Everything You Need to Know About Open Enrollment
What is open enrollment?
Open enrollment is the period during which you can freely sign up for or change health insurance plans on the Affordable Care Act marketplace. After the open enrollment period ends, you’ll have to have a qualifying event in order to sign up or change plans.
What is a qualifying event?
A qualifying event allows you and your family to sign up for health insurance outside of open enrollment period if you experience certain qualifying life events. These events include marriage, childbirth, and other major happenings.
What are the dates for the 2019 Open Enrollment Period?
For 2019 coverage, open enrollment will run from November 1, 2018, to December 15, 2018
What is changing in the HealthCare marketplace?
The Affordable Care Act still remains law. That being said, actions are being taken to dismantle it.
This week, the Trump Administration issued new rules that 1) allow small businesses and individuals who are self-employed to buy association health plans and 2) allow association plans to sell insurance across state lines.
What does this mean? It means that more people could have access to these plans – plans that are exempt from the ACA’s key provisions such as the inclusion of the 10 essential health benefits.
- Ambulatory patient services (outpatient services)
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
Who is eligible to enroll?
Anyone can shop for plans on the marketplace. Certain families are eligible for subsidies to lower the cost of health insurance, but even if you are not eligible for those tax credits, you may have affordable options on the marketplace. It is useful to shop around and see what your family is eligible for.
A subsidy is financial assistance that helps you pay for something. It’s not a loan; you don’t pay it back. There are two kinds of subsidies available from the federal government for individual health insurance plans. The Advanced Premium Tax Credit lowers your monthly health insurance payment, or premium.
What can I do to be prepared come open enrollment time?
Start researching plans as soon as possible! Knowing what kind of health insurance you’re looking for before the Open Enrollment Period even begins will put you ahead of the game. While everyone else is scrambling to understand the health insurance plans on the market, you’ll be able to get in and out of the application and enrollment process quickly, before the period is up. You can start exploring plans and learning about health insurance at any time of the year.
Each insurance company is different and may have different information they require for your application. Here is a list of information you might want to gather.
Information about any dependents that will be covered
Home and/or mailing address
Social Security numbers
Immigration documents (if applicable)
Tax filing information
Employer and income for all household members
Current health coverage information (if applicable)
The Affordable Care Act(ACA) was designed to give individuals and families greater access to affordable health insurance options including medical, dental, vision, and other types of health insurance that they may not have been able to get on their own or through an employer. Under the ACA:
- You may be able to purchase health care through a state or federal marketplace that offers a choice of plans.
- Insurers can’t refuse coverage based on gender or a pre-existing condition.
- Lifetime and annual limits on coverage are eliminated.
- Young adults can stay on their family’s insurance plan until age 26.
- Seniors who hit the Medicare Prescription Drug Plan coverage gap or “donut hole” can get a discount on medications.
Read the full text of the ACA and learn more about its provisions and relationship to patients, insurers, businesses, and families.
How to Pick the Best Health plan for the Entire Family?
Choosing health insurance for a family used to be easier, with fewer options and fewer households where parents were each covered by their own workplace plans instead of picking a joint one.
But now more and more families must make a choice at every open enrollment period about how to cover the kids due to the advent of surcharges and exclusions for covering spouses who have the option of their own workplace insurance.
As of 2015, 17% of large employers have implemented or increased surcharges for spousal coverage. Half are considering doing it in the next three to five years, according to benefit consultant Aon Hewitt.
Eight percent have eliminated coverage altogether for spouses with other options, and 45% are considering doing so.
Deciding on health insurance for the kids is further complicated by the myriad of plans available today. They just keep evolving as health care law changes and costs keep rising—up 4.2% for 2016, according to benefit consultant Mercer .
“Now it’s a lot more difficult because of network issues and deductibles,” says Kathy Paez of the non-partisan American Institutes for Research.
Making the decision even harder is today’s complicated family life. Do you choose a plan from one of the parents? One of the stepparents? Instead of two plans, a family could have four options, all with different costs and benefits.
Here are three of the top considerations:
Monthly Premium
Look first at the monthly cost, which typically starts at about $90 for the employee alone, because of rules under the Affordable Care Act.
That figure should give you an indication of the generosity of the employer, says Mercer senior partner, Tracy Watts. A $45-a-month plan, for example, would be heavily subsidized.
Also consider pricing tiers, which may include employee plus spouse and employee plus family.
If an employer offers a tier for employee plus children (versus employee plus family, which would include an eligible spouse), that is an indication that it is trying to give you a cost break, Watts says.
Deductibles and Out-of-Pocket Maximums
The next numbers to run depend on your family’s individual needs and can help you decide if a high- or low-deductible plan is best.
One plan may charge a fixed fee like $20 for office visits, while another may charge 20%. One plan may charge $10 for your child’s medication, but it could be $50 on another.
“If you have a kid with healthcare needs you can identify, that’s great,” says Karen Pollitz, senior policy fellow at the Kaiser Family Foundation, but she cautioned against forgetting about emergencies. “I can’t tell you how many days we spent in the ER. You just don’t know.”During the open enrollment period, most employers will offer access to an online tool that allows you to compare costs among plans.
Doctor Network
Just as important as cost is quality, which means seeing the doctors you want to see.
“I look for my pediatrician, and that’s the plan that my family needs to be in,” says Karen Frost, who leads health strategy and solutions for Aon Hewitt.
Divorced parents who live in different areas must carefully consider their out-of-network and emergency options. It is not unusual, for example, for one parent to live in Illinois and the other in Wisconsin, or for the family to have a kid away at college.
Health plans usually have provisions for when a child is away from home and has an emergency, Frost says.
Most experts caution against putting the kids on two plans, with one parent as a primary policyholder and the other as a secondary.
KFF’s Pollitz tried that herself years ago and found it to be too complicated and expensive. “It’s possible in some cases it would work, but what would be the cost?” she says.
Also, today’s health insurers do not provide the same sort of coordination of benefits available years ago, when you could use the secondary insurance to cover a deductible or co-pay, and end up with no out-of-pocket costs.
“For most plans today, coordination of benefits says if you have primary coverage, that’s it,” says Mercer’s Watts. “There’s not a benefit to having double coverage.”
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