Insurance During Open Enrollment

Open Enrollment for 2017 coverage started on November 1, 2016. Unless you experience a Special Enrollment Period (SEP) you will not be able to enroll in major medical health insurance until November 1, 2017. This can include marriage, divorce, the birth of a child, relocation, etc. We have handy tip sheets with important dates and terms to help you navigate through future open enrollment periods. You can also download these flyers below:

1. What is Open Enrollment?
Open Enrollment is a period of time, typically at the end of each year, when anyone can enroll in a qualified health insurance plan or make changes to an existing plan. Remember, you cannot be turned down, regardless of pre-existing conditions or financial status.

2. Open Enrollment ends January 31 for 2017 coverage.
If you miss Open Enrollment, be advised that you will not able to enroll in a plan again until November 1, 2018, unless you experience a Special Enrollment Period (SEP) also known as “qualifying life event.” This can include marriage, divorce, the birth of a child, relocation, etc. 

3. Next Open Enrollment.
The Open Enrollment period for 2018 coverage will begin on November 1, 2017 and run through January 31, 2019. 

4. Most policies will automatically renew on January 1.
Renewal policies vary from carrier to carrier. If you are already enrolled in a qualified health plan and don’t make any changes, it is likely that your policy will automatically renew on January 1, 2017. However, you should always check with your current insurance provider to verify their renewal policy.

5. Qualified Health Plans, defined.
Under the Affordable Care Act, an insurance plan must be certified, provide essential health benefits (see list below), follow established limits on cost-sharing (deductibles, co-payments, and out-of-pocket maximums), and meet other requirements. Plans that meet this requirement are called Qualified Health Plans (QHP).

6. A Qualified Health Plan includes TEN ESSENTIAL HEALTH BENEFITS, which cover:

            • Outpatient care—the kind you get without being admitted to a hospital
            • Trips to the emergency room
            • Treatment in the hospital for inpatient care
            • Care before and after your baby is born
            • Mental health and substance use disorder services, including behavioral health treatment, counseling, and psychotherapy
            • Prescription drugs
            • Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech ­language pathology,psychiatric rehabilitation, and more.
            • Lab tests
            • Preventive services including counseling, screenings, and vaccines to keep you healthy and/or provide care for managing a chronic disease
            • Pediatric services, including dental care and vision care for kids

7. The Tax Penalty for not having a qualified health plan increases yearly.
In 2016 and 2017, the tax penalty is $695 per person or 2.5% of your yearly household income. As time goes on it will continue to be adjusted for inflation.

8. Subsidies are available, but there are requirements to receive them.
The Affordable Care Act provides financial assistance for those who meet certain income requirements. The chart below shows income range and household sizes potentially eligible for subsidies. Exact subsidy amounts vary by income and the average cost of health plans in a specific geographical area. If you think you may qualify for a subsidy give us a call (877-267-3752); we can help you navigate the public exchange for your area. Below is the 2017 Federal Poverty Levels Chart.

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9. Supplemental insurance policies paired with qualified health plans can help lower total costs of health care.
Although you are required to have a qualified health plan or pay the penalty, there are ways to get the most out of your money. Consider purchasing a QHP with a lower monthly premium and a higher deductible and pairing it with a supplemental health insurance policy such as Accident Deductible Protection or REALTORS® Core Health Insurance. You can decrease your total monthly premium and reduce your out-of-pocket expenses related to health care.