This year’s open enrollment period in the individual market — for people buying insurance directly from a health plan or through Covered California rather than through an employer — begins Nov. 1, 2021 and runs through Jan. 31, 2022.
“This year’s open enrollment is really important,” explains Don Truong, director of sales at Sharp Health Plan. “Making sure that you and your loved ones have access to the best care is critical, especially during the COVID-19 pandemic. That’s why we put together the following shopping checklist to help you pick the right health insurance provider and benefit plan for next year.”
Your health insurance shopping checklist
- Shop for a health plan based on quality
You should always look at the quality of a health plan before purchasing health insurance. The National Committee for Quality Assurance (NCQA) offers annual health insurance plan ratings based on clinical quality, member satisfaction and NCQA accreditation survey results. Covered California also rates health plans based on members getting the right medical care, their care experiences and plan services. It’s also important to check on the quality of a health plan’s network — the health care facilities and doctors that you’ll have access to through your health plan.
“For example, Sharp Health Plan is the highest member-rated health plan in California, and we also hold the highest member ratings for health care, personal doctor and specialist among reporting California health plans,” explains Truong.* “Sharp Health Plan is also rated 5 out of 5 stars by Covered California.**”
- Consider what care you may need in the future
Determine what health care services you’ll likely need to use for the upcoming year. This includes specialist appointments and prescriptions. If you or anyone in your family has a new health condition, prescription or is planning to undergo surgery, you’ll want to take that into consideration when selecting a plan. It’s also a good idea to see what type of coverage your health plan offers in terms of COVID-19 screening, testing and treatment, and what your out-of-pocket costs might be for those services.
- Know how much you’ll pay and check to see if you qualify for financial assistance
The amount of coverage you get depends on the type of plan you choose. Typically, the more coverage you have, the higher your monthly premium will be. Most health plans share costs with you through deductibles, copayments and coinsurance. It’s important to understand the services a health plan covers and any associated out-of-pocket costs before picking a plan.
Health coverage is available at reduced or no cost for people with incomes below certain levels. The American Rescue Plan Act of 2021 is offering additional premium assistance through 2022. And California has made it easier for many middle-income consumers to qualify for financial help. Even if you haven’t qualified for financial help in the past, you may now. Check with Covered California to see if you qualify.
Most people can expect to see a much lower bill. This includes people who haven't qualified for financial help in the past, as they may now be eligible for premium assistance with the new law. Truong adds, “Sharp Health Plan is offering select plans through Covered California for as low as $0 a month, based on eligibility.”
- Make a list of must-have prescriptions, doctors and facilities
Every health plan has a network of providers, pharmacies and hospitals for you to use when you need to get care. It also has a list of prescriptions it covers. When evaluating a health plan, it’s a good idea to check out their network to ensure that your doctors and prescriptions are covered.
- Prepare your information
When you apply for or renew your coverage, you’ll need to provide some information about you and your household, including:
• The names, dates of birth and Social Security numbers of everyone you want to cover on your plan
• Your estimated household income for 2021 (pre-tax), if you want to see if you qualify for financial help
• Employer names, addresses and phone numbers for everyone in your household
• Immigration documents (if applicable)
If you can check off the items on the list above, then you’re ready to get insured for 2022. However, if you still have questions, there are many resources available. “We want to make sure people know that they can get help,” advises Truong. “There are lots of community resources available with experts whose job is to help you find the right coverage.”
Sharp Health Plan hosts free, virtual enrollment labs, where you can learn about health insurance options and, if you feel ready, get help with enrollment at no cost to you. Visit sharphealthplan.com/labs for dates and registration. You can also contact the Covered California service center for support.
* The source for this data is Quality Compass® 2021 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass® 2021 includes certain CAHPS® data. Any data display, analysis, interpretation or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation or conclusion. Quality Compass® is a registered trademark of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Sharp Health Plan achieved the following summary ratings (9+10): 64.73 for Rating of the Health Plan compared to the California all LOBs average (excluding PPOs & EPOs) of 50.74; 69.47 for Rating of Health Care compared to the California all LOBs average (excluding PPOs & EPOs) of 56.87; 75.69 for Rating of Personal Doctor compared to the California all LOBs average (excluding PPOs & EPOs) of 65.86; and 76.15 for Rating of Specialist compared to the California all LOBs average (excluding PPOs & EPOs) of 68.84.
** 2 CMS scores qualified health plans (QHPs) offered through the Exchanges using the Quality Rating System (QRS) based on third-party validated clinical measure data and QHP Enrollee Survey responses. CMS calculates ratings yearly on a 5-star scale. QHP issuers work with HHS-approved survey vendors that independently conduct the survey each year. QRS ratings and QHP Enrollee Survey results may change from year to year.