2020 Health Insurance Open Enrollment: The Facts

Hello Freelancer Friend, the enrollment period for health insurance is here, now through mid-December (in most states). Because health insurance is a vital topic, I decided to defer to an expert and pass along info compiled by Les Masterson for Insure.com. For more detailed information, please visit the site. https://www.insure.com/health-insurance/open-enrollment-for-individual-health-insurance.html

We have 6 weeks to make a decision on individual/ family health insurance or the Affordable Care Act (ACA) exchanges plan (in most states). We can sign up for health insurance on our state’s health insurance exchange or individual marketplace only during the annual open enrollment period, unless one has a “qualifying life event.” Those events include getting married or having a baby.

If buying health insurance on your own, there are several options for purchasing a policy:

  • Your state’s health insurance marketplace — see healthcare.gov https://www.healthcare.gov
  • Directly from a health insurance company
  • Sites like Insure.com that offers insurance quotes from multiple carriers
  • A health insurance agent
Open enrollment for 2020 individual and family health insurance plans
Begins Ends
November 1, 2019 December 15, 2019

The open enrollment period differs in these states: 

  • CA – Oct. 15, 2019 to Jan. 15, 2020
  • CO – Nov. 1, 2019 to Jan. 15, 2020
  • DC – Nov. 1 , 2019 to Jan. 31, 2020
  • MA – Nov. 1, 2019 to Jan. 23, 2020
  • MN – Nov. 1, 2019 to Dec. 23, 2019
  • NY – Nov. 1, 2019 to Jan. 31, 2020
  • RI – Nov. 1, 2019 to Dec. 23, 2019

If you buy after December 15 in the states that are extending the enrollment period, confirm when the coverage will start. Most states require you to obtain your plan by December 15 for a January 1 start date. If you buy late, your plan might not start until February 1 or March 1.

Those who qualify for Medicaid or the Children’s Health Insurance Program (CHIP) can enroll at any time, because they are state/ federal programs created for people with limited incomes or disabilities.

Marketplace Open Enrollment is for health insurance only

The Open Enrollment period does not apply to life insurance, long-term care insurance, or Medicare. The fall open enrollment period for Medicare is October 15 to December 7, 2019. If you qualify for employer-sponsored health insurance, you will want to buy health insurance through your employer. Individual insurance usually costs more than employer-sponsored plans.

That said, if you qualify for subsidies based on your income, you may find an inexpensive plan on the Affordable Care Act (ACA) Exchange. Many states offer financial help for people with income below 400% of the federal poverty limit. You can find out more about these subsidies at insure.com. 

Remember to enroll!

It is not possible to sign up for coverage if you miss open enrollment, unless one qualifies for one of the special enrollment periods. The following events may grant entrance into a special enrollment period:

  • Divorce
  • Marriage
  • Birth or adoption of a child
  • Death of a spouse or partner that leaves you without coverage
  • Your spouse or partner, who has you covered, loses his/her job and health insurance
  • You lose your job and with it your health insurance
  • Your hours are cut making you ineligible for your employer’s health insurance plan
  • You are in an HMO and move outside its coverage area

Update your plan during Open Enrollment only

What you can do during open enrollment:

  • Renew your current individual or family health insurance plan
  • Choose a new health insurance plan through the marketplace in your state or through private insurance

If currently enrolled in a marketplace health insurance plan, it will automatically renew. However, the plan may make changes to its provider network, co-pays, co-insurance and drug coverage. Your plan must send you a notice of any changes it will make for 2020.

Read the health insurance update notice to learn what it means for youConfirm that your doctors and preferred hospital are still in your network. Be aware that you may be able to use out-of-network doctors and hospitals if you’re willing to pay more. That’s an option in Preferred Provider Organization (PPO) plans. In some cases, such as Health Maintenance Organization (HMO) plans, you’re covered if you go out of network. That means you’ll have to pick up the costs. 

Prescription drug coverage also could change. The plan may no longer cover the drugs you take to manage your chronic conditions. Confirm your plan’s drug benefits for 2020 before you allow it to renew. You may need to find a different plan for your needs and now’s the time to do it. Health plans must provide an online link to the list of drugs they will cover, known as formularies.

ACA Premiums set to decrease for some plans

The premium you pay depends on several factors, including income, your state and the plan type. The Centers for Medicare and Medicaid Services said the average ACA federal exchange plans premium costs dropped for the first time this year. However, because not all plans will be cheaper, it’s still important to shop around to find the right plan for you. 

Choose a level of health plan coverage

Plans in the health insurance marketplace are divided into 4 categories:

  • Bronze – highest out-of-pocket expenses for services (lower premiums)
  • Silver
  • Gold
  • Platinum – least out-of-pocket expenses for services (higher premiums)

Each level indicates how much cost-sharing each requires. Cost-sharing includes deductibles, co-pays and co-insurance that we must pay until the annual out-of-pocket maximum limit is reached.

Bronze plans have the highest deductibles and other cost-sharing expenses. That means more out-of-pocket costs when one uses healthcare services. Silver plans have lower cost-sharing than Bronze and Gold plans even lower than Silver. Platinum plans have the lowest deductibles and co-pays. Once one signs up for a level of coverage, changes are not allowed during that year. If you choose a Bronze plan and discover you need surgery, you cannot change to a plan with a lower deductible.

Generally, the more you pay in premiums the lower your cost-sharing.

In a 2019 report, eHealth estimated that 2-person families paid more than $1,000 in premiums monthly for the first time in the individual market in 2019. Premiums for individual coverage for a single person was $448 in 2019. 

The average premiums for individual coverage according to eHealth:

  • Bronze — $440
  • Silver — $481
  • Gold — $596
  • Platinum — $706

The average premiums for family coverage according to ehealth:

  • Bronze — $1,080
  • Silver — $1,179
  • Gold — $1.426
  • Platinum — $1,460

The health plans, no matter the level, must provide some coverage for at least 10 essential benefits. They are:

  • Outpatient care including chronic disease management
  • Emergency care
  • Hospitalization
  • Pregnancy and newborn care
  • Mental health and substance abuse services
  • Prescription drugs
  • Rehabilitation services and devices
  • Lab tests
  • Preventive and wellness services
  • Dental and vision care for children

The level of coverage for these services can vary. All the plans in the marketplace must provide consumers with a brief, understandable description of what they cover and how their plan works. The Summary of Benefits and Coverage (SBC) must be posted on the plan’s website. Check out the SBCs for the different plans you are considering. This is a good way to compare plans and benefits.

Not all states require health insurance

The ACA once required nearly all Americans to have health insurance. However, Congress decided in 2017 to eliminate the individual mandate penalty. Although the individual mandate is technically still on the books, the tax penalty is not. Still, a growing number of states have implemented their own individual mandate. Here are states that have an individual mandate in 2020:

  • California
  • District of Columbia
  • Massachusetts
  • New Jersey 
  • Rhode Island
  • Vermont

I hope you found this information helpful.

Thanks for reading,

Kim

Image: Thomas Eakins (Philadelphia 1844-1916) The Agnew Clinic, 1899 courtesy of The Philadelphia Museum of Art. The painting was commissioned to honor the anatomist and surgeon David Hayes Agnew, on his retirement from teaching at the University of Pennsylvania.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s