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Open enrollment is a term you’ve probably heard thrown around a lot if you’ve been looking for insurance or following along with Obamacare. But unless you’re a health insurance agent, broker, or in the medical field in some capacity, it may not be as cut and dry as some make it out to be.
At any rate, it’s important to understand the ins and outs of open enrollment because it could significantly impact your coverage (and land you with a penalty fee if you don’t abide by it). While the rules regarding insurance could change in the next few years, the Affordable Care Act remains in place for 2018. So here is what you need to know.
The window for 2018 open enrollment is different from previous years with Obamacare. Instead of the usual three months, the enrollment period will last 45 days from November 1, 2017, through December 15, 2017.
If you are looking for a new plan, you can shop for an individual option in a few different ways:
- In the federal marketplace or state exchange
- Over the phone by calling the marketplace
- Through a health insurance provider’s website
- Through reliable health insurance comparison websites life First Quote Health
- With a local insurance broker
Keep in mind that the only way you can get an individual health plan outside of the open enrollment period is to qualify for a special enrollment period, or through private health insurance companies. To do so, you must experience a qualifying life event, such as the loss of insurance (aging out of parent’s coverage, losing eligibility for federal or state-funded coverage, etc.), household changes (marriage, divorce, having or adopting a child), changes in residence, or other qualifying events (becoming eligible for Medicaid, becoming a U.S. citizen, etc.).
The primary advantage of utilizing health insurance marketplace to source your insurance coverage is that any tax credits available to you to lower your monthly premiums are only available through the federal marketplace or state exchange. According to research conducted by the Centers for Medicare and Medicaid Services, 83% of consumers who purchased affordable health insurance through the marketplace in 2017 did so with a subsidized premium. However, with set prices, private health insurance may be a cheaper alternative.
You may want to consider shopping elsewhere for coverage and not utilizing the Affordable Care Act exchanges if:
- Your income is too high to qualify for tax credits. The current standard is 400% of the federal poverty level. If that is the case for you, your broker may be able to help you find a better alternative to those offered in the marketplace.
- You want more options. Many insurers offer the same plans on and off the exchange. However, several also offer additional options through their website or individual brokers that are not in the marketplace.
- You need a different provider network. If your preferred doctors are not included in the provider networks in the plans on the exchange, you may be able to find them with options from a broker or individual provider.
- You have a chronic condition not covered by the plans in the marketplace. Depending on your current health condition, you may need more coverage than what is available through marketplace plans. If that is the case, you can work with a broker to find what you need. This may be the case if your current medication or medical equipment is not covered by the existing marketplace plans.
Don’t worry, though, you will not have to sacrifice on the quality of your coverage by not purchasing through the marketplace. All policy providers are held to the same standards outside of the marketplace. Providers are required to provide the same level of basic coverage and to meet established minimum guidelines.
Employer-Sponsored Open Enrollment
If you have group health insurance through your employer, your enrollment period may change or vary slightly each year. The timing is dependent on several factors, but it still typically occurs during the fall. It is important to note that you can decline your employer-provided affordable health insurance; however, you will be subject to these rules:
- If you decline your employer’s group health insurance, you will not qualify for tax credits on a marketplace plan if your employer’s plan is less than 9.69% of your regular household income and covers at least 60% of medical bills.
- If you decline group insurance and then subsequently fail to purchase a plan during 2018 open enrollment, you will be uninsured and risk facing a penalty for not having affordable health insurance.
Medicare 2018 Open Enrollment
The 2018 open enrollment period is October 15 through December 7, 2017. Beneficiaries also qualify to change benefits during other periods through the year. Additionally, and unlike other plans, Medicare has “disenrollment” periods for insured individuals.
While the Affordable Care Act may change in the future, you still need to understand that open enrollment is the only guaranteed period throughout the year that you are able to purchase new affordable health insurance. Likewise, if you have more specific needs or need more aggressive coverage, it’s always best to plan ahead and start shopping early.