The open enrollment period for 2022 for many health insurance plans runs from November 1, 2021 - January 15, 2022. Many people find the process of selecting a new health insurance plan confusing, especially as plan choices and premiums change from year to year.

It’s challenging for health advisors to help people get great care if they don’t have the right insurance plan, so we help support our clients with health insurance advice. We put together a list of common questions about health insurance and open enrollment, along with their answers. You may also find this glossary of health insurance terms helpful.

1) What does open enrollment mean for me?
  • Everyone’s health insurance needs are different. If you like your current health insurance, you may not need to make any changes. If you don’t take any action, your 2021 coverage will typically continue into 2022. Sometimes providers change plans from year to year, so it may be worth checking to make sure your doctors will still be in your plan moving forward.
2) Can I switch health insurance plans mid-year?
  • This depends on the type of insurance plan and the reasons for the change. If you have a “qualifying life event,” you could be eligible for a special enrollment period.
  • Qualifying life events include a loss of existing health coverage, changes in household structure (such as getting married, divorced, or having a baby), changes in where you live, and changes in income
3) Can I be denied or charged more based on pre-existing conditions?
  • In short, no. Health insurance companies cannot refuse coverage or charge you higher premiums based on pre-existing conditions.
  • However, you can be charged more based on your age, where you live, and if you use tobacco products.
4) What is the difference between an HMO, EPO, PPO, and POS?
  • HMO (Health Maintenance Organization): Members need referrals from their primary care physician to see a specialist and must stay in-network to receive benefits.
  • EPO (Exclusive Provider Organization): Members also must stay in-network, but in contrast to an HMO, they do not need referrals to see a specialist.
  • PPO (Preferred Provider Organization): Members do not need referrals for specialists, and care is covered both in and out-of-network (but costs can be higher for out-of-network care).
  • POS (Point of Service): Requires a primary care physician to manage your care, and provides different benefits dependent upon if members use in-network or out-of-network care providers.
5) Will my insurance plan cover concierge medicine?
  • Typically, no. However, if you have a health savings account you may be able to use it to pay for some concierge services.
  • With concierge medicine, you may pay an annual membership fee upfront, but find out what other fees members incur. Check if your insurance covers your concierge doctor or if you will be responsible for out-of-pocket payments with each visit.
6) Do I still need health insurance if I have a concierge membership?
  • Yes. You may want a high-deductible health insurance plan in case of a hospital stay, because hospital stays can be very expensive. Using a health savings account may save you money and offer tax benefits.
7) How do I know if my doctor takes a particular insurance plan?
  • This can be tricky. Doctors often change plans from year to year (usually around this time), so the health insurance information on their website may not be up to date.
  • Call the doctor’s office or your health insurance plan to be sure. Look at the back of your insurance card for helpful phone numbers.
8) What are my options for buying insurance for my small business?
9) How do bronze, silver, gold, and platinum insurance plans differ?
  • The sequence goes from bronze to platinum, starting with bronze, where the premiums are low and the out-of-pocket costs are high.
  • As the metals progress to platinum, the premiums increase and the out-of-pocket costs decrease.
10) How do I know which metal level is right for me?
  • While many factors go into this decision, a good rule of thumb is that the more care you expect to use, the higher the metal tier you should consider.
11) What costs should I consider when choosing an insurance plan?
  • Be sure to look at the plan’s monthly premiums, deductible, copayments, coinsurance, and out-of-pocket costs. They all add up.
12) What if my doctor does not participate in the insurance plan that I’m considering?  
  • In this case, you should either change doctors or select a different plan.
  • While it is possible to file an appeal to get the doctor considered as “in-network,” you cannot count on your insurance company to make an exception.

Do you have questions about your current health insurance or need help choosing a new plan? Better Health Advisors is an independent company, not affiliated with any health insurance companies, and our expert health advisors can help you navigate health insurance decisions.