It’s that time of year again when you can change or add to your health plan, what has become known as Open Enrollment.  If you have never had to think about health insurance before, because you were on your parents’ plan, you got your policy through your job, or you have not yet had to think about seeking a health insurance plan and it can be confusing.  And Open Enrollment is only about your health insurance by the way, all other types of insurance, while they may have their own restrictions and rules do not pertain. 

What is Open Enrollment anyway?

The Affordable Care Act or ACA made provisions for people to be able to change or add to their health insurance freely during one period of time in the year.  You may have seen billboards and heard ads saying Open Enrollment is now.  At other times of year if you experience a life changing event such as having a baby, getting married, moving to another state or changing jobs where you lose health coverage you had with your previous job, you can make changes to your health plan.  This year’s Open Enrollment period is November 1, 2019 through December 15, 2019 (if you are in California, if not check your state’s time period, it might be different.)  As long as you sign up by December 15 this year your coverage can start on January 1, 2020.

What if I Don’t?

Back in 2017 you may remember Congress decided to get rid of the penalty for the individual mandate (the requirement that all Americans have a basic level of health insurance or be penalized through a fee on your tax return) but be careful.  States have the right to penalize individuals through State tax returns.  Check to make sure your state will no penalize you, but if you are in California, they have implemented a hefty fine for not having coverage in 2020.

What’s Covered?

All plans must give you a basic level of coverage.  It is up to you to decide if you want and can afford more coverage.  No matter what plan you choose it must cover these ten basic things:

• Outpatient care including chronic disease management
• Emergency care
• Hospitalization
• 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

Even if you choose the most basic plan you may have choices; to pay a higher premium – this is the amount you pay each month for coverage;  to pay a higher deductible – this is the threshold of costs you must cover before your insurance will begin picking up the cost; or pay higher co-pays – this is what you must pay out of your own pocket either before or alongside the insurer.  These costs are most likely fixed and depend on the type of service, so if you know you need a lot of lab tests for instance, you can choose a plan with a lower co-pays for those services.

Read the Fine Print

Although it may be tedious, read everything you can about your potential plan.  You don’t want a shock to come at an inopportune moment when you need care and it isn’t covered, or not at the level you thought.  Or you have higher out of pocket expenses than you can afford all at once.  So, don’t just stop at finding out what the monthly premium is.  Look for the deductible – and make sure you know what the individual and family deductible amounts are.  Look at the co-pay or percentage of what you are expected to pay for your care. 

Look at the list of providers.  If you have been going to the same doctor for years you may not want to change, so find out if that provider accepts the insurance you are considering.  Another consideration is what facilities accept the insurance.  You should be able to obtain a list of hospitals and clinics that accept the insurance and if there are none close by, you may want to chose a different plan. 

Make a Decision

Even if you are having difficulty deciding you have only a limited amount of time to choose.  And you certainly don’t want to pay a hefty penalty or be left without coverage altogether.  There are resources out there too.  Many non-profits offer guidance and advice about how to select the right level of coverage for your family.  Start with Covered California or your state’s marketplace.