5 Critical Aspects to Consider Prior to Open Enrollment

With open enrollment slated to begin on Nov. 1, 2016, consider these five essential things prior to beginning the upcoming open enrollment process from Pacient, a healthcare technology solution provider:

1. Determine if you’re eligible.

The Affordable Care Act (ACA) requires exchanges to be available in every state. Each state has two marketplaces: one for individuals and one for small businesses. Individuals may purchase an individual plan or family plan if they:

  • Meet state residency requirements
  • Are not in jail (unless they are in jail pending charges being dismissed)
  • Are a U.S. citizen, U.S. national or a lawfully present resident

2. Be familiar with significant terms and key dates.

To help determine whether buying insurance on the exchange is right for them, people need to first understand a few key words and phrases to make sense of some government lingo:

  • Premium Tax Credit – financial assistance that lowers the monthly premium
  • Cost-Sharing Reduction – financial assistance that lowers out-of-pocket costs on things like deductibles, copays and coinsurance
  • Coverage – another way of referring to health insurance
  • Open Enrollment Period – the time when people can sign up for insurance through the marketplace. In 2016, these dates are Nov. 1, 2016 through Jan. 31, 2017. If people do not want to use the online marketplace, they can also enroll over the phone, by mail, or with in-person help

3. Understand the financial consequences.

If an individual can afford insurance but chooses not to buy it, they’ll pay a penalty. For 2016, this amount is one of the following (whichever is higher): 2.5 percent of the annual household income or $695 per person ($347.50 for each child under 18), with a maximum penalty of $2,085 per family.

4. Realize the significant changes that have occurred for 2017.

The country’s five biggest providers of health insurance claim they are all losing money on their ACA marketplace plans. This is causing some insurers to drop coverage or cancel plans for expansion in 2017. United HealthCare, Humana, Aetna, Anthem, and Blue Cross Blue Shield have all announced significant changes to their plans. Why? A report released earlier this year from the Blue Cross Blue Shield Association found ACA enrollees had higher rates of chronic conditions, used medical services more often, and had higher medical costs. Larger numbers of sicker, older people rather than healthy, younger people are signing up for coverage through the marketplace.

5. Watch your mailbox to see if you need to take action.

If an insurance provider is dropping out of the marketplace, individuals will receive a letter telling them their coverage will not be renewed next year. If coverage is being canceled, it is back to square one. This means back to the marketplace to price and compare new plans during the upcoming 2016 open enrollment period.

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