoveredCA.com to get an estimate based on your situation.

How can I find out if I qualify for financial help?

Covered California is the only place where you can receive financial help to lower the cost of your health insurance through state and federal tax credits. In fact, four out of five people who enroll through Covered California qualify for financial help.

Today, Californians can get more financial help than ever before. Learn about how this works through both premium tax credits to lower the cost of your monthly premium and cost-sharing reductions that save you money when you get care. You can get a quick estimate to find out how much financial help you might get here.

What should I know if my income or household has changed?

If your income or household has changed, update your Covered California account as soon as possible. For 2027 coverage, use your best estimate of the income you expect to earn in 2027, rather than what you earned last year. If your income is hard to predict, make your best estimate and report changes during the year. This helps make sure your financial help amount is as accurate as possible.

Where can I get free, confidential help with open enrollment?

Free, confidential help through Covered California is available by phone, online and in person. Certified enrollers can answer questions about plans, help you understand possible financial help and guide you through enrollment. Assistance is available in multiple languages.

• By phone: Call 800-300-1506 to speak with a Covered California representative.
• Help on demand: Request a free callback from a certified enroller for first-time applicants.
• In-person help: Find a certified enroller or agent near you through CoveredCA.com.
• Online: Visit CoveredCA.com for live chat and other help options.

Open enrollment begins Nov. 1. Start preparing now at CoveredCA.com.