Open Enrollment 101: How to Get Great Health Insurance

Open Enrollment is your opportunity to purchase health insurance coverage for the next year. To help you make the most of this opportunity, here’s your crash course in the Health Insurance Marketplace open enrollment.

Start Dates and Deadlines

The open enrollment period starts on November 1 and ends on December 15. Coverage will go into effect on January 1. Some states may extend the deadline, so check with your state to be sure. If you use an extension to enroll in a plan after the normal deadline on December 15, your coverage might not start until after January 1.

Where to Enroll

Where you go to enroll will depend on where you live.

If you live in California, Colorado, Connecticut, Idaho, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont, Washington of the District of Columbia, you will need to go to your state’s health insurance exchange to find a plan and enroll. If you live in any other state, you will use the federal Marketplace at HealthCare.gov to enroll.

Need assistance? A licensed insurance agent can help you.

Eligibility Requirements

To use the Marketplace, you must meet certain criteria:

  • You live in the United States.
  • You are a U.S. citizen or national.
  • You don’t have Medicare coverage.
  • You are not incarcerated.

Premium Tax Credits

Some people who use the Marketplace to purchase health insurance qualify for premium tax credits and savings. The premium tax credit will lower the monthly premium you have to pay. You will qualify for a premium tax credit if your income is between 100 percent and 400 percent of the federal poverty level.

However, there are other restrictions. For example, if you are offered affordable and qualifying health insurance through an employer, you cannot purchase a Marketplace plan using a premium tax credit. Also, you must buy a Marketplace plan to receive the tax credit.

Plan Options

Marketplace plans are not all the same. Here’s how they can be divided:

  • Bronze, Silver, Gold and Platinum Categories: Plans are divided into categories based on how much the plan pays versus how much you pay. For Bronze plans, the insurance company typically only pays 60 percent. For Platinum plans, the insurance company typically pays 90 percent.
  • HMOs and PPOs: Plans can also be categorized based on how payments and networks function. There are multiple plan types, including HMOs, which typically limit care to network providers, and PPOs, which charge less when you use network providers.
  • Catastrophic Plans: These plans have a high deductible and a lower premium, but they are not available to everyone. They are available for people under age 30 or who meet a hardship or affordability exemption.
  • Dental Plans: If you purchase a health plan on the Marketplace, you can also purchase a dental plan.

Enrolling in a Plan

To enroll in a plan, you can go to the HealthCare.gov site or your state’s health insurance exchange site.

  • You will be able to search plans that are available in your area.
  • Before you can enroll in a plan you like, you may need to supply some information, including documentation of your annual income.
  • You will need to pay your first premium.

A licensed agent can help you select and enroll in a plan. Request assistance here.

Late Enrollment

If you miss the enrollment deadline, you may qualify for a special enrollment period based on life events. Otherwise, you will need to wait until the next year to enroll in a Marketplace plan. However, you may be able to enroll in a private health insurance plan outside of the Marketplace.

Sources
  • https://www.healthcare.gov/

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