Between November 1st and December 15th, it’s open enrollment period for the Health Insurance Marketplace. Open enrollment is a chance for all Americans to select their healthcare plans for 2019. Whether it’s your first time getting insurance on your own or you’ve done it a few times but still find it complicated, don’t worry, we’re here to help.
Today we’re going to discuss all of the ins and outs of open enrollment, including a brief history of the system, the changes you need to be aware of this year, and how to complete the process with less stress. Rather than arbitrarily selecting a plan that may not meet your needs, it’s important to understand the options you have available and make an educated decision. Let’s jump right in to learn more!
The ACA And Health Insurance Marketplace
The Affordable Care Act was signed into law by former President Obama in 2010. While the general public didn’t see much occur until the fall of 2013, federal and state agencies were working hard to create the infrastructure to support this change. Many refer to the policy as the ACA or simply as Obamacare.
The goal of the ACA was to provide affordable insurance options for everyone in the United States. Insurance providers were given the option to join a large network of plans that all lived under one system called the Health Insurance Marketplace. In October of 2013, individuals and families were allowed to enroll in the marketplace through April of the following year and could select an insurance plan that best met their needs.
Both the Health Insurance Marketplace and open enrollment are for those who do not have employer-sponsored health insurance, and until recently, individuals who opted out of insurance coverage altogether had to pay an annual fine. Starting in 2019, this individual mandate will no longer apply, so theoretically people can remain uninsured without having any negative repercussions. However, surprise medical bills can occur more often than you’d think, so it’s best to weigh your decision very carefully.
Open Enrollment Options
While there have been changes in terms of the length of open enrollment in the past, this year most states will work within the 45-day window as previously mentioned. Several parts of the country may offer longer periods of time to make your selections, so check on the specific guidelines in your area and plan accordingly.
Under the umbrella of Health Insurance Marketplace options, there are four distinct categories of plans to choose from. In general, these options are all geared toward different types of health concerns and levels of needed care:
- Bronze – With a bronze plan, individuals can expect to pay an average of 40% of their medical costs with their coverage picking up the other 60%. Bronze plans have the highest deductibles but feature the lowest monthly premiums. These types of plans are ideal for those who want insurance in the case of major injuries or illnesses but who otherwise either don’t visit the doctor or are comfortable paying for routine care out of pocket.
- Silver – Consumers can expect to pay slightly less, about 30%, of their medical costs with the remaining 70% covered by their plan. Silver plans cost slightly more than a Bronze plan but they also pay more toward routine care. Deductibles tend to be slightly lower as well. Both individuals and families who qualify for extra savings based on their income level must choose a Silver plan in order to capitalize on those discounts.
- Gold – With a Gold insurance plan, out of pocket costs are lowered to 20% on average and feature even lower deductibles than the other two lower tiered options. Although your monthly premium will be higher, the Gold plans within the Health Insurance Marketplace feature a robust array of benefits. Those who rely on medical care fairly regularly may find that a Gold plan best meets their specific needs.
- Platinum – The highest level of coverage possible, Platinum plans typically cover about 90% of your healthcare costs. These options will come with the highest monthly costs but balance that out with the lowest deductibles and the most amount of benefits. Platinum plans are ideal for those who see their physician very frequently.
What’s New For 2019
In general, the basic guidelines for open enrollment stay the same, where Americans have just 45 days to enroll in their health plan. Changes to their coverage, including switching between plans or trying to enroll in coverage for the first time, cannot occur outside of this window unless a qualifying life event like a marriage or job loss takes place.
Selecting the right level of coverage for your needs has been very challenging in years past, but keep in mind that during this year’s open enrollment, all plans in the Health Insurance Marketplace must include 10 basic benefits, including hospitalization, prescription drugs, emergency care, and dental and vision coverage for children. Open enrollment is only for health coverage, and any other types of insurance including auto or life plans are not handled during this time.
Experts note that premiums should be somewhat more affordable this year, and although plan prices do tend to increase each calendar year, most people will see a 3% to 5% increase compared to 10% or more in the past. As the cost of insurance continues to increase, so do federal subsidies, which help to lower the cost of insurance based on one’s family size and income. When you’re applying for insurance, it’s imperative to check your eligibility for all cost savings in order to help offset your monthly premiums.
What About Short-Term Plans?
Although they’ve been around for years, recent news about short-term medical plans has brought up a lot of questions for consumers. Many wonder if they should opt for this type of coverage instead of purchasing a more traditional option through the ACA. In years past, a short-term medical plan was designed just as the name entailed: to provide coverage on a very limited basis to help individuals who were changing jobs and needed care in the meantime.
This year, President Trump extended the length of short-term plans, and where these policies used to only be applicable for three months, they’re now available for 364 days. Depending on the situation, a short-term medical plan may even be eligible for a renewal, giving individuals coverage for up to 36 months. As these prices come at a lower cost than others, why wouldn’t this be the way to go?
For some, it is, especially those who are very healthy, rarely visit the doctor, and are careful enough to avoid major accidents. Yet, while short-term plans are often marketed as the ideal coverage type, particularly for millennials, individuals should keep in mind that the 10 basic benefits outlined above are not included in this type of coverage. Additionally, those with pre-existing conditions are not even eligible for a short-term plan, so it pays to consider this option very carefully before the open enrollment window ends.
Getting Ready To Apply
Once you’ve spent time determining which insurance plan will be right for you, it’s time to enroll through the Health Insurance Marketplace. Keep in mind that assistance is available nationwide, yet most find the process to be fairly straightforward. In order to complete your application, you’ll need the following information:
- Household data including names, dates of birth, Social Security Numbers, and mailing addresses for everyone in your home who will be applying for coverage
- If someone is helping you complete the application, you’ll need their professional information
- Immigrants may be asked to provide documentation during their enrollment process
- Financial information, including how you file your taxes, where your income originates, and an estimate of your household income are important pieces of data to determine your savings eligibility
- Employer information, as well as current health coverage information, is also required
Remember that deciding on your health insurance coverage for 2019 is a big decision, and it may be smart to take some time to consider what your needs will look like. If you’re in great health and have enough savings to pay for doctor visits, a Bronze plan might be your best bet. Families with accident-prone children could find that they need an entirely different level of coverage.
Everyone’s circumstances will differ, and keep in mind that a short-term plan, as well as opting to forego coverage entirely, are also choices to consider. In the end, you control the path of your own healthcare and get to determine what works best for you. But, it’s best to decide sooner rather than later, as December 15th will be here before we know it!
About Slingshot Health
Slingshot Health is a health tech startup that brings top healthcare providers and patients together. Patients bid on the cost of services and healthcare providers accept bids based on availability. Slingshot Health is unique in that it is a mutual marketplace putting both patients and providers back in control. Visit us at slingshothealth.com.