Note: 2016 open enrollment runs November 1st, 2016 through January 31st, 2016.
When open enrollment for health insurance coverage begins, will you be ready? Doing some legwork now can help you secure the best Obamacare qualified health plan for yourself and your family.
Avoid scrambling to pick a plan at the last-minute and becoming frustrated by any technology glitches from an over-worked system. Use this checklist to prepare.
1. Mark your calendar.
Note these important dates, or risk going without coverage:
- 2017 open-enrollment period: The next Obamacare open-enrollment period runs Nov. 1st, 2016, through Jan. 31st, 2017. This applies to qualified health plans on the state-based and federally facilitated exchanges as well as in the private marketplace.
- Monthly enrollment deadlines: Plans take effect on the first of the month. You must apply and enroll by the 15th of the month prior to when you need coverage to begin. That means if you want your plan to take effect Jan. 1st, 2017, you must enroll by Dec. 15, 2016.
If you miss 2017 open enrollment and do not qualify for an exemption, you could end up without health insurance and face a tax penalty. Special enrollment periods may be granted to those with qualifying life events such as a change in family status (e.g., divorce, marriage, birth, adoption), move, or loss of job-based coverage.
2. Evaluate your current coverage.
Was your 2016 health plan a good fit? It may be helpful to sit down and look at how you used your health insurance in 2016 before recommit to the same plan or shop for a new one.
Consider the following:
- How much did you pay in monthly premium and out-of-pocket expenses such as deductible, copay, coinsurance and noncovered health care expenses?
- How much will your monthly costs increase in 2016? Will your income rise in 2017, not allowing you to qualify for a tax subsidy?
- What benefits did you use? Did you buy too much coverage for your needs or too little?
- Were you happy with the plan’s in-network providers and hospitals? Will they remain in-network for 2017?
- Do you anticipate a change in health care needs for 2017? For instance, will you be adding or losing a dependent? Did you develop a condition in 20164 that will require ongoing medical care or continued use of prescription drugs?
Findings from The Kaiser Family Foundation’s June 2014 Survey of Non-Group Health Insurance Enrollees showed that individuals with ACA-compliant health insurance plans are “more likely than those with non-compliant plans to report their health as ‘only fair’ or ‘poor.’”3 The report’s conclusion stated, “This suggests that people in new, ACA-compliant plans are somewhat sicker than those in the non-group market previously, some of whom have been able to retain their non-compliant coverage under transition policies.”4 Whether individuals purchase health insurance on or away from the exchanges, they are lumped into the same risk pool.
3. Budget for health care in 2017.
Look at the big picture. What can you afford to spend on monthly premium? If you or your family members require medical care, will you have the funds to pay 100 percent out-of-pocket until you meet your plan deductible?
Keep these numbers in mind when you go to select a health insurance plan for 2017. You might find that for a few dollars more per month, you can enroll in a different metal plan with a higher cost-sharing percentage form the insurance carrier and get a substantially lower annual plan deductible.
4. Calculate your 2017 Obamacare tax credit.
If your income is between 100% -400% of the federal poverty level, you might be eligible for a premium tax credit. This can reduce your monthly premium payments or result in a refund when you file your 2016 federal income taxes in 2017. If you buy a silver plan and are within the 250% range of the federal poverty level, you might also qualify for cost-sharing subsidies that reduce your out-of-pocket costs, including deductible, copays and coinsurance.
Only health insurance plans sold on the state-based and federally facilitated exchanges qualify for financial assistance. If you buy in the private marketplace, you will not be eligible for tax credits and cost-sharing subsidies.
5. Explore your options.
As suggested above, don’t be too quick to renew or ditch your current coverage. You may find another plan offers more value per dollar and better suits your healthcare needs, or what you have is still the best option.
In-depth plan information may not be available until open enrollment begins. In the meantime, consider which metal plan to select, the best place for you to buy health insurance (i.e., your state’s exchange or the private marketplace), and additional insurance products to round out your coverage.
Supplemental insurance plans including dental and vision insurance and bundled gap plans provide additional benefits for a relatively small monthly premium. These can work in tandem with your major medical plan by paying for care not covered by your health insurance.
If you qualify for Medicaid or CHIP, you do not need to wait for open enrollment. You can apply for these programs year-round.
6. Brush up on health insurance and health care reform.
Do you feel comfortable with terms such as deductible, copay and coinsurance —and understand how they work? Beyond monthly premium, do you know why one metal level may serve you better than another? Are you aware that you can face a tax penalty for going without health insurance coverage and that narrow networks and drug formularies may impact your access to providers, hospitals and prescription drugs? Visit trusted sources to read up on the facts.
There is a lot to comprehend. If you have questions at any point in the shopping process, contact an exchange-based helper, an agent or broker, or health insurance carriers’ customer service personnel. Knowing what you are buying and how it works can give you confidence that you have selected the right plan for you and your family.
Visit HealthCare.com to compare your options or for more information on health insurance and the Affordable Care Act.