Open Enrollment for the Affordable Care Act began this week, and we’re here to give you the information you need.
What is Open Enrollment?
Open enrollment is when you can buy, change or update your health insurance plan. Open enrollment for the ACA runs from November 1 through January 31. That is the only time you can buy health insurance on the exchange, unless you have a qualifying life event.
What is a qualifying life event?
A qualifying life event allows you to buy or change health insurance even when it is not open enrollment. There are 4 basic qualifying events according to healthcare.gov:
- Loss of health coverage
- Change in household
- Change in residence
- Other (change in income, becoming a US citizen) go to healthcare.gov for a full discussion.
Important Dates
- November 1, 2016: Open Enrollment started — first day to enroll, re-enroll, or change a 2017 insurance plan through the Health Insurance Marketplace. Coverage can start as soon as January 1, 2017.
- December 15, 2016: Last day to enroll in or change plans for coverage to start January 1, 2017.
- January 1, 2017: 2017 coverage starts for those who enroll or change plans by December 15.
- January 31, 2017: Last day to enroll in or change a 2017 health plan. After this date, you can enroll or change plans only if you qualify for a Special Enrollment Period.
What You Need to Know
- Enrollment online takes between 1 and 2 hours usually.
- You’ll need income information, Social Security numbers and contact information for you, your spouse and any dependents.
Terms You Need to Know
- Premiums are how much you pay each month for your insurance policy.
- Deductibles are how much you pay out of pocket before your insurance kicks in. A high deductible plan has low premiums but high out of pocket costs when you get treatment.
- Copays are what you pay per doctor’s visit or treatment. Usually specialists have a higher copay than a primary care physician.
- Cost sharing is when you pay a percentage of the total cost of a drug or treatment. This is usually reserved for newer, higher priced drugs. You pay a set percentage, usually around 20% of the cost. This can be hundreds of dollars.
- Grandfathered plans a grandfathered plan must have been in existence prior to March 23, 2010, and cannot make significant changes to their coverage (for example, increasing patient cost-sharing, cutting benefits, or reducing employer contributions).
Helpful Websites
Healthcare.gov - Assistance/insurance marketplace information to purchase insurance.
- Putting Patients First® Gain a better understanding of their options in the health insurance marketplace; find coverage that meets individual health care and budget needs.
- Estimate My Costs Estimate total annual out-of-pocket costs.
- Answer My Questions - Answers questions about health insurance marketplace.
- The Kaiser Family Foundation has an insurance price calculator. They have solid reliable information about the Affordable Care Act and insurance coverage.
- Prevent Cancer has a webpage that allows you to compare screening coverage on a state by state basis.
- Patient Advocate Foundation - (800) 532-5274 - Acts as liaison for insurance issues; National uninsured patient directory and National underinsured patient directory offer links to organizations that can help locally.
If you still have questions, contact our Patient Support Navigators at (877) 422-2030! We’re here to help and will give you the information you need to set you up for success and provide you with support.