1. The open enrollment deadlines have changed
This year, open enrollment starts Nov. 1, 2017, and continues through Dec. 15, 2017. Your coverage will begin Jan. 1, 2018. The federal government’s current rule changed the open enrollment period from the three months it lasted previously to just 45 days now.
2. You must sign up if you don’t have health insurance from another source
You need to sign up for health insurance during open enrollment if:
- You don’t have health insurance through your employer or your spouse’s employer.
- You don’t have government coverage (such as VA, Medicare and Medicaid).
- You’re over the age of 26 and can no longer be on a parent’s health insurance.
- You qualify for tax credits to help you pay for health insurance coverage.
3. This is the time to make changes to your current plan
What you can do during open enrollment:
- You can renew your current individual/family health insurance plan.
- You can choose a new health insurance plan through the marketplace in your state or through private insurance.
If you are currently enrolled in a marketplace health insurance plan, it will automatically renew. However, the plan may make changes to its provider network, copays, co-insurance, and drug coverage.
4. Marketplace open enrollment is only for individual/ family health insurance
If you qualify for employer-sponsored health insurance, you will likely want to buy health insurance through your employer and will not be affected by the fall open enrollment period for the government-run marketplaces. Ask your employer when its open enrollment period is.
5. If you miss open enrollment, you may have to wait for a year to sign up
If you miss open enrollment, you won’t be able to sign up for coverage unless you qualify for a special enrollment period.
- Birth, adoption, or foster care within 60 days
- Marriage within 60 days
- Loss of minimum essential coverage due to no fault of your own within 60 days; cancellation due to nonpayment is not a reason
- Loss of coverage due to a permanent move to a new county or state within 60 days
- Expiration of a non-calendar year policy within 60 days
- Advanced Premium Tax Credit (APTC) or cost-sharing eligibility change
- Unintentional error in enrollment or non-enrollment by the exchange or HHS
- Contract violation by a Qualified Health Plan (QHP)
- Change in immigration status within the last 60 days
- Change of income affecting your current marketplace application and health insurance enrollment
6. Penalties for not having health insurance
If you went without health insurance in 2017, the penalty is 2.5% of your income or $695 per adult (whichever is more) and the penalty for each child in the family without coverage is up to $347.50 with the maximum penalty set at $2,085. For the 2018 tax year and beyond, the penalty will remain at 2.5%, but the flat and maximum amounts will adjust for inflation.
7. All health plans must cover 10 essential benefits
All health plans, no matter the level, must provide some coverage for at least 10 essential benefits. They are:
- Outpatient care including chronic disease management
- Emergency care
- Pregnancy and newborn care
- Mental health and substance abuse services
- Prescription drugs
- Rehabilitation services and devices
- Lab tests
- Preventive and wellness services
- Dental and vision care for children
The level of coverage for these services can vary. All the plans in the marketplace must provide consumers with a brief, understandable description of what they cover and how their plan works.
If you have questions about open enrollment or other insurance questions, we’re happy to help. Contact us today.
Bill McCarthy | Advisor