Healthcare open enrollment tips from an expert on Oklahoma's rules

As healthcare enrollment season is well underway, The Oklahoman asked Sonja J. Hughes to answer some of the most commonly asked questions about the process. Hughes is the vice president of strategy and service excellence for managed healthcare company Aetna, and is based in Oklahoma City.

The following four questions about healthcare enrollment are among the most common asked of Hughes.

Q: What is open enrollment for health insurance? When is it?

A: Open enrollment is a time when Oklahomans can enroll in a health insurance plan. While many people enroll in a plan through their company, some are eligible and enroll in Medicaid, which is called SoonerCare in Oklahoma (a joint federal and state program providing health coverage for people meeting certain criteria such as income) or Medicare (a federal health insurance program for people aged 65 and older and younger people with certain disabilities). Alternatively, you can enroll on the ACA Marketplace like over 189,000 Oklahomans did for 2022 coverage.

While open enrollment for employer plans is company specific, enrollment for marketplace plans generally runs from Nov. 1, 2022, through Jan. 15, 2023. The annual enrollment period for Medicare plans runs from Oct. 15 to Dec. 7 each year. You can apply for Medicaid anytime. Be sure to check out plan information for details on important dates and eligibility.

What factors should I consider when making health insurance decisions and open enrollment decisions?

It all depends on your unique needs and budget. So when considering health insurance for 2023, think about what you and your family may need to support your preventive care needs, clinical conditions, acute health needs or life events. For example, are you planning to have a baby or retire? For individuals and families eligible for Medicaid, plans generally provide access to care at low cost or no cost to members.

What out-of-pocket costs should I expect from my plan?

You'll want to look at the costs of health plans each year because plan options or your situation can change. A premium is the monthly amount you pay for coverage. A deductible is the amount you must pay for covered health care services or prescriptions before your health plan begins to pay. The out-of-pocket maximum is the limit on what you'll have to pay in a year for covered health care services. Coinsurance is a percentage you pay after you've met your deductible, and a copayment is a fixed amount you typically pay at the time of care. Out-of-pocket costs vary by plan, so it's important to review these costs before you enroll in a plan. For example, costs can be low or not applicable for people eligible for Medicaid.

How can I get the most out of my insurance benefits, including any added-value features?

There are some simple things you can do to get the most out of your plan and save money. Seeing health care providers that are in your plan's network can lower your costs. Also, regular checkups and screenings can be low cost and identify problems early, and some insurers offer tools that help you compare costs before you go to the doctor. Also look for value added benefits. For example, Medicaid plans will often include benefits like respite care and transportation to and from medical appointments.

Sonja J. Hughes, MD, MHA, FACOG, is vice president of strategy & service excellence for Aetna and is based in Oklahoma City.