It’s almost that time of year again, open enrollment season! If you are not part of a group health plan and unhappy with your coverage, get ready because your time to shop for health insurance is rapidly approaching.

Starting November 1 and ending December 15, the health insurance market will be open to anyone who would like to enroll in a healthcare plan for 2018.

The Importance of Open Enrollment

“Open enrollment is almost a household word, but that does not mean that it is completely understood by everyone. Pay close attention because here is why the next three months are going to be critical for which healthcare you’ll be enrolling in.

During open enrollment, you can enroll in any new plan available for you. By law, health insurance companies may not discriminate based on any health condition. Premium rates are equal for all based on age and the state you live in. Whatever plan you enroll in during this period will be in effect through December 31, 2018. You will not be able to upgrade or switch plans beforehand, no matter how much you’re willing to pay out of pocket.

The only way one can switch plans in 2018, after open enrollment concludes, is if they qualify for a group plan or they lose existing health coverage due to a qualifying circumstance, such as a death in the family, divorce, loss of employment or termination of Medicaid coverage.

It is important to note that even though group plans can commence all year round, the current open season can be very helpful for people who are employed or part of another insurance group too. During open season, you can obtain group coverage without many of the year-round requirements, such as excluding a particular percentage of the group from participating in the plan. You will be able to meet participation requirements with just one out of 40 employees during open enrollment. Yes, you read that right, one out of 40 employees.

In any case, 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.

Choose the Best Plan for You

We at Cosmo Insurance will give you some good news you’ll want to hear about your health care options. While some premiums in the individual market have become more expensive than ever, the market is also more saturated than ever with different options—some of them more cost efficient than others.

Cosmo knows these options inside out, and will guide you towards the best one for you. Horizon and AmeriHealth New Jersey will be continuing their health options from last year and offering competitive premiums. Horizon will be adding on mobile chats and video consultations with doctors, while AmeriHealth New Jersey’s new partnership with RWJBarnabas Health has allowed the carrier to expand its options. One popular insurer, Oscar, will be coming back to New Jersey this year. Oscar offers quality insurance and will be bringing health options to New Jersey for small businesses and individuals. It is a savvy technology-based carrier that provides ease of access to their thousands of members through telemedicine. Oscar has a network of world-class doctors and hospitals within the reliable QualCare and an app that will allow you to have a free Virtual Visit, book an appointment with a doctor and receive prescriptions quickly. They can help you find a doctor, understand your plan and save money on care all throughout your phone.

Another major attractive option for small businesses in New Jersey is husband-and-wife group plans. Cosmo found a quality insurer that offers group rate coverage with significant savings for a two person, husband-and-wife group. If a husband and wife are partners or work for the same corporation (25+ hours per week) they can qualify for the affordable coverage—even if there is no one else in the group. Previously, insurers did not offer group coverage for husband and wife alone.

And if you thought things couldn’t get any better than that, than you’re going to be surprised. You have the option of choosing between Tier One/Tier Two plans from the same insurer. The Tier One plan offers you lower premiums and out of pocket expenses than the Tier Two plan simply by virtue of the different physician/medical facility network you can use. The Tier One plans find physicians and medical facilities that will be willing to negotiate lower reimbursement rates than the conventional Tier Two networks.

The Bottom Line

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 coverage. 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 and greater peace of mind in every aspect of your coverage.

You are busy, and possibly confused and/or not thrilled about delving into the intricacies of healthcare. We agents are the rare breed that enjoys this stuff. 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.

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!

By Mark Herschlag

 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].