Open Enrollment: What Is It and How Does It Work?
For millions of Americans, the end of the year is open enrollment season – a yearly opportunity to take stock of your health care needs and select the health insurance plan that works best for you. It is a window of time – typically in the fall – when you can sign up for health insurance, review, assess, and modify your existing benefits.
There are more choices than ever to help you find a plan that will best suit your health needs. Think of it like planning a trip: you don’t pack a surfboard if you are planning to hike in the mountains. Likewise, there is a lot to think about when selecting a health plan for the next year. What does it cost? Does it include your prescription or preferred doctors? Understanding health insurance basics and how open enrollment works is essential for making informed choices about your benefits and insurance coverage.
Here’s How Open Enrollment Typically Works:
- Eligibility: Anyone eligible for health insurance can participate in Open Enrollment. This includes you, your dependents, and individuals looking to buy insurance through the individual marketplace (e.g., through the ACA exchanges)
- Review Options: During the Open Enrollment period, you have the opportunity to review your current insurance coverage and assess their healthcare needs for the upcoming year. You should consider factors like changes in your health, anticipated medical expenses, and any new coverage options that might be available.
- Enrollment or Changes: You can use the Open Enrollment period to either enroll in a new insurance plan, make changes to your existing plan, or renew your current coverage. This might involve switching plans, adding or removing dependents, changing coverage levels, or adjusting other plan details.
- Deadline: Open Enrollment is time sensitive. Once the designated period ends, you generally cannot make changes to your insurance coverage until the next Open Enrollment period unless you experience a qualifying life event (such as marriage, birth of a child, job loss, or relocation), which triggers a Special Enrollment Period.
- Coverage Start: The new coverage usually begins at the start of the upcoming calendar year, though this can vary depending on the specific insurance plan and enrollment date.
Which Plans Don’t Use Open Enrollment?
- CHIP (Children’s Health Insurance Program) – CHIP offers low-cost health coverage for children from birth through age 18. CHIP permits enrollment at any time so you can ensure your children have coverage year-round.
- Medicaid – Medicaid is a joint federal and state program that helps cover medical costs for some people with limited income and resources. Medicaid allows enrollment in health insurance during any time of year, provided you qualify.
- Short-Term Health Insurance – health insurance plan with a limited duration, typically several months to a year. These plans are geared toward people who need temporary medical insurance to bridge the gap between longer-term plans. These plans don’t have enrollment periods because the need for this type of insurance is difficult to predict.
It’s important to note that missing the Open Enrollment period without a qualifying life event can result in being without health insurance coverage until the next Open Enrollment period. To ensure you have the coverage you need, carefully review your options and make any necessary changes during the designated Open Enrollment timeframe.
Health insurance providers are committed to helping all Americans make informed health coverage choices for themselves and their families. Open Enrollment is a great time to explore the benefits already available to you in your current plan, including discounts and wellness opportunities that can save you money and keep you healthy.
Financial Aid: Helping Your Employees With Their Student Loan Debt
In the U.S., the outstanding balance is $1.75 trillion in student loan debt. Approximately 55% of students from public four-year universities have student loans, with a balance of $37,338 owed per borrower. Beginning in October, workers nationwide will need to resume payments on their student loans for the first time since March 2020. The pandemic-related pause on both payments and interest accumulation that is ending is a stressor for employees who are increasingly seeking financial assistance from their employers.
People across all age groups struggle to balance student debt and retirement savings. It is reported that as many as 81% of people with student loans have needed to delay important life goals such as retirement or buying a home. Contributing early to a workplace retirement account is important so that employees can maximize the effect of compound interest in retirement.
3 Major Ways That Employers Can Help Their Workforce Pay Off Their Student Loans and Save for Retirement:
- Student Loan Repayment Assistance Programs – Employers can offer their employees student loan repayment assistance (LRAP) as a recruiting and retention tool. With LRAP, the employer makes monthly student loan payments to the employee’s lender, helping the employee to repay their student loans quicker. Additionally, through 2025, employers can repay up to $5,250 a year tax-free on employee student loans through the 2020 CARES Act.
- 401(k) Match for Student Loan Repayments – In December 2022, the Securing a Strong Retirement Act (SECURE 2.0) became law. This law – which starts in January 2024 – allows employers to match contributions to workplace plans – including 401(k)s, 403(b)s, 457(b)s, and simple IRAs – based on an employee’s qualified loan payments.
- Financial Literacy Programs – These educational tools can help teach employees how to develop a budget and savings plan, create attainable goals, project retirement needs, purchase a home and manage mortgage options, and manage debt- including student loan and credit card payment options.
Let’s face it, work isn’t the only thing stressing employees out – money can be a huge source of anxiety and a constant source of stress. With millions of Americans struggling to repay their student loans and/or save for retirement, this financial pressure can seep into their performance in the workplace. And managing finances isn’t just stressful – it’s time-consuming. Having access to financial well-being benefits and resources can empower employees to get on the path to financial prosperity.
Exploring Family-Building Benefits
Did you know that in 2017 the American Medical Association and the World Health Organization recognized infertility as a disease? Approximately 17.5% – roughly one in six couples– are affected by infertility in the U.S.
As societal norms and employee expectations continue to evolve, companies are recognizing the importance of offering comprehensive benefits packages that cater to the needs of their workforce. One area that has gained attention in recent years is fertility benefits. Here’s an overview of emerging fertility benefits and their significance:
- Fertility Treatments Coverage: Fertility treatments, such as in vitro fertilization (IVF) or intrauterine insemination (IUI), can be expensive and may not be covered by traditional health insurance plans. Fertility treatment coverage can help employees overcome financial barriers and access the fertility treatments they need to start or expand their families.
- Egg Freezing: Egg freezing allows individuals to preserve their eggs for future use. This can be particularly beneficial for employees who want to delay starting a family due to personal or professional reasons.
- Fertility Preservation: Some medical treatments, such as chemotherapy or radiation therapy, can have a negative impact on fertility. Fertility preservation options, such as freezing embryos or sperm freezing, can help individuals protect their fertility before undergoing such treatments.
- Adoption Assistance: In addition to fertility treatments, companies are expanding their benefits to include adoption assistance programs. These programs can provide financial support, counseling services, and resources to employees who are going through the adoption process. By offering adoption assistance, employers show their commitment to supporting various pathways to parenthood and promoting inclusivity.
- Fertility Education and Support: Many employers are going beyond financial coverage and offering educational resources and support for employees navigating fertility challenges. This can include access to fertility experts, educational seminars, counseling services, and fertility wellness programs.
Since fertility coverage is relatively new, fertility benefits can vary greatly. However, essentially there are two options for coverage:
- Cover specific treatments under their health plan
- Offer to pay a portion of treatment costs as a voluntary benefit
Employee expectations around benefits and workplace support have evolved in step with the growing desire for fertility and family-forming benefits. By offering emerging fertility benefits, employers demonstrate their commitment to supporting employees’ family-building journeys and recognizing the diverse needs of their workforce. These benefits can enhance employee satisfaction, improve work-life balance, and contribute to a more supportive workplace culture.
The Benefits of Health Insurance: Why we all need it
Health insurance may not be the most exciting thing to shop for but it’s one of the most important things that you can buy for yourself and for your family. Having health insurance has many benefits. It protects you and your family from financial loss in the same way that home or car insurance does. Even if you are in good health, you never know when you might have an accident or get sick.
Here are some key advantages of having health insurance:
- Access to Medical Care: Health insurance provides you with access to a network of healthcare providers, hospitals, and specialists. It ensures that you can receive timely medical attention when needed, promoting early diagnosis and treatment.
- Financial Protection: One of the most significant benefits of health insurance is the financial protection it provides. Medical expenses can be substantial, especially in the case of major illnesses, surgeries, or emergencies. Health insurance helps mitigate these costs, preventing individuals from facing overwhelming medical bills and potential debt.
- Preventive Care: Health insurance plans cover preventive services at no cost if you use an in-network provider. This includes routine check-ups, vaccinations, screenings, and counseling services.
- Coverage for Essential Health Services: Health insurance plans typically cover essential health services, such as hospitalization, emergency care, prescription drugs, maternity care, mental health services, and rehabilitation.
- Health and Wellness Programs: Some health insurance plans offer additional benefits such as wellness programs, gym memberships, and access to health management tools. These initiatives encourage you to adopt a healthier lifestyle, manage chronic conditions, and take proactive steps towards improving your overall well-being.
- Specialist Care and Treatment: Health insurance often covers specialized medical care, including consultations with specialists, diagnostic tests, and treatments. Having access to specialists can be crucial for managing complex or chronic conditions effectively.
- Family Coverage: Health insurance plans often provide coverage for family members, including spouses and dependent children.
- Peace of Mind: Knowing that you have health insurance can bring peace of mind, reducing stress and anxiety about potential medical expenses. It allows you to focus on your health and recovery without the added burden of worrying about the financial implications.
Your health is your most valued asset. With a good health insurance plan, you help protect the health and financial future of yourself and your family for a lifetime. It’s important to note that the specific benefits and coverage may vary depending on the health insurance plan, provider, and local regulations. Make sure to review and understand the terms and conditions of a health insurance policy before enrolling.
Focus on Your Employees’ Financial Well-Being with Safety Nets
In the wake of the Great Depression and WWII, employers started to add benefits packages. Healthcare had fallen by the wayside for families working to access the basic necessities of life. The idea was to support the employee’s personal needs while keeping and attracting the best talents in the workforce. This trend of offering benefits has continued into the 21st century. In the present era, most employees that join the workforce are Millennials (born between 1981-1996) and Generation Z (born between 1997-2012). Over half of them have said they want help building a more secure financial future. Over half of them have said they want help building a more secure financial future.
Employee benefits play a crucial role in providing financial safety nets for employees. When employees experience less financial stress, employers see better employee productivity and fewer work absences. To aid with financial guidance and resources, many employers are offering financial wellness benefits beyond typical retirement plans. Here are some common financial safety nets that may be included in employee benefit packages:
- Retirement Plans: Employer-sponsored retirement plans, such as 401(k) or pension plans, enable employees to save for their post-employment years. These plans typically offer contributions from both the employer and employee, providing a safety net for financial stability during retirement.
- Disability Insurance: Disability insurance provides income replacement if an employee becomes unable to work due to a disability. It helps protect against loss of income during an extended period of absence from work. More disabilities are caused by illness rather than injury – including common conditions like heart disease, back pain or arthritis.
- Life Insurance: Life insurance offers financial protection to employees’ beneficiaries in the event of their death. It provides a lump sum payment or regular income to dependents, helping them cope with financial obligations.
- Paid Time Off (PTO): Paid leave policies, such as vacation days, sick leave, and personal days, offer employees the flexibility to take time off while still receiving their regular pay. This benefit supports employees during times of illness, personal emergencies, or the need for work-life balance.
- Flexible Spending Accounts (FSAs) or Health Savings Accounts (HSAs): FSAs and HSAs allow employees to set aside pre-tax dollars for qualified healthcare expenses or dependent care expenses. These accounts reduce the financial burden of medical or childcare costs.
- Tuition Reimbursement or Assistance Programs: Realizing student loans burden many employees, a growing number of employers are willing to offer help. Employers may also offer educational assistance programs to help employees pursue further education or skill development.
- Financial Education and Counseling: Employers may provide financial education programs and counseling services to help employees manage their finances effectively. Financial planning provides access to financial advisors who can help employees develop an overall financial plan including retirement savings and investing. Financial coaching helps employees manage their personal finances, such as budgeting and managing credit.
- Employee Assistance Programs (EAP): EAPs offer confidential counseling, mental health support, and resources to employees and their families. These programs help employees address personal and work-related challenges and promote overall well-being.
It’s important to note that the specific benefits offered by employers can vary widely. When it comes to benefits, employers know the cost of providing the best options pays off with better talent and more productive workers. Ultimately, having some financial safety nets in place for employees helps workers achieve their financial goals and save more of their hard-earned money for both expected and unexpected expenses.
How To Be an Wise Healthcare Consumer
With health care costs on the rise, it’s more important than ever to take responsibility for your medical care choices. Asking questions and researching your options are good ways to start taking control of how much you spend on health care. Becoming an educated healthcare consumer is important for making informed decisions about your health and getting the best possible care. Here are some steps you can take to become an educated healthcare consumer:
- Research and gather information: Start by researching healthcare providers, hospitals, and clinics in your area. Look for information about their reputation, specialties, and patient reviews so you know the best places to seek dependable care.
- Understand your health insurance: Familiarize yourself with the details of your health insurance plan, including coverage, deductibles, copayments, and network providers.
- Seek reliable sources: Use trusted sources of health information such as reputable medical websites, government health agencies, and academic institutions. Be cautious of misinformation on the internet and rely on evidence-based information to make informed decisions about your health.
- Prepare for appointments: Before visiting a healthcare provider, write down a list of questions or concerns you want to discuss. Bring relevant medical records, test results, and a list of medications you are taking. Being prepared will help you make the most of your appointment and ensure that your concerns are addressed.
- Communicate effectively: During your appointments, be an active participant in your healthcare. Clearly express your symptoms, concerns, and goals to your healthcare provider. Ask questions if something is unclear and request explanations for any medical terms or treatment options that you don’t understand.
- Understand treatment options: If your healthcare provider recommends a treatment or procedure, take the time to understand the benefits, risks, alternatives, and potential costs involved. Ask for additional resources or a second opinion if necessary.
- Advocate for yourself: Be proactive in managing your healthcare. If you have concerns about a diagnosis, treatment plan, or medication, don’t hesitate to speak up and ask for clarification or alternative options. Remember that you have the right to be informed and actively participate in decisions about your health.
- Review medical bills: Errors can occur in medical billing codes and in coverage, so taking a few minutes to read through the bill could save you money by catching potentially costly mistakes. If you have questions or notice any discrepancies, contact your healthcare provider or insurance company for clarification.
- Take care of your overall health: Beyond specific healthcare encounters, focus on maintaining a healthy lifestyle. Eat a balanced diet, engage in regular physical activity, manage stress, and get sufficient sleep. Taking care of your overall health can help prevent many health issues and reduce the need for medical interventions.
- Stay informed and up to date: Continue to educate yourself about relevant health topics and advancements in healthcare. Stay informed about new research, treatments, and preventive measures.
Remember, being an educated healthcare consumer is an ongoing process. By actively seeking information, communicating effectively with healthcare providers, and advocating for yourself, you can make informed decisions and take control of your health.
Understanding Employee Assistance Programs
As much as employers might prefer that employees’ personal affairs do not interfere with their work, the reality is that problems outside of the workplace can and do impact job performance. Many of these issues go unaddressed due to fear of stigmatization, leading to further declines in employee health and productivity. Anxiety and stress, financial troubles, substance abuse and other personal problems can also lead to increased absenteeism. To help combat these issues, many employers offer a workplace benefit called an Employee Assistance Program (EAP) that is designed to help employees address everyday challenges.
What is an EAP?
An EAP provides voluntary, confidential services to employees who need help managing personal difficulties or life challenges. The idea is to address personal issues before they interfere with work performance. The employee assistance program is one of the top benefits employers offer in America—for a good reason. They are one way that companies support the well-being of their employees. An EAP generally offers confidential assessment, short-term counseling, referrals and follow-up services for employees.
Typically, an EAP grants employees access to a set number of sessions with a therapist, and the employee would not accrue any co-pay, deductible, or other out-of-pocket costs for the service. For example, Nick has been struggling with depression. To sooth his anxiety, he has begun drinking every day. It’s gradually escalated to the point where he is late to work, has frequent absences, and is missing deadlines. He knows he needs to talk with someone who can offer him alcohol abuse resources. He accesses his company-sponsored EAP.
Meredith is a full-time, married employee with two small children and is also caring for her aging mother who suffers from Alzheimer’s. She is constantly stressed due to the heavy burden of her daily life. The schedule has left her exhausted and she misses work each month due to feeling burnt out. She reaches out to her EAP counselor for time management and mental health tips.
Here are some other common services included in EAPs:
One reason behind the popularity of EAPs is that it’s a mutually beneficial program for employers and employees. After all, your employees are the foundation of your company. Healthy and happy employees are more productive and engaged in their jobs which is great for your company’s bottom line!
Understanding Health Savings Accounts
Are you the type of person who loves to save money? You’ll be happy to know that there’s a way to do so with your health care costs. It starts with medical expense accounts which let you set aside money to pay for certain health products and services. One type of medical expense account is a Health Savings Account (HSA).
How Does An HSA Work?
An HSA is a type of personal savings account you can use to pay certain health care costs. An HSA lets you pay for qualified health, dental and vision care costs for yourself, spouse and dependents with tax-free money. The money you contribute comes out of your paycheck – before taxes – and that is how you save to pay for your out-of-pocket health care expenses. Like a regular savings account, your HSA has an interest rate that allows your money to grow while sitting in the account. Your employer also has the option of contributing to your HSA, helping it to grow faster.
If you don’t use all of your HSA funds during the calendar year, you can roll that money over. An HSA is owned by you so you take it with you no matter if you change plans, change jobs or if you decide to retire. You will get a debit card which is linked to your HSA when you set up your account that you use to pay for eligible expenses.
You must be enrolled in a High Deductible Health Plan (HDHP) to open and contribute to an HSA. HDHPs medical plans aim to minimize your health care costs if you don’t use your plan a lot but keep you financially protected in cases of illness or emergency. Similar to a car insurance policy, you pay for your expenses up to the point that you meet your deductible and then the insurance coverage begins. The higher the deductible you choose, the smaller the monthly cost will be. But it also means that when you have health expenses, you are responsible for all of the costs up to your deductible amount. Rather than pay for your health expenses that occur before hitting your deductible out of your pocket, you can pay for those expenses using pre-tax dollars from your HSA account.
Federal law includes strict guidelines for HSAs including HDHP cost sharing and annual limits on contributions. The amount you contribute can be adjusted throughout the year but they do have an annual limit on how much you can contribute per year. This limit is set by the IRS and usually increases each year. Contribution limits for 2023 and 2024 are:
What Are the Benefits of Having an HSA?
- Money goes in tax-free – Your HSA contributions are made on a pre-tax basis and are also tax deductible
- Money comes out tax-free – Eligible healthcare purchases can be made directly from the HSA account
- Earn interest, tax-free – The interest on HSA funds grows on a tax-free basis. Unlike most savings accounts, interest earned on an HSA is not considered taxable income when funds are used for eligible medical expenses.
- Your HSA balance can be invested – Depending on your HSA, you may be eligible to invest your HSA similar to a 401k or IRA – in an interest-bearing account, mutual fund, stocks or bonds.
- Your HSA balance can be carried over – Unlike a Flexible Spending Account (FSA), an HSA is not a use-it-or-lose-it account. You can carry over your balance year after year.
- You can use your HSA to add to your retirement funds – After the age of 65, you can withdraw funds from your HSA for any reason without penalty.
The Bottom Line
HSAs are often referred to as triple tax-advantaged and are one of the best savings and investment tools available under the U.S. tax code. As a person ages, medical expenses tend to increase, particularly when reaching retirement age and beyond. Therefore, starting an HSA early and allowing it to accumulate over a long period, can contribute greatly to securing your financial future.
Health Insurance: Four Factors Driving the Increasing Healthcare Costs
Healthcare costs, and consequently employee health benefit costs, have been growing at an alarming rate in recent years. The U.S. as a nation spends more on health care than any other developed country but has worse health outcomes. How is this possible?
Four Key Factors Driving U.S. Healthcare Costs:
- Aging Population
Healthcare gets more expensive when the population expands, as people get older and live longer. The Baby Boomers, one of America’s largest adult generations, is approaching retirement age. Because of this, the 65+ population is growing at an unprecedented rate. According to the U.S. Census Bureau, 21% of the entire population will be age 65 or older by 2030. Older Americans will make up almost one-quarter of the population by 2060.
This growth is likely to contribute to rising healthcare costs in two important ways:
- Growth in Medicare enrollment
- More complex, chronic conditions
- U.S. Population Is Growing More Unhealthy
According to the Center for Disease Control and Prevention (CDC), 6 out of every 10 adults in the U.S. have at least one chronic disease, such as asthma, heart disease, high blood pressure, or diabetes, which all drive up health insurance costs. In 2020, the health care costs of people with at least one chronic condition were responsible for 86% of health care spending.
Additionally, recent data finds that nearly 20% of children and 40% of adults over 20 in the U.S. are either overweight or obese, which can lead to chronic diseases and inflated healthcare spending.
- Rising Drug Prices
On average, Americans shell out almost twice as much for pharmaceutical drugs as citizens of other industrialized countries pay. Moreover, prescription drug spending in the U.S. will grow by 6.1% each year through 2027, according to the Centers for Medicare and Medicaid Services (CMS) estimates.
Drug pricing strategies also contribute to rising healthcare costs. Drug manufacturers establish a list price based on their product’s estimated value, and manufacturers can raise this list price as they see fit. In the United States, there are few regulations to prevent manufacturers from inflating drug prices in this way.
- Administrative Costs
Simply put, multiple systems create waste. “Administrative” costs are frequently cited as a cause for excess medical spending. The U.S. spends about 8% of its health care dollar on administrative costs, compared to 1% to 3% in the 10 other countries the JAMA study looked at.
Why is administrative spending so high in the United States? The U.S. operates within a complex, multi-payor system, in which healthcare costs are financed by many different payors. With so many stakeholders involved, healthcare administration becomes a complicated, inefficient process.
These inefficiencies contribute to excess administrative spending. The main component of excess administrative spending is billing and insurance-related (BIR) costs. These are overhead costs related to medical billing, and include services like claims submission, claims reconciliation and payment processing.
Administrative costs, an aging population, rising prescription drug costs, and lifestyle choices all play a factor in ballooning healthcare expenses. While some of these factors are not in your control, others are. Find out where you can make a difference, not only in health insurance costs, but also to your overall health!
Volunteering to Help Others – Your Mental Health Will Thank You!
Volunteers make an immeasurable difference in people’s lives and often serve with the intention of helping others. But, did you know that volunteering can benefit your mental health as well?
While it’s true that the more you volunteer, the more benefits you’ll experience, volunteering doesn’t have to involve a long-term commitment or take a huge amount of time out of your busy day. Donating your time in even simple ways can help those in need and improve your health and happiness.
Here are a few of the mental health benefits that result from volunteering:
- Improves Mental and Physical Health – Volunteer activities keep people moving and thinking at the same time. Additionally, volunteering reduces stress and increases positive, relaxed feelings by releasing dopamine. By spending time in service to others, volunteers report feeling a sense of meaning and appreciation, both given and received, which can have a stress-reducing effect. Reduced stress further decreases risk of many physical and mental health problems, such as heart disease, stroke, depression, anxiety and general illness.
- Provides a Sense of Purpose – Volunteering connects you with a cause bigger than yourself. Many individuals feel that where they volunteer says something about who they are. Dedicating time to a cause can give you new direction and allow you to find meaning in something unexpected. It can also take your mind off your own troubles while keeping you mentally stimulated.
- Nurtures New and Existing Relationships – Loneliness has been described as an epidemic in the U.S. and making friends as an adult can be difficult. Volunteering is a remedy to this problem because it increases social interactions and builds a support system based on shared interests. Like-minded, like-hearted people come together over common values. Whether it is campaigning for specific political goals, volunteering time to help sick children in the hospital or working in a soup kitchen, a volunteer activity can help break the ice with potential new friends all while giving back to your community.
- Increases Confidence – Some volunteering activities require learning new skills. Being in an unfamiliar environment while gaining a new skill provides mental stimulation. Additionally, while growing your skill set to make a difference for others, you gain a sense of pride which can lead to having a more positive view of yourself.
- Ignites Passion – Volunteering is a fun way to explore different interests and learn from others. It can be an energizing escape from your daily routine – especially if you work in front of a computer all day in an office and long to be more active outdoors. You can look for opportunities to help with walking dogs at your local animal shelter or help with building homes for those in need.
- Makes You Happy – Research shows that brain activity spikes during volunteer activities. We are social animals and are designed to be part of a wider community. Volunteering helps you make the world a better place and helping others provides great pleasure.
What are you passionate about?
Do you want to feel good while doing good?
How would you like to see the world be a better place?
There’s a volunteer activity perfect for your skill set and time availability. Churches, schools, or libraries can always use your support. Whether it’s tutoring a student, visiting the elderly, caring for abandoned animals, or being a baby cuddler (yes – that’s holding babies in the neonatal intensive care unit in the hospitals!), the possibilities are endless. There are even ways to volunteer remotely via phone or computer. Getting involved will boost your well-being while you are making a difference in the community.
