Are You Ready for Open Enrollment?
The time between now and when you should enroll for a health plan that is compatible with the Affordable Insurance Act (ACA) is getting shorter. The Annual Open Enrollment Period begins on November 1. You can also make changes to your existing plan during this period. You have until January 15 to enroll or make changes to your insurance plan for your cover to be effective starting February 1 2023. Dates can vary depending on the state.
Some of the changes you can make include:
- Adding or eliminating dependants
- Joining or removing a coverage
- Enrolling as a first-timer
Available Insurance Plans
There are several insurance benefits you can access under the ACA and which insurers in all states must offer. These include:
- Coverage despite having a pre-existing condition
- Prescription drugs
- Mental health
- Maternity care
- Emergency services
- Substance abuse services
- Preventive care
Plans can come in tier form, representing different price plans and coverage and include:
- Bronze – Cheap plans designed for those who are young and healthy and do not constantly need medical attention. On the downside, they involve limited cost-sharing or high deductibles
- Silver – Provide a middle-ground between coverage and cost if you have a few medical needs that need attention now and then
- Gold and platinum – The most expensive plans but they come with cost-sharing benefits. They are best if you will need significant medical care
What if You Miss Open Enrollment?
The OEP is your chance to take charge of your health insurance by changing or signing up for important health plans including dental and vision covers.
Missing enrollment, for instance, your employer’s enrollment deadlines could mean:
- Losing coverage for you and your family
- Losing the chance to make changes until the next period
- Fines and charges in some instances as stipulated under the Affordable Care Act (ACA)
There are other healthcare plans you can enroll in in case you miss your deadline like joining your spouse’s plan through spousal benefits if their employee enrollment period is still on or taking short-term health insurance for up to 364 days (you can reapply for up to 36 months in select states).
Short-term health insurance plans, however, are non-ACA plans that may deny you cover in case you have a pre-existing condition.
Can You Buy Health Plan Coverage Outside the Open Enrollment Period?
Most of the healthcare enrollment options are limited to the Open Enrollment Period (OEP). You’ll have to wait until the next OEP to sign up.
You can, however, change your plan outside the OEP or what is termed as a ‘Special Enrollment Opportunity’ (SEP) under the following circumstances:
- If you lose your eligibility for other coverage for other justifiable reasons other than the failure to pay premiums. These include conditions such as losing or quitting your job or reduced work hours and losing your student coverage upon graduation
- Adding a dependent through giving birth or adopting a child. Being pregnant does not count
- Marriage, although with some limitations
- Losing a dependent status, for instance for due to death, separation or divorce, or attaining an age when you should be excluded from a parental plan
- Permanent movement to a different state or an area within your state but outside your health coverage area (with some limitations)
- When an employee stops contributing to COBRA premiums (Continuation of Health Coverage) or when you exhaust COBRA coverage
- When there’s an enrollment or eligibility error by an agent or other representative
- Income changes that qualify you for an increase or decrease in subsidies
- Immigration status change
- You miss an enrollment period because of certain exceptional circumstances, like being impacted by a natural disaster or an emergency
- Your level of income is at or below 150% Federal Poverty Level (FPL), you qualify to enroll throughout the year once your income is verified
Your SEP is valid for 60 days from the occurrence of the special event. You can also ask for a SEP up to 60 days beforehand if you foresee an event that can lead to a special enrollment like giving birth or graduating. Your new cover then becomes effective as soon as the old one runs out. SEP enrollments are effective the first day of the next month after you sign up.
How Open Enrollment Works When You Are Receiving Health Coverage from Your Employer
You may not have to wait until the OEP starts to get covered. Employees often set their open enrollment periods which may start a few weeks earlier or may run together with the OEP dates. Most companies schedule their enrollment period to end a few days before the OEP to ensure that employees make their submissions on time
Confirm with your employer when the next open enrollment period will be so that you can sign up. Your employee may pay some of the benefits while you pay for others through salary deferral.
Important Information to Have When Looking for Coverage
There are various important documents you should have in place for a smooth coverage. These include:
- Birthdate and Social Security Number
- Information on your Federal tax
- Your current health insurance plan names and policy numbers
- Income documents and employer information
- Deductions from your self employment if any
- I-94 form or passport
How to Prepare for Enrollment
Healthcare enrollment should not be a last-minute event. You should plan carefully to get the best plan that will cover your health needs. The process can be confusing if you are doing all the research on your own. Here’s how you can prepare for open enrollment:
1. Be aware of the changes in open enrollment
First, be aware of the exact enrollment dates as they have been changing since 2014. Different states have different open enrollment periods (OEP), so you should confirm your state’s OEP. The premiums also change every year, with premiums reducing by 3%, which means that they will be more affordable.
2. Start planning months earlier, which is now
Starting your review process early gives you ample time to review your options and decide how you will use your coverage optimally for your health needs. Create a renewal timeline where you take time to analyze the different healthcare plans and what you’ll need to change.
3. Research and plan to keep up with any new healthcare laws
Research new laws on health coverage so that you do not find yourself cut out or face legal penalties. Some states penalize the insured such as Rhode Island, California, New Jersey, Massachusetts, and Washington D.C.
4. Look for opportunities to save on out-of-pocket costs
Assess your eligibility for an Advanced Premium Tax Credit (APTC) or Cost Sharing Reduction (CSR) by looking at the plan options. You can save your out-of-pocket costs by shifting to a different plan or using a deductible option.
The government will help pay for your premium if you have an APTC while CSRs can improve your benefits overall and reduce your costs.
5. Prepare your income and tax records
You should have your income and tax statements ready if you plan on taking a new plan.
6. Compare current with upcoming year coverage
Review your coverage and compare it to what the coverage will look like in the upcoming year in terms of costs and benefits. Make changes if you are unhappy with the coverage for the coming year.
Review changes in rules, costs, and benefits for the upcoming year.
7. Always look around for better deals
Look at other health plans options even if your current one covers you well. You might find one with more coverage or lower prices. A qualified insurance agent can help you comb through your options to find a high-coverage low-cost plan.
8. Choose according to your needs
Consider your health and personal needs. Make sure the plan you settle for includes:
- Doctors and hospitals in your network
- All your drugs
- Pharmacies in your preferred network
- Whether your healthcare coverage travels with you if you move
9. If you’re an employer:
- Plan ahead so that your employees have at least 10 days to complete online enrollment
- Determine the eligibility for new benefits and ensure employees are viewing the right plans
Some of the considerations that will also help you analyze and review new plans include:
- How much you’ve spent on healthcare in previous years
- How much out-of-pocket costs you could incur
- How your plan’s coverage changed since the previous year
The Easier Way to Find Your Ideal Healthcare Plan
The plan you choose will affect your future healthcare needs, including what you pay for and how easy it will be to make changes. Finding the right insurance cover can be an uphill task if you do not know what and where to look.
You can hire an experienced agent to help you analyze different available options and choose an insurance plan that provides maximum cover at the most optimal cost. Contact a MyHst Agent to learn more about OEP, its changes, and requirements. Our agents will help you find the best healthcare plan for your unique needs so you can sign up before time runs out.
Healthcare Solutions Team is a wholly-owned subsidiary of the National General Insurance Group and Allstate Insurance Company