How Does Open Enrollment Affect Me?

You have likely heard of open enrollment. Whether from a commercial on TV, an ad on your favorite website or from your HR department, you’re probably familiar with the term.

But do you know what exactly it means? Or better yet, what it means to you?

You have likely heard of open enrollment. Whether from a commercial on TV, an ad on your favorite website or from your HR department, you’re probably familiar with the term.

But do you know what exactly it means? Or better yet, what it means to you?

Let’s explore what open enrollment is and how it may affect you.

What is Open Enrollment?

Open enrollment is the time of year when you, as an individual or employee, can add, drop, or make changes to your health insurance.

For employer-based and individual coverage, open enrollment is the only time you can switch or sign up for a new health insurance plan. The exception is if you qualify for a Special Enrollment Period (SEP) triggered by a Qualifying Life Event (QLE), which we’ll cover later.

For employer-based coverage, open enrollment is usually the only time you can drop coverage. For individual marketplace coverage, you can drop coverage at any time of the year.

When is Open Enrollment?

In 2019, the marketplace open enrollment period starts Friday, November 1st and ends Sunday, December 15th.

Plans purchased during open enrollment go into effect on January 1st, 2020.

California, Colorado, and Washington D.C. have permanently extended their open enrollment period to October 15, 2019 to January 15, 2020. Massachusetts, New York, and a few other states will have extended enrollment periods this year.

Some employer’s open enrollment period coincides with the marketplace dates, but not all. If you get health insurance through your employer, check to see when your open enrollment period is.

Can I get Marketplace coverage?

To qualify for marketplace coverage, you must meet a few requirements. You have to be a U.S. citizen or national, living in the U.S. and cannot be currently incarcerated.

Additionally, if you have health insurance from your job, a spouse, or your parents, you’re not eligible. If you or any of your dependents qualify for Medicaid, Medicare or the Children’s Health Insurance Program (CHIP), you can’t purchase marketplace insurance.

You can purchase a marketplace plan if you have employer-based coverage. However, you’ll pay full price for the policy unless your employer’s insurance doesn’t meet specific standards. Most employer-based plans meet the criteria.

How do I choose a plan?

Marketplace plans are divided into four categories – bronze, silver, gold, and platinum – known as metal tiers. Bronze plans usually have the lowest premiums and platinum plans have the highest.

Low premium plans generally cover fewer healthcare costs. Higher premium plans usually provide better coverage for procedures, services, and prescriptions. If you visit your doctor often or have several medications, gold or platinum plans may be a better choice for you. If you don’t plan to see a doctor often and don’t have many prescriptions, a bronze plan may work well.

If you’re 30 or under or over 30 and qualify for a hardship/affordability exemption, you may be eligible for catastrophic coverage. These plans come with very high deductibles ($8,150 in 2020) and are intended to provide coverage for an unexpected disaster.

EPO, HMO, POS, or PPO?

Some healthcare plans let you choose the healthcare providers and facilities you use, while others only cover services from in-network providers.

Health maintenance organizations (HMOs) and exclusive provider organizations (EPOs) cover providers within your plan’s network.

Preferred provider organizations (PPOs) and point of service plans (POS) allow you to visit doctors in or out-of-network, though in-network providers are usually less expensive. Some of these plans may still require referrals for out-of-network doctors.

To ensure you can see your favorite doctors read your plan details carefully to be sure it covers what you need before you enroll.

Will premiums increase in 2020?

Several factors play a role in determining premium costs every year. According to the Drivers of 2020 Health Insurance Premium Changes brief by the American Academy of Actuaries, key components for 2020 include:

  • Continued rising health care costs
  • Recent and ongoing policy changes, such as short-term health plans, association health plans, and health reimbursement arrangements (HRAs)
  • The elimination of the individual mandate penalty
  • Possible use of risk adjustment data validation audit adjustments in 2020 premium prices
  • State actions
  • The reinstatement of the health insurance provider fee

Premium prices for 2020 will be determined by combining these factors and will vary depending on where you live. Premium price increases for 2020 are predicted to be moderate, which is welcome news for those who’ve seen several premium increases over the past few years.

How do I prepare for enrollment?

When you enroll for health insurance, you’ll be asked to provide basic information about your household size, employment, and income information about each person who lives there.

Healthcare.gov provides a helpful checklist to use to have your information ready when it’s time to sign up.

How do I enroll?

Once you’ve determined your eligibility for coverage and what type of plan will best fit your needs, there are several ways to enroll:

  • Online – Visit the Need Health Insurance page and select your state to get started.
  • Phone – Call 1-800-318-2596 to apply for a health insurance plan to enroll over the phone.
  • In-person – Visit the Find Local Help page and enter your zip code to find a locally trained counselor to get information and enroll in person.
  • Mail – Complete a paper application and mail it in. You can download an application here.

What happens if I miss the open enrollment period?

If you miss the deadline (for marketplace or employer coverage), you can enroll if you qualify for a Special Enrollment Period (SEP).

To qualify for a SEP, you must have a Qualifying Life Event (QLE). Experiencing certain life events, like getting married, divorced, having a baby, adopting a child, or losing health insurance allows you to get health insurance outside open enrollment.

You can use this handy questionnaire to see if you qualify for a SEP.

Open enrollment will be here soon. Take time to review your current health insurance policy and decide if you need to make changes for 2020.Disclaimer: the content presented in this article are for informational purposes only, and is not, and must not be considered tax, investment, legal, accounting or financial planning advice, nor a recommendation as to a specific course of action. Investors should consult all available information, including fund prospectuses, and consult with appropriate tax, investment, accounting, legal, and accounting professionals, as appropriate, before making any investment or utilizing any financial planning strategy.

Vicky Warren, Nurse, Healthcare Writer