{"id":17855,"date":"2018-10-23T15:20:47","date_gmt":"2018-10-23T20:20:47","guid":{"rendered":"http:\/\/thepapergown.zocdoc.com\/?p=17855"},"modified":"2023-03-03T15:04:11","modified_gmt":"2023-03-03T20:04:11","slug":"open-enrollment-2019","status":"publish","type":"post","link":"https:\/\/www.zocdoc.com\/blog\/guides\/open-enrollment-2019\/","title":{"rendered":"A Guide to Open Enrollment for 2019"},"content":{"rendered":"

The time to enroll for coverage through the 2019 Health Insurance Marketplace is here. Open enrollment runs through Dec. 15, and it\u2019s a critical time of year for Americans who depend on the marketplace (also known as the health insurance exchange) for healthcare coverage.<\/span><\/p>\n

The enrollment process will be familiar to anyone who\u2019s previously bought insurance through the exchange. But there are some important changes to the Affordable Care Act for 2019, including the end of the individual mandate that once required people to purchase insurance or face a fine. Depending on where you live, you could also see changes to the specifics of your plan’s coverage or the price of your premiums.\u00a0<\/span><\/p>\n

Whether you\u2019re keeping your plan from last year or looking to enroll through the exchange for the first time, we\u2019ve put together a guide to what you need to know about open enrollment.<\/p>\n

When is the open enrollment period?<\/h2>\n

The 2018 nationwide open enrollment period<\/a> runs from Nov. 1 until Dec. 15, with insurance plans going into effect on Jan. 1, 2019. A handful of states have extended their deadlines, allowing residents to enroll after Dec. 15 for insurance plans that take effect as late as February or March.<\/p>\n

The marketplace open enrollment window may coincide with some employers’ open enrollment periods for health insurance. If you have access to insurance through your job or through your spouse, check with your employer or your partner’s employer for enrollment dates, plan options and other details.<\/p>\n

Do I qualify for coverage on the marketplace?<\/h2>\n

To be <\/span>eligible for coverage through the marketplace<\/span><\/a>, you must be a U.S. citizen or national who\u2019s living in the U.S., isn\u2019t currently incarcerated and isn\u2019t already insured through your job, a spouse or a parent.<\/span><\/p>\n

If you or your dependents qualify for Medicaid, Medicare or the Children\u2019s Health Insurance Program (CHIP), you aren\u2019t eligible for marketplace coverage.<\/span><\/p>\n

One exception: If your employer <\/span>charges more than 9.86 percent of your yearly household<\/span><\/a> income for health insurance, you can choose to purchase insurance through the marketplace instead.<\/span><\/p>\n

\"find<\/a><\/p>\n

How can I enroll?<\/h2>\n

You can <\/span>enroll for coverage<\/span><\/a> online, over the phone, with in-person help from an assister, through an agent or broker, or by mail. <\/span><\/p>\n

If you previously enrolled with the help of an <\/span>in-person navigator<\/span><\/a>, it might be more difficult to do that this year. The Trump administration <\/span>cut funding for navigators to $10 million for 2019<\/span><\/a>, down from $36.8 million the previous year and $63 million the year before that.<\/span><\/p>\n

\u201cThose living in rural areas will be the most affected by these cuts, as these programs may not have the budget to conduct outreach there,\u201d says <\/span>Rosemarie Day<\/span><\/a>, founder and CEO of Day Health Strategies and previously the founding chief operating officer of the Massachusetts health exchange. <\/span><\/p>\n

What if I don\u2019t want health insurance? Will I have to pay a fine?<\/h2>\n

New this year, you can choose to forego coverage without facing a penalty. At the end of 2017, Congress passed a tax bill that repealed the individual mandate, which required individuals to buy health insurance. Up until now, you could be hit with a fine equal to 2.5 percent of your household income or $695 per person \u2014 whichever was higher \u2014 for opting out of health insurance. <\/span><\/p>\n

Without the individual mandate, people who are generally healthy might be more likely to skip coverage, says Harry Nelson, founder of the healthcare law firm Nelson Hardiman and co-author of the book <\/span>From Obamacare to Trumpcare: Why You Should Care<\/span><\/i>.<\/span><\/a> The repeal could also have an impact on people who remain insured.<\/span><\/p>\n

\u201cWhat we end up with is a risk pool that\u2019s older and sicker,\u201d Nelson says. \u201cBy letting the population that we call the \u2018young invincibles\u2019 stay out of the market, we\u2019ve essentially worsened the risk pools and made insurance more expensive for everyone that\u2019s still in the pool.\u201d<\/span><\/p>\n

Are premiums going up in 2019?<\/h2>\n

The average increase in premiums across the country is only around 3 percent, Day says, which is on par with inflation. But that average doesn\u2019t account for differences across state lines. <\/span><\/p>\n

\u201cThere will be a lot of variation among states,\u201d she says. \u201cPrices will go up or down depending on which state you live in and which carrier you use.\u201d<\/span><\/p>\n

In states where premiums are going up, the cost for insurance companies to treat sick enrollees is part of the equation.<\/span><\/p>\n

\u201cThere are some unique issues driving up premiums, like the expansion of addiction treatments and mental healthcare,\u201d Nelson says. \u201cMany of the insurance companies are still adjusting to the broadened scope of care and are having difficulty controlling costs.\u201d <\/span><\/p>\n

What do I need to prepare before I enroll?<\/h2>\n

You\u2019ll need to provide basic information about your household size, as well as employer and income information for every person in your household. Walk through <\/span>this checklist<\/span><\/a> from the Department of Health and Human Services to get ready for enrollment.<\/span><\/p>\n

\"find<\/a><\/p>\n

What kind of plan do I need?<\/h2>\n

As you <\/span>compare plans<\/span><\/a>, you\u2019ll see options in four categories: Bronze, Silver, Gold and Platinum. In general, Bronze plans have the lowest premiums, which increase as you progress to Silver, Gold and Platinum.<\/span><\/p>\n

Weighing lower premiums vs. broader coverage<\/strong><\/em><\/span><\/p>\n

The tradeoff for plans with lower premiums is that they generally cover fewer medical expenses. Likewise, if you pay a higher premium for a higher-tier plan, you\u2019ll usually receive better coverage for the procedures, prescriptions and services you need. But the categories aren\u2019t indicators of the quality of care \u2014 they only represent the scope of each plan\u2019s coverage. <\/span><\/p>\n

Although Gold and Platinum plans come with higher monthly premiums, these plans are usually a good option for people who need frequent medical care or prescriptions. If you don\u2019t expect to make regular visits to the doctor, you might be comfortable with a Bronze plan. <\/span><\/p>\n

If you\u2019re under 30, you may be eligible for a <\/span>catastrophic plan<\/span><\/a>, which comes with a low premium and a high deductible. Coverage doesn\u2019t kick in until you meet the $7,900 deductible, so these plans are intended to provide coverage only in the case of an unexpected disaster.<\/span><\/p>\n

EPO, HMO, POS or PPO: Which is right for me?<\/strong><\/em><\/span><\/p>\n

Some plans<\/span><\/a> let you choose your own doctors, but others only cover services from a pool of in-network providers. <\/span><\/p>\n

Exclusive provider organization (EPO) plans and health maintenance organization (HMO) plans only cover providers within your plan\u2019s network. Point of service (POS) and preferred provider organization (PPO) plans cover visits to doctors whether or not they\u2019re in the network, but in-network providers are still usually less expensive, and some plans may require a referral for out-of-network doctors. <\/span><\/p>\n

If you have a favorite doctor or you want to confirm coverage for a specific procedure or prescription, read the plan\u2019s details as you shop around to make sure you\u2019ll be covered before you enroll.<\/span><\/p>\n

Will my current plan\u2019s coverage change in 2019?<\/h2>\n

The Affordable Care Act <\/span>guarantees 10 essential health benefits<\/span><\/a>, which include preventive services, prescriptions, pregnancy and childbirth care, and mental health services, among others.<\/span><\/p>\n

But when the Trump administration released its final rule for ACA implementation earlier this year, it gave states new leeway to define their own \u201cbenchmark\u201d plans.<\/span><\/p>\n

\u201cSince the 10 essential health benefits are somewhat broad,\u201d Day says, \u201ceach state picks what is called a \u2018benchmark plan,\u2019 which establishes a minimum level of coverage at a more detailed level of specificity, which all plans in the state must adhere to.\u201d<\/span><\/p>\n

The 10 essential health benefits are still safe, Day says, but states could take advantage of the leeway to cut back on coverage in certain areas. This new flexibility allowed Alabama to reduce the number of prescription drugs it would cover, while Illinois took the opposite approach, expanding its benchmark plan to cover a wider range of chronic pain treatments and mental health services, <\/span>according to <\/span>Modern Healthcare<\/span><\/i><\/a>.<\/span><\/p>\n

\u201cWhat we\u2019re seeing is a split between some of the more liberal, blue states which are really holding the line and sticking to the original benefits,\u201d Nelson says, \u201cand some more conservative states that are looking at the financial challenges in the plans and considering reductions.\u201d<\/span><\/p>\n

Do I qualify for a subsidy to help cover costs?<\/h2>\n

Your eligibility for a subsidy or <\/span>premium tax credit<\/span><\/a> depends on your income and the number of people in your household. You can use <\/span>this calculator<\/span><\/a> to see if you qualify for any savings. If you don\u2019t qualify for savings, you may still be able to purchase a plan through the marketplace at full price.<\/span><\/p>\n

How likely is a repeal-and-replace of the ACA?<\/h2>\n

When Donald Trump was elected president in 2016, talk of efforts to repeal and replace the ACA (also known as Obamacare) quickly picked up steam, but attempts from Republicans in Congress have thus far been unsuccessful. <\/span><\/p>\n

Nevertheless, the administration has succeeded in dismantling key components of the ACA by eliminating the individual mandate and granting more flexibility to states. For now, Nelson doubts that a full repeal-and-replace effort will come to fruition.<\/span><\/p>\n

\u201cMy sense is there is not as strong a political will for further repeal of Obamacare,\u201d Nelson says. \u201cI think the administration got the victory it wanted, and my sense is that Republicans are going to move on to other issues.\u201d<\/span><\/p>\n

What if I miss the open enrollment period?<\/h2>\n

If you miss the Dec. 15 deadline, you can still enroll if you qualify for a Special Enrollment Period. Certain life events, like getting married, losing coverage or having a baby, qualify you to enroll outside of the open enrollment period. <\/span>This questionnaire<\/span><\/a> will help you determine if you qualify.<\/span><\/p>\n

\n

Ready to book a doctor’s appointment? Visit Zocdoc.<\/span><\/a><\/span><\/h1>\n","protected":false},"excerpt":{"rendered":"

Whether you\u2019re keeping last year’s plan or using the health insurance exchange for the first time, here’s what you’ll need to know. <\/p>\n","protected":false},"author":21,"featured_media":17865,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[227],"tags":[112,78],"class_list":["post-17855","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-guides","tag-aca","tag-health-insurance","reviewer-dr-nassim-assefi"],"yoast_head":"\nEverything You Need to Know About Open Enrollment 2019<\/title>\n<meta name=\"description\" content=\"Whether you\u2019re keeping your plan or looking to use the health insurance exchange for the first time, here's what you'll need to know for open enrollment.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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