Healthcare Insurance Open Enrollment 2015

Make a note, because these are important dates you need on your radar:

• November 15, 2014 – Open enrollment to buy, change or renew your personal health insurance policy begins.
• December 15, 2014 – The last day to purchase health insurance to be certain it will be in effect January 1, 2014.
• December 31, 2015 -All policies purchased from a government-run exchange/marketplace (e.g. Healthcare.gov or your state’s exchange) expire at midnight, no matter when you enrolled.
• February 15, 2015 – Open enrollment closes. If you don’t have a qualifying health insurance plan, you will be fined. This year, it’s a hefty $325 per adult, $162.50 per child, up to $975 for a family or 2% of your family income, whichever amount is bigger.

If you don’t have any health insurance or if you want to change or renew the plan you have now, you have a very narrow window to act. The good news is that you have some options:

• You can buy a qualifying plan on a government-run exchange. The federal government says it’s working really hard to make sure that Healthcare.gov will be fully functional and able to handle the anticipated volume this time around.
• You have the right to buy your insurance directly from an insurance company. You can shop and compare policies here.

Purchasing Option Pros & Cons

Tax credits to assist with premiums and federal subsidies to assist with out-of-pocket costs are only available through government-run exchanges. However, there are restrictions on which plans qualify for assistance as well as eligibility requirements you must meet. You may find better options and benefits by going direct. In either case, your health care insurance will be provided by an insurance carrier in the private sector, which must by law offer plans that include at least the 10 essential benefits required by Obamacare, put the same caps on your out-of-pocket expenses, and guarantee issue/renewal regardless of your current or past health history. They must also offer any additional benefits that may be mandated by your state.

Automatic Enrollment

If you bought your 2014 health coverage on an exchange you should have received a notice by now telling you that you’ve either been automatically re-enrolled in the same plan or one that is very much like it. You don’t need to do anything, but you probably should at least explore your options. Here’s why. That same or similar plan may have a very different premium — one that’s increased quite a bit since last year. Your automatic re-enrollment may or may not include last year’s financial assistance depending on changes in your income or household or whether or not you gave them permission to use the same financial info you provided last year. Here again, it’s best to take a look at all your options before you sign on the dotted line.

Plan Options

Whether purchased on or off an exchange all qualifying plans (meaning they’re compliant with provisions of the Affordable Care Act, aka Obamacare) fall into one of four metal plans:  Bronze, Silver, Gold and Platinum. What the insurance company covers versus what you’re responsible for increases, as do the premiums, as the perceived value of the metal increases (Bronze is lowest, Platinum highest). Higher monthly premiums equate to a lower percentage of out-of-pocket costs for you up to the government-imposed caps. This year, that cap is $6,600 for an individual and $13,200 for a family; not counting any additional limits on prescription drugs that may apply.

The Bottom Line

What you actually pay for your health insurance will depend on a number of things including the plan you pick, your age, whether you use tobacco (although this is not allowed in some states), where you live, how many family members are on your plan, and whether you take advantage of financial assistance. The only way to know is to shop and compare.

What Happens If You Miss the Deadline?

You may still be able to purchase or change your insurance after the Open Enrollment closes on February 15, 2015 if you are eligible for a Special Enrollment Period. Qualification depends on certain life events like moving to a new coverage area, getting married or divorced, having or adopting a baby and losing your employer-provided health insurance. You have 60 days from the triggering event to apply for special enrollment.

You can also consider a short-term health insurance policy. It won’t help you avoid the tax penalty, but it will provide you with necessary basic healthcare coverage for a short period of time. That may be all you need to cover the gap until you qualify for a special enrollment period.