Open enrollment—
a Headway Guide
A clear guide to choosing mental health insurance coverage during open enrollment. So you can focus on what matters most: your care.
Open enrollment is your annual chance to switch health insurance
What is open enrollment?
Open Enrollment refers to a time at the end of every calendar year when you can choose or update your health insurance plan for the upcoming year.
During open enrollment, you can review the coverage options offered by your employer or insurance marketplace and make sure you select a plan that fits your needs, especially when it comes to mental health care.
When does open enrollment start for 2025?
Your open enrollment timeline depends on how you get your insurance. Here's a quick breakdown:
If you get insurance through work: Check with your HR department or benefits portal — most employers hold open enrollment in fall 2024 (typically October or November). Mark your calendar when those dates are announced!
If you use Healthcare.gov or your state's marketplace: November 1, 2024 – January 15, 2025. Enroll by December 15, 2024, to have your coverage start January 1.
If you have Medicare: October 15 – December 7, 2024. This gives you time to have your new coverage ready for January 1.
Remember: Missing these windows could mean waiting another year to change plans, unless you qualify for a special enrollment period due to major life changes like moving, marriage, or job loss. These are often called Qualifying Life Events, and vary from plan to plan.
How to choose the right plan
While it might feel overwhelming, breaking down the process into manageable steps can help you choose a plan that keeps you connected to your provider and fits your budget.
Before diving into plan details, take a moment to reflect on your healthcare situation. Understanding what matters most to you will help narrow down your options and ensure you choose a plan that truly fits your life. Think about your current care routine and any changes you anticipate in the coming year.
Think about your current and expected mental health care needs for 2025:
• Factor in how often you see your provider and any medications you take
• Check to make sure your current Headway provider is in-network with plans you're considering
• Think about other healthcare needs beyond mental health
• List out any planned procedures or changes in care for the coming year
• Evaluate if you need flexibility in choosing providers or prefer a set network
• Consider your travel patterns and whether you need coverage in multiple locations
Insurance terms can be confusing, but understanding the different types of costs helps you predict your total healthcare spending for the year.
Monthly premium
Your regular payment to maintain coverage, like a subscription fee. Remember: The plan with the lowest monthly premium isn't always the most affordable option when you factor in other costs.
Total yearly costs = (monthly premium × 12) + expected out-of-pocket expenses
Deductible
The set amount you must spend out of pocket before insurance kicks in.
For example: With a $2000 deductible, you’ll pay the first $2000 of covered services. After that, your insurance company will start to contribute to your healthcare costs.
Until you’ve met the deductible, you’ll pay the out-of-pocket price for mental health visits set by your insurance company, which varies depending on factors like the length of session, or if your provider is managing prescribed medication.
Copay
A flat rate per service set by your insurance plan.
With a copay, you’ll pay the same amount for each mental health care session regardless of type or length. Your insurer covers the rest.
Coinsurance
Your share of costs after meeting the deductible.
For example: with 20% coinsurance, you pay 20% of the service cost, and the insurer pays 80%.
Out-of-pocket max
The most you could spend in a year on in-network care — consider it like a safety net for medical costs.
In most cases, once you reach this number, you’ll no longer need to pay a copay or coinsurance for mental health care, and you’ll owe $0 per session, until your plan resets for a new annual cycle.
Understand the plans
Different plan types balance cost, flexibility, and network size. It’s important to understand these differences to help you find the right fit. Once you've narrowed down your options, double-check that your preferred Headway provider is in-network with your chosen plan.
PPO
Think of a PPO as the "flexibility-first" option. These plans give you the most freedom to choose your providers and don't require referrals, though this flexibility comes with higher monthly costs. PPOs are popular among people who want to keep their existing doctors or might need to see specialists regularly.
- Higher premiums
- Larger networks
- More provider choice: No referrals needed to see specialists, and can see out-of-network providers (at higher cost)
HDHP
HMOs are all about coordinated care through a specific network. These plans are like a healthcare home base — you'll have a primary doctor coordinating your care within a set network of providers. While more restrictive, HMOs typically cost less each month and have simpler billing.
- Lower monthly premiums
- Restricted networks
- Requires selecting a primary care physician
- Needs referrals for specialist care
- Must stay in-network (except emergencies)
HMO
HDHPs are a trade-off that can work well for healthy individuals, or those who are willing to plan financially for care. These plans offer lower monthly payments in exchange for paying more when you actually need care.
These plans work well with a Health Savings Account (HSA), letting you save tax-free money for medical expenses.
- Lowest monthly premiums but high deductible
- You pay most costs out of pocket until meeting the deductible (at least $1,650 for individuals and $3,300 for families in 2025)
Estimate your cost of care
You can estimate your total health costs annually as a sum of your premiums, plus expected out of pocket expenses in the form of copays, coinsurance, or the cost needed to meet your deductible.
Total yearly costs = (monthly premium × 12) + expected out-of-pocket expenses
Log in to your Headway account any time to review how much you spent so far in the current year, with your existing plan.
Visit your Insurance page to review the latest information that your insurer has shared with us. Most plans track all medical costs together, but if your plan tracks mental healthcare costs separately from all medical expenses, your Headway benefits page will show only the mental healthcare costs.
You can also visit your Billing page to review your costs for mental healthcare on Headway.
How to read your Summary of Benefits and Coverage
In health insurance, SBC stands for Summary of Benefits and Coverage. It’s a standardized document that every insurance plan must provide to break down exactly what a plan covers, and how costs are shared between you and the plan.
Think of it like your health plan's "nutrition label” — it makes it easier to understand and compare different plans during open enrollment.
When it comes to mental healthcare specifically, you’ll want to review the coverage details and copays in your SBC to estimate how much your mental health care may cost you with each plan. Look specifically at the "If you need mental health services" section, and check whether therapy is listed under "office visits" or has special coverage rules.
When mental health is listed as a benefit, your session costs should be clearly laid out in your SBC. In the example Aetna plan below, the member has a $50 copay, and the deductible doesn’t apply.
If your SBC does not include Mental Health benefits, you can look at office visits for your primary care doctor, which generally aligns with a mental health office visit.
Your SBC might have a different benefit for PCP vs Specialist, as seen in the example Cigna plan below. This can still apply to mental health, and is usually the difference between visiting a talk therapist versus a psychiatrist (who can manage prescribed medication).
You can also search your SBC for telehealth-specific benefits, which are becoming increasingly popular among plans. In the UMR example below, mental health benefits and telehealth benefits are listed — and apply to care — separately.
Don't hesitate to ask your HR department or insurance provider to explain anything unclear.
Ask these questions to make sure you’ve picked the right plan
Getting help
Headway is here to provide the support you need.
Find answers to common questions from Headway clients
If you're already a client on Headway, you can review your latest benefits here.
For additional questions about compliance or Headway in general, contact our support team.
Disclaimer
This document should be used for general informational purposes only. The contents do not constitute legal or health advice and should not be used as a substitute for advice from legal counsel or a medical professional. Use this page as a reference guide, not as a definitive source of information regarding health insurance plans.