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Everything a procrastinator needs to know about Open Enrollment

By October 11, 2019 Personal Insurance
Woman-on-Phone

Its  October in Arizona and there’s some exciting things happening… its’ finally not 100 degrees everyday, Pumpkin Spice everything, and women trying to get into sweater weather (truth hurts). Beyond that, in the health insurance world we are coming into what we call Procrastination Season. This is where no one realizes how important health insurance is or open enrollment and as a collective nation we wait until December 13th at midnight to Eat that Frog.

That stops today.

In a pure sense of definition- open enrollment is the single time of year an individual can enroll for health insurance coverage for the following year. In lame terms… if you don’t want to pay out of pocket for ridiculous health care bills then it’s time to pick your plan and get signed up for individual health insurance.

Open Enrollment for individuals starts November 1 and ends December 15 2019.Unless you have a “special case” (more on that in a moment) then this is the only time you will be able to enroll.

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I realize the excitement  of insurance is lost on most, but the idea here is to give you the facts about what you need to know even if you are a procrastinator like myself. Let’s start with the basics.

Who are the Insurance Carriers for 2019 Open Enrollment Season?

At this time there will be three insurance companies offering plans on Healthcare.gov, also known as The Marketplace. Ambetter, Blue Cross Blue Shield of Arizona and Bright are the three carriers in Pima County. In Maricopa County there are the additional options of Oscar Health plan, and Cigna Healthcare.  Each carrier has various plan options, and multiple physician and hospital networks to choose from. Yourr independent insurance agent ill always be the number 1 resource for information and education about the upcoming plan options for 2020. But let’s say you want to be extra prepared. Let’s say you want to learn the lingo before you meet with your agent. The few tips/tricks below will help you get into the spirit of the season.

What is a Special Election Period?

There are some ways through Special Election Periods that you can have an opportunity to gain individual health insurance coverage outside the open enrollment period. Here are some examples of some special enrollment periods.

  • Getting Married
  • Getting Divorced (limited to only if you are losing coverage)
  • Moving to a new coverage area
  • Getting out of jail

Is there any kind of financial break that I might be eligible for?

In an effort to make health insurance affordable you can apply for something called an Advanced Premium Tax Credit, most commonly known as a subsidy.  Remember when your Math teacher in High School said “You’ll use Algebra everyday.” It would come in handy here to figure your subsidy… There’s this crazy formula that includes, your income, cost of insurance, IRS affordability rules, Federal Poverty Guidelines, the easiest way to find out if and how much you qualify for, is to use this calculator from The Kaiser Family Foundation.

Pro-Tip : If you and your dependents are eligible for coverage through an employer plan, AND that plan meets the guidelines of affordability by the IRS, you will not receive a subsidy. There’s this messy area (yes I know it’s not the only one) when we start bringing employer plans into the mix but I digress, back to the subsidy

If you qualify if the subsidy, you won’t actually receive the money. The money can be used three ways. It can be subtracted from your monthly premium, you can take it all at the end of the year on your taxes, or a combination of both. Personally in my experience, I suggest to use it all each month. Let’s say you choose that option, Healthcare.gov sends the money to your insurance company your behalf. It will show up as a credit on your bill each month.

Example: lets say your premium is $500 a month, and your subsidy is $250 per month. You will receive a bill showing an amount due of $250.

Am I going to have to change doctors?

Hopefully not!

Here’s where we touch on the physicians and hospital networks. Brokers are familiar with which carriers contract with with Doctor groups and hospitals. This could be a big deal for you if you need a specific Doctor.

If you call you Doctor’s office and say, “Do you contract with Blue Cross?” odds are they will say “yes”, and you’ll think you’re all set. Well, the Blue Cross plans on The Marketplace are HMO style plans, and only contract with specific Doctors. You might get lucky and your Doctor could be considered In-Network, but a broker can help you find that specific Doctor in the Blue Cross directory. This could make a difference between you having to pay out of pocket, or having your visit covered by insurance. You know that saying, “The biggest mistakes are usually the most expensive” choosing the wrong network could be one of those.

Currently Ambetter has the largest network in Pima County. They are the only carrier to contract with all eight (8) hospitals in Pima County! Bright Health only contracts with 2 hospitals in Pima County, St. Josephs and St. Mary’s which are Carondelet facilities, you would also only have access to Carondelet doctors.

What do I need for Open Enrollment 2020

  • There’s only a few thing you will need to get yourself enrolled.
  • An idea of your 2020 household income. As I mentioned before this will determine whither you get an financial help with your premiums.
  • A healthcare.gov username and password. This is something you can do ahead of time
  • You will also need names, dates of birth, and social security numbers for everybody in the household. Regardless if they are enrolling or not.

Sometimes healthcare.gov will require you to upload them additional information. This could be proof of income, proof of your citizenship, or proof of your residence.  This one doesn’t need to be done right away they give you 60 days to get them in, however, your insurance can’t be active until healthcare.gov receives the documents and approves them.

The penalty

You’ll remember in past years, there was tax penalty for not having ACA complaint insurance . It was used as a way to encourage people to enroll in coverage, almost as a scare tactic. Good news that penalty went away this year!

However.. We all know the horror stories of huge medical bills, and bankruptcy . The penalty here is taking on the cost of unexpected medical bills. Sure, there are State programs out there and Non-profits to help. Insurance is the transfer of risk, why not pay someone a few thousand dollars a year to protect yourself from a few hundred thousand dollars?

I already have coverage though, what do I need to do.

You might not need to do anything. If your plan is not being cancelled, your insurance carrier should re-enroll you into your same plan. I think it’s best to take care of it so you know it’s done. It’s giving yourself some piece of mind. However if you have a subsidy, you will need to update your income information

Who can you call for help?

I’m going to say it loud for the people in the cheap seats—  Find a licensed agent.

Licensed agents, or brokers, will be able to help you better than any information online can provide. They legally can answer questions regarding the plan options available, they can help you fill out the subsidy application, they can help you when you have claims issues, they can explain the thing you get in the mail that says, This is Not a Bill. You.Will.Have.Questions.

If you already work with one great, get in contact with them and get on their calendar. If you do not, here are some places you can find one, NAHU Agent Search, Healthcare.gov has a list, or good ole Google and here is my contact information.

Open Enrollment doesn’t have to be scary. In fact, it can be easy. Stay ahead of it and don’t wait until the last minute. Take it from someone who rides the procrastination train often, this isn’t one that you want to wait on. The time to plan and ready yourself for Open Enrollment 2020 is right now.