We just stuffed ourselves for another Thanksgiving and it’s less than a month away from Christmas! Did you think that’s what I was talking about? It’s what most people think about in November and December, but this time of year can also create a lot of anxiety for the chronically ill. It’s called open enrollment.
Those who work for large companies and have group insurance where the employer pays most of the premium cost may not quite understand (although I’m hearing that even in those cases, folks are paying more and receiving less benefits). But if you are self-employed, elderly, or are disabled, open enrollment can leave your head spinning. You have a small window to decide on your healthcare plan which you will be stuck with for the entire next year, so it is not the time to make a crucial error! Yes, there are agents who can help with navigating this process, but many of them are very busy because so many people need help.
Because the government website is often slow, another site is healthsherpa.com which some insurance agents utilize. For the chronically ill, it is imperative that you enter in your doctors and medications to see if they are covered under each plan. Make sure to look at deductibles, co-pays, and what types of care are omitted from the plan. For example, pain management is sometimes not included. To the healthy, a plan with a $6000 individual deductible might be worth the risk to lower premiums, but the sick have a combined problem of not being able to pay for the deductible in addition to needing lower premiums because they are possibly unable to work.
This can be a scary process. For me, I pray for wisdom and God’s direction to get into the right plan. It’s not a decision that can be made in one day. Be methodical and try to remove emotion from the process. A decision based on emotion rarely has good outcomes. Still, even with the best planning, the fear may remain for the chronically ill that they may find themselves in a battle for coverage over this next year with the insurance company. It might be for crucial medication, coverage for a specific doctor, or coverage for larger costs such as equipment or hospital stays. Memories of previous situations like these can haunt the chronically ill so it becomes a battle of the mind during this time of decision-making.
I tell my daughter that if insurance roadblocks do occur over the upcoming year, we will just have to deal with it and pray for guidance. If medication is denied and it is too expensive to afford, it might mean that a disabled person may suffer a setback. A mostly healthy person with a good income might say, “No big deal if my insurance won’t cover this medication. I’ll just pay cash for it.” But can you imagine if you had no way to pay for that $300 or $1000 a month prescription? Again, a mostly healthy person would say, “there are cheaper generics that could be afforded.” Not so in certain cases. Some more affordable medications may not work for that individual. One app that is worth a look is GoodRx. It can be used even if a person has insurance and it searches pharmacies for the cheapest cash cost on drugs. Unfortunately, it cannot help when the cost is more than a person can afford.
These are the things the chronically ill are thinking about this time of year. It’s sort of a shame that open enrollment must occur during what is supposed to be a joyous time. What about you? Are you trying to figure out the best healthcare for next year? You are not alone, so don’t try to figure it all out on your own! My favorite verse is Jeremiah 33:3 where it says, “Call unto me and I will answer thee, and show thee great and mighty things which thou knowest not.” I may not know what to do, but God will help me when I call out to Him