Open enrollment promises to be fast and furious this year, especially for those who need health insurance starting New Year’s Day. The 2015 Obamacare open-enrollment period lasts only three months—Nov. 15, 2014, through Feb. 15, 2015—compared with 2014’s six months.
Even so, don’t rush. Whether you need coverage starting Jan. 1 (sign up by Dec. 15, 2014) or March 1 (sign up by Feb. 15, 2015), proceed in a proactive manner that allows you to pick the best health insurance plan for you and your family in the year to come. These six tips will help optimize your 2015 open-enrollment experience.
1. Shop Around.
Maybe you liked your 2014 health insurance plan. Maybe the rate won’t change much for 2015 or will change very little. You can keep it, and nobody is saying you shouldn’t.
However, 2015 is a new year with new rates, new networks and new options. Insurance companies and plans entered and exited the exchanges and private marketplaces. Even subsidies will be impacted by these shifts.
Take the time to reevaluate your anticipated healthcare needs and financial situation for 2015, recalculate your subsidy amount, and look at your options on and away from the exchange. You may wind up with the same plan, but you may also find one that serves as a better fit.
“There is no ‘average’ consumer, and no ‘average’ price,” said Jeff Smedsrud, CEO of HealthCare.com.
Don’t rely on what works for most. Do your own research and spend a little time shopping around to help ensure you get your coverage just right.
2. Remember: You can switch.
As indicated above, you are not stuck with the same health insurance plan. Not even if it’s set for automatic renewal, which is the case for all federally facilitated exchange plans and some state-based exchange plans.
If your silver (or bronze, gold or platinum) plan network does not include your preferred providers and hospitals, you can move to one that does. If your healthcare needs changed and a bronze plan no longer seems best, consider a silver or gold plan. In the age of Obamacare, you cannot be denied major medical insurance coverage or charged more based on your health history.
“You now have the ability to change your plan to IMPROVE your coverage even if you have a new medical condition,” Smedsrud said. “Consumers are no longer locked into a high deductible plan if they have new medical expenses.”
You can also switch from an exchange-based plan to a private marketplace plan and vice versa. Just remember that only health insurance plans purchased through state-based and federally facilitated exchanges qualify for premium tax credits and cost-sharing subsidies.
3. Consider more than the cost of premium.
Monthly premium is only a fraction of your annual healthcare costs. You need to look at your annual net cost for healthcare.
When comparing plans, look at the deductible, coinsurance and copayment amounts. Is there a prescription drug deductible? Are the medications you use covered by the plan or will you pay for some entirely out of pocket? Also be sure to factor in out-of-pocket expenses for healthcare your health insurance benefits won’t cover.
Smedsrud offers this formula for calculating your net healthcare costs for the year:
Premium – possible subsidy = net cost of insurance + expected out-of-pocket healthcare costs = net cost of healthcare
4. Avoid a gap in coverage.
If you are not sure what health insurance plan to choose and are feeling under pressure, do not panic. You may opt for auto-renewal to avoid a lapse in health insurance benefits, and then keep shopping. You have until Feb. 15 to select a new plan—or just stick with your old one. After Feb. 15, however, you will need to qualify for a special enrollment period of you want to switch.
5. Report income and family size changes.
Get your advanced premium tax credit right from the get-go. If you expect your income to increase in 2015 and/or see decrease in family size and do not report it to your state-based or federally facilitated health insurance exchange, you may owe the IRS when you file federal taxes in 2016. Likewise, a decrease in income and/or increase in family size could mean you are eligible for a larger subsidy to reduce monthly premium payments. These changes should be reported year-round.
6. Run into website problems? Keep shopping!
Officials have been hard at work fixing state and federal exchange websites to ensure we don’t run into the frustrations of 2014 open enrollment. However, if you experience website congestion, you can at least begin the shopping process at HealthCare.com.
HealthCare.com lets you compare health insurance plans on and away from state-based and federally facilitated exchanges. You can learn what options and rates are available to you, get more plan details, compare plan details and calculate your premium tax credit subsidy.
If you find a plan you like at HealthCare.com but want to take advantage of any premium tax credits and cost-sharing subsidies for which you are eligible, you must then purchase coverage from your state’s exchange. Smedsrud advises there are four ways to do this:
- Through your state’s exchange website
- Through another Web-based entity such as HealthCare.com, eHealth or GetInsured
- Through a call center with CMS-approved licensed agents, such as those available at HealthCare.com
- With a local agent or broker—find one through online searches, recommendations from family and friends, and your state’s exchange website
A licensed, CMS-approved agent can help you review your options and begin the enrollment process.
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