It’s almost crunch time. Obamacare open enrollment for 2015 health insurance plans will be here in less than a month. We all learned a lot during the first open-enrollment period, but there are lessons only the second open-enrollment period can teach. Several factors could impact how well it goes for you and your family and whether or not you wind up with coverage that satisfies your healthcare needs and financial abilities.
Avoid learning these lessons through experience. As November nears and the dash for 2015 coverage begins, here are nine factors to keep on your radar:
1. 2015 open enrollment begins on Sat. Nov. 15, 2014, and runs half as long as 2014 open enrollment.
The 2015 open-enrollment period for ACA-compliant private health insurance plans will be three months shorter than 2014’s six-month open-enrollment period. Americans have from Nov. 15, 2014, through Feb. 15, 2015, to select and enroll in a health insurance plan.
2. If you want to change your health insurance plan and need a Jan. 1, 2015, effective date, you must enroll by Dec. 15, 2014.
That means once the open-enrollment period begins, you will have exactly four weeks to shop for a health insurance plan and enroll.
After Dec. 15, 2014, enrollment deadlines are as follows:
- Enroll between Dec. 16, 2014, and Jan. 15, 2015, to begin coverage Feb. 1
- Enroll between Jan. 16, 2015, and Feb. 15, 2015, to begin coverage March 1
- After Feb. 15, 2015, you must qualify for a special enrollment period if you wish to buy or change health insurance plans
3. Federal exchange plan pricing will not be announced until after Nov. 4, 2014.
The District of Columbia and a handful of states—Colorado, Oregon, Maryland, Minnesota and New York, to name a few—have finalized 2015 health insurance rates for plans sold on and away from their state-based exchanges. This information is publicly available. However, approved pricing for federally facilitated health insurance exchanges will not be announced until after the mid-term elections, which are on Nov. 4, and other state-based exchanges will release them at their own pace leading up to Nov. 15.
4. Average rate increases are for plans not for people.
Many organizations and exchanges are reporting relatively gently average health insurance rate increases nationwide. These are across health insurance plans, not for individuals. While the average increase across plans may not sound low, it is unlikely the average rate increase among consumers will be the same.
For instance, a plan with more than 250,000 policyholders may increase 9.1 percent while another with only 250 policyholders may see a decrease of 2.5 percent. In this case, the average increase for plans in this region was 5.8 percent, but it certainly was not the average increase for consumers.
5. Your health insurance plan will renew or expire on Jan. 1, 2015, no matter when your 2014 coverage took effect.
If your 2014 health insurance coverage took effect March 1, 2014, it will end or renew with the new year, not March 1. All ACA-compliant health insurance plans in the individual market will expire or renew on Jan. 1, 2015, regardless of whether or not they are exchange-based, stated the NAIC in an email.
6. Your insurance company must notify you of renewal before the first day of open enrollment—Nov. 15, 2014.
According to the NAIC, HHS guidance released Sept. 2 requires insurance companies to send renewal notices before the first day of open enrollment, regardless of when the plan was first purchased. In an email, the NAIC stated, “The guidance also notes that insurers should not send these notices to consumers until the plan has been fully certified by the Exchange for 2015, which occurred at the beginning of October.”
Depending on when insurers send these letters and how they send them, you could wind up with a relatively short notice and have less than four weeks to shop, compare and enroll in a health insurance plan.
“It is worth noting that some states require renewal notices to go out 90 days from renewal. There is still some question of process in those states,” stated the NAIC. “Consumers will want to contact their State Insurance Departments with concerns regarding this.”
If your grandfathered or non-grandfathered health insurance plan is being discontinued, the guidance notes that your insurance company must provide a 90-day written notice alerting you and making you aware of other health insurance options. However, because some issuers will not finalize 2015 plans until closer to open enrollment, the HHS guidance states, “This means that, in connection with the 2015 open enrollment period, consumers potentially could receive discontinuance notices without being able to take prompt action to shop for new coverage, and issuers may not be able to suggest replacement coverage options as explicitly envisioned by these Federal standard notices.” The guidance goes on to say enforcement action will not be taken against insurance companies for failing to provide 90-day notice “as long as the issuer sends the notice consistent with the timeframes applicable to renewal notices.” States were encouraged to “provide similar flexibility to issuers,” and the guidance ensured officials are working to improve this timing in the future.
Bottom line: Be especially aware of mail from your state-based or federally facilitated exchange and your insurance company in the weeks ahead. Don’t throw notices away. Open them. Review the contents. Consider what action you need to take to ensure you wind up with the right health insurance coverage in the year to come.
7. If your health insurance plan is no longer offered in 2015 and it will be automatically renewed, you will be switched to another plan.
If your carrier left the marketplace or stopped offering the health insurance plan you had in 2014, you may be automatically enrolled in something similar for 2015. Be aware, this plan could cost you more in monthly premium and you are free to switch.
“Carriers are required to notify consumers,” said Jeff Smedsrud, CEO of HealthCare.com, “However, the costs can easily be $1,000 or more than what they paid the previous year. You should especially be on the lookout for network changes under these circumstances.”
While you may think a bronze plan is a bronze plan and benefits will be relatively similar, consider that deductibles, coinsurance, copayments and networks may not be. When you receive your auto-renewal notification, whether or not it is for the exact same plan or a similar one, you should look at all of your options and be sure it’s the plan you want for the year to come.
All federally facilitated health insurance exchanges will automatically renew plans. States will make their own decisions regarding auto-renewal. You will be notified by your exchange and your health insurance company.
8. If your plan automatically renews and you then decide you want a different health insurance plan after Dec. 15, you can still make the change.
If your health insurance coverage has been automatically renewed and you decide you want to change plans, you can. Your renewed coverage will begin Jan. 1, 2015, and you will have until Feb. 15 to shop and enroll in a different plan. After Feb. 15, you must remain with the same plan until 2016 unless you qualify for a special enrollment period.
9. You must report financial changes to your exchange by Dec. 15, 2014, in order for subsidy adjustments to take effect by Jan. 1, 2015.
If your financial circumstances have changed or you expect them to change in 2015, your subsidy eligibility will be impacted. It is critical to report these changes as soon as possible. Otherwise, you will get the same subsidy in 2015—and that is a bad thing.
If you are receiving advance payments of your premium tax credit to reduce your monthly rate, failing to report income changes can impact you in one of two ways:
A) If you expect to earn more money in 2015 (or are earning more right now) and fail to report the change promptly, you may premium subsidies that you are no longer eligible for and will likely owe the IRS money in 2016 when you file your 2015 federal income taxes.
B) If you expect to earn less money in 2015 (or are earning less right now) and fail to report the change promptly, you may have to wait for your increased subsidy to take effect and therefore wind up paying higher monthly premiums than you can afford. This could potentially result in missed payments and canceled coverage.
Keep all of this in mind as Nov. 15 nears and use it to create your strategy for open enrollment. Millions will be visiting state-based and federally facilitated exchange exchanges to shop and enroll in health insurance coverage with a Jan. 1, 2015, effective date. Potentially congested websites a la 2014 open-enrollment, automatic renewals and a briefer open-enrollment period may make it tempting to just go with the same coverage in 2015. Don’t.
“Shop around and remember you’re in control,” Smedsrud said.
Visit HealthCare.com to research your plan options and calculate your subsidy. If you qualify for a subsidy and want to take advantage of it, you will have to buy from your state’s exchange. Nonetheless, you may request a quote at HealthCare.com or call (877) 275-0485 to speak to a licensed, CMS-approved agent who can review your options with you and help you with the enrollment process—on and away from your state’s health insurance exchange.
Enrollment for 2015 health insurance plans does not begin until Nov. 15. If you need coverage in the final months of 2014, contact an agent or your exchange to see if you qualify for a special enrollment period. You may also consider a short term health insurance plan—get a quote at HealthCare.com.
 Department of Health & Human Services. “Form and Manner of Notices When Discontinuing or Renewing a Product in the Group or Individual Market.” Sept. 2, 2014. http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Renewal-Notices-9-3-14-FINAL.PDF.
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