Struggling to find a therapist who truly feels like the right fit, and is covered by your insurance? Do you wish you could simply choose the person you want to work with, based on their expertise and not your insurance plan? Discover how adjusting your benefits during open enrollment can help you do just that!
Autumn brings a heap of holidays, and we all know that usually means lots of spending… So what if we told you that you could also do some savings? Open enrollment offers a chance to adjust your insurance coverage, giving you access to benefits that fit your needs and budget.
But, how does this help make therapy affordable? Well, open enrollment allows you to explore options like out-of-network (OON) benefits, which gives you the flexibility to choose the therapist you feel most comfortable with, while still being reimbursed for therapy costs.
This way, you can focus on finding the right support without stretching your budget, making mental health a sustainable part of your life. Curious to find out more? Let’s dive in!
What Is Open Enrollment?
First things first! Let’s start by understanding what open enrollment is and how you can get the most out of it.
Open enrollment is a once-a-year chance to review, assess, and modify your existing insurance benefits or enroll in new a plan. Outside this limited window, changes to your insurance typically require a major life event, such as having a baby, getting married, or losing other health coverage.
Think of open enrollment as an opportunity to review your health costs and make informed decisions that will affect both your finances and your healthcare options for the upcoming year.
During this period, consider how your current insurance supports mental health care. Whether you already have a therapist or are thinking of starting therapy, this is a great time to choose an insurance plan that aligns with your goals.
When Does Open Enrollment End?
Knowing the open enrollment deadlines is crucial, as missing them could leave you with benefits that don’t meet your needs for an entire year. So, mark your calendar and take the time to thoroughly review your options in advance.
Remember, exact dates vary each year and by state, so always check for the most accurate enrollment information.
Important Dates to Remember:
- November 1: Open Enrollment begins. This is the first day you can enroll in, renew, or change health plans through the Marketplace for the upcoming year. Coverage can start as soon as January 1.
- December 15: Last day to enroll in or change plans if you want your coverage to begin on January 1.
- January 1: Coverage starts for everyone who signed up or changed their plan by December 15 and paid their first premium.
- January 15: Open Enrollment ends. This is the last day to enroll in or change plans. After this date, you can only make changes if you qualify for a Special Enrollment Period.
- February 1: Coverage starts for those who enrolled or changed plans between December 16 and January 15, as long as they paid their first premium.
If you get health insurance through work, these dates may differ. Each employer sets their open enrollment period, so check with them to ensure you don’t miss the chance to update your benefits.
How Does Open Enrollment Work?
During open enrollment, you can enroll in or change your benefits, whether they’re offered through your workplace or the government marketplace. Therefore, this is the ideal time to identify the options that best support your mental health needs.
These are some common adjustments you can make:
- Enroll in new health benefits:
Sign up for new health plans that may better suit your needs.
- Select different coverage levels:
Choose between different coverage options, such as individual or family plans, to ensure you have the right support for yourself and your loved ones.
- Choose between different plan types:
Decide on the type of health plan that works best for you, such as a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO), considering which may offer better access to mental health providers.
- Modify or update current coverage:
Take this opportunity to adjust your existing health coverage, such as increasing coverage limits or adding beneficiaries.
How Do Plans With Out-of-Network Benefits Work?
A common concern for those starting therapy is finding a therapist with whom they feel at ease, but being limited to the in-network providers specified by their insurance plan. We know that finding the right fit in therapy can make all the difference! If you’re looking for someone with a specific approach or expertise, you may find the best fit outside your network.
The good news is that many insurances offer OON benefits, which lets you choose professionals who aren’t part of your plan’s network while still getting reimbursed for some of the fees. OON benefits help bridge the gap, allowing you to prioritize finding the therapist you feel most connected with.
These benefits give you the flexibility to choose specialized therapists that may not be available in-network. This can be a significant advantage, especially if your ideal therapist doesn’t accept insurance or isn’t affiliated with your network.
While the initial out-of-pocket costs may seem higher, you can generally receive between 50% to 80% of the therapy costs. This ultimately makes therapy more affordable and sustainable for your mental health journey.
Want to know how much you would be reimbursed for a session with one of our therapists? Get an estimate with the instant benefit calculator on our Rates & Insurance page!
3 Tips To Help You Choose the Right Benefits During Open Enrollment
1. Opt for a plan that includes out-of-network benefits
Open enrollment is a chance to make mental health care more accessible and affordable by carefully selecting a plan that supports your therapeutic needs.
OON benefits empower you to work with a therapist who’s the best match for you, while still being reimbursed. Thus, fostering a more fulfilling and effective therapy journey.
2. Explore the PPOs offered by your employer
If you get health insurance through your job, start by learning more about the PPO options included in your benefits package.
PPO plans offer the freedom to receive care from any provider — in or out of your network. This gives you more control in choosing the best therapist for your needs.
3. Avoid HMO and EPO plans
These plans don’t cover care from OON providers, leaving you responsible for the full payment of your therapy costs, in case you choose to work with a specific professional or specialist.
Need Help with Insurance?
We know that navigating insurance can feel overwhelming, and we don’t want it to stand in the way of your decision to start therapy. So, we’re here to help! At New Connections, we handle the out-of-network paperwork for you. This saves you time and expedites the process of getting reimbursed.
If you have any questions, don’t hesitate to reach out! Talk to us to learn more, or schedule a free 15-minute consultation here.
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