‘Tis the Season…  

The holiday season is approaching. You have gift lists and special preparations to make. However, another important season is also upon us: insurance open enrollment. This year, it’s more important than ever for you to take advantage of open enrollment season to get the coverage you need.

You need to stay on top of this because the insurance open enrollment period has been reduced from three months to 45 days: November 1 to December 15. Miss enrolling during these dates and you could be out of insurance for 2018. Start now to evaluate your health insurance needs!

These are the insurance open enrollment dates for those enrolling through the Affordable Care Act (ACA). If you receive health insurance through your employer, you need to follow your employer’s enrollment dates, which could differ from the federal government. Most plans enrollment periods typically run from around October through the end of the calendar year, so the season is upon us!

Either way, you still need to evaluate your family’s insurance needs and make any appropriate adjustments for 2018.

The Top Ten Benefits

In the debate over healthcare, the federal government settled on 10 benefits or areas of coverage it considered essential. In order to qualify for the marketplace, every health plan needs to include all ten of them. While not every person will need to make use of all ten areas of coverage, these ten cover what the majority of Americans needs at some point in their lives:

  • Outpatient care
  • Emergency care
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance abuse services
  • Prescription drugs
  • Rehabilitation services and devices
  • Lab tests
  • Preventive and wellness services
  • Dental and vision care for children

Although every insurance plan must include coverage for all ten services, the extent of the coverage can vary considerably from one plan to another.

Insurance open enrollment is the best time for you to reassess your most pressing health concerns. If you have developed a heart condition, for example, you might want double check your current policy. Does it offer the best coverage on prescriptions and lab tests? If you’re hoping to start a family, you should pay closer attention to your policy’s pregnancy and newborn care provisions.

What’s New with You?

Perhaps you haven’t paid much attention to your policy’s coverage on rehabilitation services and devices until now.

  • Are you a soccer mom? Which sports are the kids playing next year? Could they potentially get injured and need physical therapy?
  • Are you a weekend warrior? Computer nerd by weekday and racquetball player on Saturdays? Is it getting tougher going from sedentary desk job to full-throttle athlete?
  • Are you an octogenarian whose doctor is suggesting hip replacement surgery next year? Even a spring chicken needs physical therapy following surgery!

Whatever your specific circumstances are, have you considered whether your insurance coverage for physical therapy will be adequate for you and your family’s needs?

The Clock is Ticking

Insurance open enrollment used to last 60 to 90 days, but this year you have only 45 days to decide your insurance option (if enrolling through ACA). Understanding both the legal and medical language can be challenging. As you look over potential healthcare plans, be sure to start with the Summary of Benefits statements.

Even if you receive health insurance through an employer, it might be worth taking some time during insurance open enrollment to discuss your benefits with your human resources department. In addition to clarifying what exactly your insurance covers, you might be able to press for better coverage.

Large employers have some clout with health insurance companies. When companies discover a competitive edge in recruiting the best employees by offering better benefits or when they can lower losses related to employee sick leave by improving workforce health and well-being, companies can negotiate better rates for health care coverage.

What Am I Looking For?

If you are on your own to select a health plan during insurance open enrollment, we have some suggestions to help you compare plans.

  • Referrals and Right to Choose. While you have the right to choose your health care providers, you do need to pay attention to any restrictions on that choice. HMOs, for example, typically have networks, and your preferred provider might not be a member of that network. Check which health plans your preferred providers honor before you sign up! Other times your coverage of physical therapy depends upon a doctor’s referral. Before you make the call, make sure you understand any requirements related to referrals first.
  • Each condition. Some plans limit your access to physical therapy by covering only one condition during the year. If you’re generally healthy and feel confident you can avoid accidents and injuries, you might be willing to take this gamble. The rest of us might not feel so lucky. Be sure each condition will be covered. You deserve to receive treatment for every health issue you face regardless of the calendar!
  • Each “episode of care.” Wouldn’t it be nice if your condition could be treated once and forever? However, that’s not the real world. Arthritis is degenerative. It’s one condition, but you could be in a world of hurt if your condition were only covered for one “episode of care”! As your condition changes during the year, you need continued care for each and every episode. Make sure your plan includes this provision during insurance open enrollment.
  • Restoration of function. This language is important because it allows you to receive therapy until you are back to normal. Your recovery from knee replacement might fall in line with the usual length of recovery, but what if you have a setback? Your coverage shouldn’t be cut off after an arbitrary brief time frame.
  • Functional independence. If you suffer from a chronic condition, pay attention to what a health plan says in regard to functional independence. You will likely need to see your physical therapist more than once a year. Your therapist might need to evaluate your exercise regimen or reassess your need for assistive devices. Children grow; they need devices to “grow” with them. Benefit language that includes functional independence allows for changes in a patient’s chronic condition.

Who Can You Turn To?

There’s no shortage of people happy to give you advice, but can you trust it? The right choice of health plan for your neighbor might not be the best option for you. You need advice, but you need sound advice. And this year, you need that advice sooner rather than later!

The staff at Midland Physical Therapy knows how important rehabilitation services are as one of the ten essential benefits. So if you could use some help in understanding what your health plan does or doesn’t cover, come talk to us! We’ll answer your questions or put you in touch with a qualified expert who can.

Insurance open enrollment begins November 1st. It will be over on December 15th. Don’t put off getting answers to your questions. You know that Midland Physical Therapy is here for all your physical rehabilitation needs. Now you know we’re here for your peace of mind, too! Just give us a call at (989) 832-6485 or Contact Us today. We’ll make time for you.