What You Need to Know for Open Enrollment

August 9, 2018

Now is the time to start re-evaluating your health insurance needs for the new year.

It can seem like a major headache to deal with wading into the health insurance coverage waters again, but it’s well worth your while.

Consider any changes you or your family have experienced in terms of income or health status and it’s easy to see why you need to take a fresh look at what you have and what you need.

Here are 10 things you need to know about the Open Enrollment Period.

1. If your needs have changed, Open Enrollment is for you.

Here’s why you should sign up for coverage during Open Enrollment:

  • Your current plan is being eliminated.
  • You don’t have coverage through an employer.
  • You don’t have any form of government coverage.
  • You’re turning 27 and can no longer be covered under your parents’ health insurance.
  • You are eligible for tax credits to help you cover the costs of health care.

2. Now is the time to make changes to your current plan.

There are a few things you can do during the Open Enrollment Period.

  • Review your options.
  • Renew your current plan.
  • Choose a new plan.

Your plan will automatically renew without any action on your part, but be aware that the plan could make changes to providers, copays or drug coverage, so you need to do your homework.

3. If you miss the window for Open Enrollment, you have to wait.

If you miss open enrollment, you will have to wait a year to sign up or make changes to your health care unless you qualify for a special enrollment period with situations such as divorce, marriage, birth, death of a spouse or losing a job through which you were receiving health insurance.

4. There are four levels of health insurance plans.

They are bronze, silver, gold and platinum. Bronze has the lowest premiums and higher out-of-pocket expense, while platinum has the highest premiums, lower deductibles and coinsurance.

The personal health histories of each of your family members may help you determine which level is best for you.

5. All health plans have to cover these 10 benefits.

These 10 essential benefits must be covered no matter the level of coverage:

  • 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
  • Preventative and wellness services
  • Dental and vision care for children

6. Eligibility for tax credits is determined by income and family size.

You may qualify for a tax credit if your income and family size fall within 138 and 400 percent of the Federal Poverty Level. Find out with this chart.

7. Are you exempt from having to buy health insurance?

These are the reasons you could be excluded:

  • You were uninsured for less than three months of the year.
  • You’re the victim of domestic violence or you suffered from a natural or human-caused disaster, such as a fire or flood that caused significant damage to your property.
  • You experienced the recent death of a close family member or you had unexpected expenses related to caring for an elderly, ill or disabled family member.
  • You filed for bankruptcy or were evicted from your home.
  • You’re an illegal alien.
  • You’re currently in prison or in custody.
  • You’re a member of a recognized religious sect that objects to carrying insurance.
  • If you lived out of the country for more than 330 days of the current year.

Let the pros help

When it comes to navigating the often-murky waters of the ACA Open Enrollment Period and health insurance in general, you probably need some help.

At UROne Benefits™, we’re prepared to help you review your current coverage and find a plan that best suits your needs – physical and budgetary – for the future. Call us today at 800-722-7331.