Cooler nights, shorter days, and falling leaves all signal the switch from summer to autumn. And one more sure sign of the changing seasons is the approach of the open enrollment period for health care coverage. Open enrollment 2019 begins soon and runs for a short time, so it is wise to start planning.

For some, this enrollment period will involve no action at all other than continuing with the coverage they already have in place, either through an employer or the marketplace.

For many, however, this can be a confusing six weeks, full of questions and research as they try to determine the right plan for themselves and their families.

Tomlin Health Insurance understands the confusion and anxiety that can arise when making these decisions, and we are here to help. Let’s start with a refresher on the Affordable Care Act before moving into the specifics of the open enrollment period.

Affordable Care Act (ACA)

Frequently referred to as Obamacare, the Patient Protection and Affordable Care Act was signed into law by President Barack Obama on March 23, 2010. It aims to provide medical insurance coverage to millions of US citizens who were previously uninsured.

Some of the provisions under the ACA are:

  • Coverage for children up to age 26, even if not enrolled in school and not living with parents
  • Prohibitions against limiting or denying coverage for pre-existing conditions
  • Expansion of Medicaid to some individuals under 65 years of age, depending on income
  • Introduction of a penalty for those who do not have at least the minimum health care coverage required
  • Creation of an insurance marketplace, or exchange, where individuals can purchase coverage

What is the Open Enrollment Period?

In general, open enrollment is a designated time when individuals can select health care coverage for the coming year. This coverage could be through Medicare, an employer, or the insurance marketplace.

The enrollment period is typically the only time of the year when you can sign up for new health care coverage or change the coverage you already have. Unless you have a life event that qualifies you for a special enrollment period, such as getting married or having a baby, you will not be able to sign up for medical insurance outside of the window of time allowed under the ACA. Therefore, it is critical that you are prepared to make your decision in a timely manner.

The open enrollment periods for coverage that begins January 1, 2019, are as follows:

  • Health insurance exchange: November 1 – December 15, 2018

Determine Your Eligibility to Shop on the Exchange

Before you launch yourself into researching all of the health care coverage options on the market, be sure you are qualified to use the exchange. To purchase insurance through the government-sponsored marketplace, you must meet specific requirements.

  • You must be a citizen of the United States or be here lawfully.
  • You must reside in the United States.
  • You cannot be incarcerated.
  • You cannot use the marketplace to apply for Medicare. It has its own open enrollment period and process.

open enrollment 2019

How Do I Choose an Insurance Plan During Open Enrollment for 2019?

Last year’s insurance selection window was quite a bit shorter than in previous years, and it is likely to remain in its current, shorter range for a while now. So it is vital that you have all of the information you need by the time open enrollment begins.

Here are four things to consider as you prepare to select a medical insurance plan.

  1. Which “metal” level do you need? The marketplace includes plans that fall under four levels: bronze, silver, gold, and platinum. These designations indicate the way the plan costs are shared between you and the insurance company. That is, they dictate what percentage is your responsibility. For example, in bronze level coverage, the insurance company may pay 60% while you pay 40%. These proportions shift as you move up the levels.
  2. Which type of plan do you prefer? Coverage is offered in many forms. From Health Maintenance Organizations (HMOs) to Preferred Provider Organizations (PPOs), there are several options in how services are provided. This decision will dictate issues such as referrals and whether or not your providers must be in a specific network.
  3. How much can you afford to pay out of pocket? Deductibles, coinsurance, and copayments will all come from you, so it is essential to compare the out-of-pocket costs across the different plans you are considering. In general, coverage with lower monthly premiums will demand higher out-of-pocket expenses, and vice versa.
  4. Do you want to keep specific providers? When comparing plans, be sure to check if your doctors are considered in-network. Some people aren’t concerned about remaining under a specific doctor’s care, but for others, this is a significant consideration. If it is important to you that you can continue seeing a particular provider, make sure he or she is covered in the plan you choose.

Do I Need to Choose a Different Plan During Open Enrollment for 2019?

  • For most, it is not necessary to come and choose a plan each year. For Lane County residents insured by Providence Health Plan, there are very few changes coming for next year (other than higher rates and slightly higher maximum out of pocket limits). If you are satisfied with your plan, you can just ‘let it roll’.
  • If you are receiving a tax credit from healthcare.gov to help pay for your coverage, your credit will likely increase enough to pay the new, higher premiums in 2019 as long as there have been no changes in household composition or income. This is what has happened the last few years.
  • If you are unhappy with your plan or coverage, please reach out to us.

The ACA-qualified plans are the best plans. If you are paying the full cost for your plan because you do not qualify for a tax credit, we do have less expensive, alternative options. These plans are not ACA-qualified, but the ACA tax penalty does not exist in 2019. Typically, these plans will not cover mental health, prescriptions, and/or will have limits on pre-existing conditions. Just let us know if you’re interested. In summary; they are not as good, but they save money for people who do not qualify for a tax credit.

Tomlin Health Insurance Can Help You Navigate Open Enrollment

With all of the talk of levels and networks and different coverage, it is important to remember that none of these designations impact the quality of care you receive. That is, choosing a bronze level plan rather than a platinum level plan does not mean that you will receive inferior care from your doctors. Selecting a PPO over an HMO doesn’t indicate better care. All of these variations impact the cost of the plan, not the quality of your medical care.

Nonetheless, this process can feel overwhelming and confusing. At Tomlin Health Insurance, our expert staff will help you through the whirlwind of open enrollment for 2019. We diligently work with you to determine your needs and desires so we can guide you in selecting the right coverage for you and your family.

Health care is critical at every stage of life, and we will help you to rest easy in the knowledge that you have the coverage you need.