It’s that time of year again. We are in Open Enrollment season. If you are not part of a group health plan and are unhappy with your coverage, now is the time to shop for health insurance.
From November 15 through January 29 the health insurance market is open to anyone who would like to enroll in a healthcare plan for 2016. By law, health insurance companies may not discriminate based on any health condition. Premium rates are equal for all based on your age and the state in which you live.
Be aware that the plan you choose during this “open enrollment” period is the plan you will have until January 2017, with NO ability to switch earlier. Individuals cannot enroll in any health insurance plan, no matter how healthy they are or how much they are willing to pay until the next open enrollment period in late 2016 for coverage in 2017. However, there is an exception to the law. If someone loses healthcare coverage during the year due to a qualifying circumstance, such as a death in the family, divorce, loss of employment or termination of Medicaid coverage, they are then permitted to enroll in another plan.
The reason for the limited open enrollment season is that the ACA requires insurers to cover individuals with major pre-existing health conditions. If people were allowed to enroll whenever they wanted, no one would enroll in a plan when they were healthy. Healthcare premiums would thus be stratospheric.
It is important to note that even though group plans can commence at any time during the year, the current open season can be very helpful for people who are employed or part of another insurance group as well. During open season, you can obtain group coverage without many of the year-round requirements, such as secluding a particular percentage of the group from participating in the plan.
Don’t remain uninsured! It is crucial to get coverage now for 2016 to avoid ACA penalties and being vulnerable to crushing healthcare bills for another year.
Even if you are already insured, don’t just sit back and swallow a premium increase. There may be better plans for you out there today, with benefits that better suit your needs, a better provider network and/or more competitive premiums. The health insurance market is constantly changing, with innovative and well-priced options added each year.
When assessing your options for next year, there are several important things to keep in mind.
First and foremost, bear in mind that if you earn below 400% of the poverty level, you can get significant federal ACA subsidies to pay for your premiums when purchasing a plan on the exchange. But be honest about your earnings. The subsidies are based on the income you project to earn in 2016. If you end up earning more than what you tell the government now, you will need to pay Uncle Sam back next year for the excess he paid you this year. That’s certainly not on your wish list.
When deciding between plans, make sure that you understand what each plan means for you. The current array of plans can be confusing, with various “tiers” and different in-network and out-of-network coverages. Let a knowledgeable agent explain to you – honestly – what each plan will mean for you in the real world, for your expected expenses. Look carefully into the provider network of each plan being offered to you. Are your doctors and preferred medical facilities covered?
Whatever plan you end up choosing, the earlier you begin the process, the better. You will have more time to understand your options and make a wise decision. When you enroll earlier, you will have your ID cards in time for the new coverage year and greater peace of mind in every aspect of your coverage. Waiting for the last minute to enroll can give you great headaches as well, such as having to delay your appointment with your physician even if you very much need the visit.
You are busy, and possibly confused and/or not thrilled about delving into the intricacies of healthcare. We agents are the rare breed that enjoy this stuff. Ask us for help. We understand that you’re flustered and overwhelmed. However, a little time and effort now can pay enormous dividends throughout the next year, both financially and in the quality of your healthcare.
Just give Cosmo Insurance Agency a call. We will simplify the process for you!
Mark Herschlag is the founder and CEO of Cosmo Insurance Agency, which is based in Ocean County. Cosmo Insurance Agency offers personalized solutions for individuals and businesses looking to obtain health, life, dental, long term care or disability insurance.
For more information or for a free, no-obligation quote, please call (201) 817-1388 or email
[email protected].
By Mark Herschlag
