Health Insurance: It’s Open Enrollment Season – Now What?


If you don’t have health insurance, or want a new plan, you can use the Obamacare Health Insurance Marketplace to get coverage. If your employer doesn’t provide affordable health insurance, the prices are likely to be better through Obamacare (also called the Affordable Care Act).

Each year, health insurance companies make changes to their benefits, premiums, deductibles, and copayments. During open enrollment, you can enroll in a health insurance plan that fits your needs.

Open enrollment for Obamacare is from November 1 – December 15. Only 5 states (California, Colorado, Minnesota, Washington, Massachusetts, and the District of Columbia) have slightly longer open enrollment. However, many other insurance plans, including workplace plans, individual plans, and Medicare, also have open enrollment at the same time of year.

If you already have health insurance, it’s important to use open enrollment to review your plan’s coverage. You can check that it still meets your needs and change it if needed.

Why is the Open Enrollment Period so Important?

Open enrollment is when you can look around to make sure you aren’t paying more than necessary for good health insurance. Make sure you will be getting the services and benefits you need.

If you were enrolled in a plan in 2017, you will be automatically re-enrolled in 2018 for the same or similar plan. But, that plan could be more expensive or may not cover the services you need. You will not be able to change this plan once the open enrollment period ends, so don’t let yourself be automatically re-enrolled unless you are sure that the policy is what you want.

You can also use open enrollment to get health insurance for the first time. The law requires you to have health insurance, and the penalty goes up every year. In 2018, you can face a minimum fine of $695 or 2.5% of your income (whichever is higher), and up to $2,085 if you don’t have health insurance.

You can get your insurance through the Affordable Care Act (“Obamacare”) on healthcare.gov (sometimes called the marketplace or the exchange).

Health insurance might also be offered through your job or your spouse’s job. Most employers will send out reminders about open enrollment and set aside a two-week period for reviewing the available health plans.

Whether you already had a health plan this year or not, here are some basic tips you should think about for 2018:

  • Do your homework. Reviewing your options could save you hundreds or thousands of dollars. Even if you liked your plan this year, it might not be the best choice for next year. And, it might be cheaper for your children to be on your spouse’s insurance plan instead of yours.
  • Double-check that the medications you are taking and the doctors you see are covered by the plan you choose. Choosing a cheaper plan could cost you more in the long run if your doctor is out-of-network or if your plan doesn’t cover something you need, such as a smoking cessation drug. Most insurance companies have a website where you can check which doctors and medications are covered.
  • Check that the services you need are covered. Are you going to need specific services that some insurance plans exclude, such as bariatric surgery, certain types of counseling or smoking cessation programs, or surgery to fix complications from cosmetic surgery? These exclusions are often hard to find – and you may not know they aren’t covered until you need them and get denied. Before signing up, you should call the insurance company to find out what is covered and what isn’t.
  • Don’t forget about vision and dental plans. These plans cover preventive services like eye exams and teeth cleaning. Some plans include dental benefits. You can also buy these plans separately through the exchange. Some plans on the exchange include vision benefits. If your insurance is covering anyone under the age of 18, they must offer dental and vision coverage. Routinely getting your teeth and eyes checked could help prevent more serious medical problems down the road. On the other hand, these plans might cost more than they are worth to you, so consider your own needs before deciding.

If you’re buying an insurance plan through healthcare.gov or state exchange websites:

  • Update your household and income information. You might be able to save money compared to last year.
  • Check that the plan covers what you need. Even if you were automatically enrolled, the plan might be different than last year.

Open Enrollment for 2018 Health Insurance

If you’re buying health insurance for 2018 through healthcare.gov, here are the important dates:

November 1, 2017: The first day you can enroll in a 2018 insurance plan.

December 15, 2017: The last date to enroll for coverage that starts January 1, 2018*. If you miss this deadline, you can’t sign up for a health plan for the rest of 2017. The only exception is if you qualify for a Special Enrollment Period, if you lose your health insurance, get married, or have a baby. Click here to learn more about the Special Enrollment Period. If you don’t change or re-enroll in a plan, you will automatically be enrolled into the same or a similar plan as you were this year. You will not be able to change this plan after the open enrollment period ends, even if it costs more or includes different coverage, so be sure to decide what you want to do before Dec 15.

If you live in California, Colorado, Minnesota, Washington, Massachusetts, or the District of Columbia, you have a little extra time to sign up.

January 1, 2018: The date your 2018 coverage starts if you enrolled or changed plans by December 15. If you live in one of the 5 states listed above, or Washington, D.C., you should check to see when your coverage would start.

Remember:

  • Coverage is affordable: The tax credit through healthcare.gov reduces most people’s premiums to be between $50 and $100 per month. Last year, 8 out of 10 people qualified for this reduction. Make sure to check your options to see how much the co-payments and deductibles are.
  • Cost-sharing reductions (CSR) are still available: Subsidies are available for people who have an income of 100%-250% of the federal poverty level. CSR are only available in Silver plans. Insurers raised monthly premiums because the Trump Administration stopped reimbursing them, but insurance companies are still required to discount those costs for many consumers.
  • Signing up for coverage is easy: It takes about 10 minutes to submit an application. You can even sign up on your smartphone! Out-of-pocket cost estimators like this one can help you estimate your total healthcare costs for the year including premiums, deductibles, and co-pays. There are tools to help you look up doctors and prescription drugs, so you can figure out which plans will cover your needs
  • Start early: The healthcare.gov website will be closed for 5 out of the 6 Sundays from midnight to noon EST during the open enrollment period, and there will be surges in the number of people trying to sign up on some days, especially in December.
  • Free, expert help is available: Free, anonymous help is available 24/7 if you want to talk to someone about your options or if you have questions about signing up. You can call 1-800-318-2596 or you can find local help by searching on HealthCare.gov.
  • If you don’t sign up by December 15th, you may have to pay a penalty: The minimum penalty for not having health insurance is $695 or 2.5% of your income (whichever is higher), but the fine can be up to $2,085.

To learn more about how healthcare.gov works, check out https://www.healthcare.gov/quick-guide/

Want to know how much health insurance will cost you? Use this calculator to find out!

Definitions:

  • Premium: the amount you pay for your health insurance every month.
  • Deductible: the amount you pay for covered health care services before your insurance plan starts to pay.
  • Copay: a fixed amount you pay for a covered health care service after you pay your deductible.

All articles on our website have been approved by Dr. Diana Zuckerman and other senior staff.