A Guide to Navigating Open Enrollment

Choosing Health Insurance That’s Right for You

Join Christine, a Takeda Patient Access Manager (PAM), as she walks you through the ins and outs of Open Enrollment—which is the period each year when you can sign up for health insurance, renew your current coverage, or change your plan. She’ll answer questions about Open Enrollment and explain why it’s so important to plan for. We hope you find it informative!

Transcript:

Chapter 1: Introduction

This program is only intended for patients and caregivers who are enrolled in a Takeda Patient Support Program.

Christine: Hi there! I’m Christine—a Takeda Patient Access Manager. I’m here today to help answer questions you may have about Open Enrollment. This yearly event can feel like a complex process, but I’m here to provide information that will hopefully make it, well, less complex!

Christine: During today’s program, I’ll be taking peoples’ questions about Open Enrollment and health insurance. These are two subjects that I love talking about and helping people to better understand, but I also totally get that these can be very dry subjects—drier than a desert in summertime!

So, throughout this program, my goal is to keep you informed and engaged. I’ll try to explain things in easy-to-understand terms, and I’ll direct you to helpful links where you can learn more.

Links to more resources are also provided on the web page you are viewing this program from; you’ll find them right below the video player.

Links to third-party websites are provided as resources and not intended to be an endorsement. Takeda is not responsible for their content.

I also want to mention that if there’s something you’re just desperate to learn about and can’t wait to see, we’ve made it easy for you to jump ahead to a different part of the program. Simply select the chapter you’re interested in on the right-hand side of your video player.

But really, I urge you to watch the whole thing. Lastly, and as always, I want to remind you that your dedicated Takeda support specialist is just a phone call away when you need them.

Okay, now on to our first question.

Chapter 2: Why Open Enrollment Is Important

Carrie: I’m Carrie, and my question is: I have health insurance. So why should I care about Open Enrollment?

Christine: Great question to get us started, Carrie! Open Enrollment is the period each year when you can sign up for health insurance, renew your current coverage, or change your plan. Open Enrollment can involve different things for different people. It depends on your situation and the type of coverage you have, such as:

Commercial, or private, health insurance through your job
A plan through the Health Insurance Marketplace
Or coverage through Medicare

We’ll talk a little more about these different types of coverage throughout the program. But right now, we’re ready for our next question.

Chapter 3: When Open Enrollment Occurs

Leon: My name is Leon. And I’d like to know, does Open Enrollment happen at the same time every year?

Christine: Thank you, Leon! Another very important question. Based on the type of insurance you have, whether it’s private insurance, such as through your job, or a public plan, such as through Medicare, the dates for Open Enrollment can differ.

If you have a commercial, or private, plan through your job, Open Enrollment dates can vary based on your employer. Open Enrollment often takes place during the fall, but it’s important to check with your human resources department for specific dates.

Keep in mind, you can also have private coverage through the Health Insurance Marketplace. The Health Insurance Marketplace can go by many names, so it can get a little confusing—it can be referred to as the ACA or the Affordable Care Act, Obamacare (now Bidencare), or the Healthcare Exchange, to name a few. Open Enrollment dates can also vary for these plans. Visit Healthcare.gov for more information.

Links to third-party websites are provided as resources and not intended to be an endorsement. Takeda is not responsible for their content.

If you’re eligible for Medicare, there are a few Open Enrollment periods depending on your situation:

If you’re already on a Medicare plan, the yearly Open Enrollment period runs from October 15th through December 7th for coverage that starts on January 1st

If you are newly eligible for Medicare, you can join a plan during your Initial Enrollment Period, which occurs over a 7-month period starting 3 months before the month you turn 65
Medicare also offers special enrollment periods

You can learn more about these at Medicare.gov.

Links to third-party websites are provided as resources and not intended to be an endorsement. Takeda is not responsible for their content.

Okay, so we’ve talked about what Open Enrollment is and when it occurs. What’s our next question? Come on, bring it on!

Chapter 4: How to Prepare for Open Enrollment

Tiffany: Hi, I’m Tiffany, and my question is, what’s the best way to prepare for Open Enrollment?

Christine: I love this question, Tiffany, because Open Enrollment really is about being well prepared. You see, changes to healthcare insurance laws happen from time to time. That’s why, regardless of your situation, it’s important to understand your current plan and the options available to you for the coming year.

Use the Open Enrollment period to learn more about your insurance options so you can make decisions based on what’s best for you. This can help ensure that the plan you choose:

Offers comprehensive coverage that fits your needs
And is a good value for your total costs, which include premiums, deductibles, co-pays, and coinsurance

I think we have another question.

Chapter 5: Health Insurance Terms Explained

Victor: Hi there, I’m Victor. I always get confused by certain terms. Premium, deductible, co-pay, coinsurance? What’s the difference?

Christine: Thanks, Victor! Great question, and I totally get it. You’re not alone; health insurance terminology is confusing, and that’s a fact. But I’m here today to help make it less confusing, and I want you to know that when you’re preparing for Open Enrollment, it’s helpful to arm yourself with knowledge and understand what certain terms mean. So let’s run through a few of them. Actually, let’s walk through them so we don’t trip!

A premium is the amount you pay for your health insurance every month
A co-pay is the amount you pay to a healthcare provider at the time of an appointment or other service. This amount may vary for different services within the same plan, including prescriptions, lab tests, or visits to specialists
A deductible is the amount you pay each year for covered prescriptions or healthcare services before your health plan starts to pay. Once you have reached your plan’s deductible amount for the year, you will most likely only pay the co-pay or coinsurance for any covered prescription or service after that. Your plan will pay the rest
Coinsurance is the share of healthcare costs after you’ve met your deductible. So, for example, if your plan covers 80% of a service, you’ll have to pay the other 20%. The 20% you pay is the coinsurance
And the out-of-pocket maximum is the most you must pay for covered services in a plan year. After you spend this amount on deductibles, co-payments, and coinsurance, your health plan will pay the rest

Before I go on to the next question, there are two more terms I’d like to talk about:

They are co-pay accumulators and co-pay maximizers. When these are used by a plan, the plan does not allow you to count a drug maker’s co-pay assistance payments for your treatment toward your annual deductible and out-of-pocket costs. You should definitely keep an eye out for them when choosing a plan

You can learn more about these and other insurance terms at the links provided. Now, let’s take our next question.

Links to third-party websites are provided as resources and not intended to be an endorsement. Takeda is not responsible for their content.

Chapter 6: Navigating Open Enrollment

Cecilia: Hi Christine. I’m Cecilia. Do you have any tips for navigating Open Enrollment?

Christine: Cecilia, your question is right on point! Navigating Open Enrollment is the reason we’re here today. So, let’s get started.

Okay, tip number one: whether you have private insurance or coverage through Medicare, you want to determine your medical needs for the year ahead. So what does that mean? You’ll need to consider a few important points, such as:

All the medications you anticipate you’ll be prescribed, and if they are on the formulary of the insurance plan that you choose. The formulary is the list of prescription drugs covered by your insurance plan, and it can change annually
You’ll also want to anticipate all the types of care you may require. This includes your primary care provider and any specialists you’ll need to consult with, as well as any facilities and/or hospitals that may provide you care

And you’ll want to know if your providers and facilities are in-network or out-of-network. In-network costs are typically lower than out-of-network costs. But of course, you can still use facilities and providers that are out-of-network if that’s your preference
You also want to consider any medical services that you will continue to receive in the year ahead, such as home health, nursing, and/or infusion services

And finally, consider the total costs involved. This includes deductibles, premium costs, co-pays, and so on

Once you determine your medical needs, my second tip is: Start shopping! Review your available options to determine the right plan for you.

If you have commercial, or private, health insurance through your employer or through the Health Insurance Marketplace, you should be provided documents to help you fully understand your current plan or any plan you may be considering. These documents include:

The Summary of Benefits and Coverage, or SBC—this is an easy-to-understand summary of the plan’s benefits and coverage
And the Summary Plan Description, which offers information on what the plan provides, how it operates, and how to file a claim

If you have questions about a health insurance plan, you can speak with:

Your employer’s human resources department
The administrator of the health plan
Your union, if you belong to one
And, of course, your Takeda support specialist

You should also determine your medical needs for the year ahead if your coverage is through Medicare. For additional information about Medicare, there’s a 24-hour helpline at 1-800-MEDICARE. It offers recorded answers to many Medicare-related questions, but you can also get connected with an agent at any time.

Government websites are also a good source of information.

Links to third-party websites are provided as resources and not intended to be an endorsement. Takeda is not responsible for their content.

Now, my third tip is simple: Don’t be shy about asking for help from your Takeda support specialist. They’re here to answer your Open Enrollment questions.

Okay, I think we’re ready for another question.

Chapter 7: Medicaid and Open Enrollment

Sofia: Hi Christine. I’m Sofia, and I’m on Medicaid. What do I need to know about Open Enrollment?

Christine: Thank you, Sofia, for your question. For coverage through Medicaid and the Children’s Health Insurance Program, or CHIP, enrollment can occur at any time of year. There is no specific period for Open Enrollment.

These programs provide free or low-cost health coverage to millions of Americans.

Our time together today is winding down, but we do have time for one more question.

Chapter 8: Changing Insurance After Open Enrollment Ends

Marcus: Hi Christine. I’m Marcus. My question is, can I make any changes to my health insurance plan after Open Enrollment ends?

Christine: Thanks, Marcus. After the formal Open Enrollment period ends, you are typically not allowed to change your insurance plan for a full year. But if you experience certain life events, you may be able to make changes to your current plan. These include:

Marriage
The birth of a child
Adoption
Divorce
The death of a spouse
Moving to a different area
Certain age-related changes, such as turning 65
And employment changes such as:

Changing jobs or losing your job
Going from full-time to part-time employment
Or retiring

That’s all the time we have for questions today. I want to thank you for tuning in, and I also want to thank all the folks who asked such great questions!

I hope you found this helpful and informative. I want to wish you all the best during this upcoming Open Enrollment season and in the year ahead.

Once again, if you have questions about Open Enrollment or health insurance, please call your Takeda support specialist. Thank you.

TAKEDA and the TAKEDA logo are registered trademarks of Takeda Pharmaceutical Company Limited.

US-NON-7731v1.0 09/22

This program is only intended for patients and caregivers who are enrolled in a Takeda Patient Support Program,
Takeda’s OnePath or Takeda’s Hematology Support Center.

Christine lives in California with her husband and 3 children. She has worked in healthcare for over 15 years. As a Takeda Patient Access Manager (PAM), she walks patients and caregivers through the insurance process and helps them understand what’s covered and what’s not. When she’s not assisting patients, Christine likes to spend time outdoors with her family. She enjoys mountain biking and camping.