7 Easy Steps to Prepare for Open Enrollment

Print Friendly, PDF & Email

Since President Obama signed the Act into law in March 2010, the Patient Protection and Affordable Care Act (also known as the ACA or Obamacare) has made major inroads on its goals of providing accessibility, affordability and quality care for all Americans. Across the board, there have been increases in the number of people that have insurance, slowed growth in insurance costs and systematic changes to the overall approach to patient care: physicians and healthcare systems are now incented to keep people well, rather than only treat them when they are sick.

Accessibility

As of early 2016, more than 9 in 10 Americans have health insurance — a decrease in the uninsured of 43% since the ACA was enacted.

ahc_openenrollment_numbers

Affordability

For Americans purchasing health insurance through the Federal Marketplace in 2015, nearly 80% can purchase their coverage for $100/month or less after tax credits.

openenrollment_cost

Improved Quality

ahc_openenrollment_76_million

Amazing Healthcare Consultants makes it easy to take control of your personal healthcare.

Download our FREE Amazing Guide to Open Enrollment Planning Workbook to help you find a balance between affordability and quality healthcare in your insurance coverage.

Prioritize your needs, compare plans and avoiding common mistakes.

Click here to download your planning tool today!

Looking to store your healthcare information online? Amazing Healthcare Consultants has an exclusive offer for our readers. Store your information online and access it on the go with CareSync. Use promo code AMAZING16 for 10% off of any CareSync plan. Offer expires 12/31/16

ahc_open_enrollment_workbook

The challenge of Obamacare — as it would have been under any President, Democrat or Republican — is that healthcare is so deeply personal. What looks great in terms of significant statistical improvements brings little comfort in the face of individual pain or family financial struggles.

Historically, the insurance industry is, at best, opaque. In virtually every other service industry you would expect to receive an accurate price quote up front, with a detailed breakdown of costs.

  • Ask yourself… would you take your car in for major repairs, knowing you’re financially responsible for them, and not request a detailed quote up front?
  • When you get your hair cut and colored, do you expect to receive bills weeks or months later for the scissors, the shampoo, and the hair dye (because other vendors supplied them)?

The thought is ludicrous. And yet, this is the reality of the healthcare system for the past several decades.

For better or worse, those lucky enough to have insurance were largely shielded from the full cost of receiving healthcare. No more. The system is in the throes of a long, drawn-out process of improving pricing and service transparency. We’ll get there, but it will not be easy. Or pretty.

Amazing Healthcare Consultants believes the system is not perfect, but the best way to feel comfortable with the ACA choices you need to make is to educate yourself on your options. Whether you’re purchasing insurance for the first time from the Federal Marketplace or a state exchange, or renewing your coverage and looking at other options, this Amazing Guide will help you be prepared to make smarter, more informed choices.

OPEN ENROLLMENT DATES FOR 2017

There are several places to buy insurance from, with varying enrollment dates. However, if you buy insurance through the Federal Marketplace or a state healthcare exchange, you have a limited time to buy insurance. Use this chart below to determine when your coverage will begin.

November 1, 2016 – January 31, 2017

If you sign up during this timeframe…Your coverage will begin:
November 1 - December 15, 2016January 1, 2017
December 16, 2016 - January 15, 2017February 1, 2017
January 16 - January 31, 2017March 1, 2017

*Open enrollment dates may vary based on provider

Amazing Tip Amazing Tip! If you already have insurance, make sure you sign up during the correct period to avoid any gaps in coverage.

Chapter 1:

What is the Affordable Care Act?

Is Obamacare the same thing as the Affordable Care Act? Do we have national healthcare? Do I have to buy insurance?  Will it cost me more money?

If it seems like there are a lot of questions and confusion about the Affordable Care Act, it’s because the Act isn’t one thing, it’s many.

To begin, the Affordable Care Act (ACA) has three goals:

  1. Increase access to healthcare services for all Americans
  2. Make healthcare affordable for all Americans
  3. Improve the quality of care all Americans receive.

A major package of reforms was created to accomplish these goals, which was passed into law by the U.S. Congress. The reforms are known as the Patient Protection and Affordable Care Act, or Obamacare, after President Barack Obama who championed the bill and signed it into law in 2010.

What Does ObamaCare Do?

According to the independent website ObamacareFacts.com, “The Affordable Care Act does lots of important things including:

  • Offering Americans a number of new benefits, rights, and protections in regards to their healthcare
  • Setting up a Health Insurance Marketplace (HealthCare.Gov) where Americans can purchase federally regulated and subsidized Health Insurance during open enrollment.
  • Expanding Medicaid to all adults in many states.
  • Improving Medicare for seniors and those with long-term disabilities.
  • Expanding employer coverage to millions of employees.
  • Requiring most people to have coverage each month from 2014 in order to get an exemption, or pay a fee.
  • and introducing new taxes and tax breaks, among other provisions.”

It’s important to note that the Federal Government isn’t the supplier of health insurance. And it isn’t a national healthcare system like they have in Canada and Great Britain. Instead, the ACA makes private insurance available to all Americans and regulates the health insurance industry.

Who Offers Health Insurance and How Do You Buy It?

Here’s a handy chart to understand the different ways you can purchase health insurance.

Who offers health insurance?How do you get it?Amazing Insider Info
Federal Exchange Also known as the Federal Marketplace, or MarketplaceHealthcare.govThe federal government does not provide health insurance on healthcare.gov. Instead, you purchase private insurance through the Marketplace website, which groups plans from different providers into various categories (Bronze, Silver, Gold and Platinum) to make it easier to compare costs and coverage.
State Exchanges Also known as State MarketplacesStates can have their own insurance exchanges, or participate in the Federal Marketplace12 States plus the District of Columbia have their state insurance exchanges: California, Colorado, Connecticut, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, New York, Rhode Island, Vermont, Washington
Private InsurancePurchase directly from any of the hundreds of private insurance companies, such as UnitedHealth, Humana, Kaiser Permanente, Anthem, Aetna, and Blue Cross/Blue Shield (to name a few)Before you shop directly for insurance with a private company, check the Marketplace to see if you qualify for healthcare tax credits.
Employer-sponsored InsurancePrivate insurance offered through your employer. The employer frequently pays some portion of the monthly premium.This type of insurance may be for an individual or family. Check to see what your employer covers. Employer-sponsored insurance may have distinct enrollment periods, and enrollment may be dependent on satisfying certain employment conditions.
MedicaidMedicaid is a combined federal and state-funded healthcare program for qualifying individuals and families who lack resources to obtain insurance coverage elsewhere.You must qualify for Medicaid to receive benefits. To apply, or see if you qualify, click here.
MedicareMedicare is a federally-funded insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD).Our Guide to Medicare will be published soon
CHIPCHIP is the Children’s Health Insurance Program, which provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid.If your children need health coverage, they may be eligible for the Children’s Health Insurance Program (CHIP). If they qualify, you won’t have to buy an insurance plan to cover them. You can enroll in CHIP at any time.

How Much Does Health Insurance Cost?

The most straightforward answer is, it depends.

But here are two key things you should know.

  1. Private insurance companies set the cost of health insurance, not the government. To make comparison shopping easier, the ACA requires all private insurance plans in the Marketplace to fall into one of four “metal” categories, Bronze, Silver, Gold and Platinum. These categories cover from 60-90% of your healthcare costs, respectively.
    aca_health_plans
  2. You can earn a tax credit (subsidy) to offset the cost of insurance premiums. Generally speaking, the amount of tax credit received depends on your income.  To receive the tax credit, you must purchase health insurance through the Marketplace. Like a discount, the tax credit is applied as you move through the purchase process.
    The Kaiser Family Foundation noted in their article, Explaining Healthcare Reform: Questions About Health Insurance Subsidies that “the ACA offers subsidies to reduce monthly premiums and out-of-pocket costs in an effort to expand access to affordable health insurance for moderate and low-income people – particularly those without access to affordable coverage through their employer, Medicaid, or Medicare.”

Who Needs Health Insurance Under the Affordable Care Act?

The ACA requires an individual mandate, which means everyone must have some form of qualified health insurance. If you choose not to purchase insurance, you will be fined $695 per adult or 2.5 percent of taxable income when you file your federal income taxes, whichever is higher. Your children will also be fined but at a lower rate.

If you…Do you need to buy insurance under the Affordable Care Act?
Have health insurance from your employerNo, You are considered covered under your employer’s insurance plan.
Are under 26 years oldNo, If you are covered under your parent’s health insurance plan.
Are 65 or olderNo, You must sign up for Medicare instead.
Have middle-to-low incomeIt depends, You may be eligible for Medicaid, CHIP instead.

Amazing TipAmazing Tip! If you’re not sure, check!

Are There Exceptions to the Individual Mandate?

Yes. An exemption (that is, you are not required to adhere to the individual mandate and purchase health insurance) may be granted for temporary hardships, low-income status, or if you meet one of the criteria listed below:

  • You belong to a federally recognized Native American tribe
  • You are eligible for Indian Health Services
  • You belong to a recognized religious sect that is against insurance, Medicare and Social Security
  • You participate in an approved healthcare sharing ministry
  • You’re currently in jail or prison
  • You’re living abroad as a U.S. citizen
  • You’re classified as “a certain type of non-citizen” or “not lawfully present.”

If you are a lawfully present immigrant, you are eligible to purchase insurance from the Federal or state Marketplaces. If you are illegally in the U.S., you are not eligible for coverage.

How is Healthcare Better with the Affordable Care Act?

Before the ACA, insurance coverage provided by private insurance companies to individuals (or as part of a group employment plan) had unfair limitations and restrictions. The ACA eliminated these restrictions, which ensures expanded coverage for virtually all Americans.

Before ACAAfter ACA
You can be dropped from your insurance for a pre-existing conditionYesNo
You can be dropped from your insurance if you get sickYesNo
You will pay more if you’re older*YesNo
You will pay more if you’re a womanYesNo
You can be denied coverage if you’re pregnantYesNo
You can have lifetime limits on your health insurance coverageYesNo

How Many People Are Covered by the Affordable Care Act?

Across the board, the ACA has improved health insurance coverage for Americans. The Department of Health and Human Services has provided extensive statistical reporting on overall insurance coverage, as well as for particular population groups: “Since the passage of the Affordable Care Act, we have seen the largest reduction in the uninsured in four decades—with about 16.4 million uninsured people gaining health coverage. Those gains come primarily from the Marketplace, young adults who can stay on their parents’ plans until they turn 26, and Medicaid expansions.”

Young Adults
  • 6.1 million uninsured young adults ages 19 to 25 have gained health insurance coverage because of the Affordable Care Act.
  • Up to 30 million 18-34 year-olds with a pre-existing condition, can no longer be charged higher premiums or denied coverage altogether under the Affordable Care Act.
Young Adults
  • An estimated 8.7 million American women with individual insurance coverage gained coverage for maternity services because of the healthcare law.
  • An estimated 55.6 million women with private health insurance have access to recommended preventive services like mammograms or flu shots with no copay or deductible.
Latinos
  • 4.2 million Latinos (ages 18-64) gained health insurance coverage, lowering the uninsured rate among Latinos by 7.7 percentage points.
  • 8.8 million Latinos with private health insurance now have access to preventive services like mammograms, cervical cancer screenings, or flu shots with no copay or deductible.
African Americans
  • 2.3 million African Americans (ages 18-64) gained health insurance coverage, lowering the uninsured rate among African Americans by 6.8 percentage points.
  • 7.8 million African Americans with private insurance now have access to preventive services like mammograms or flu shots with no copay or deductible

In a recent article authored by President Obama in the Journal of American Medical Association, he stated that “Since the Affordable Care Act became law, the uninsured rate for people under 65 has declined by 43%, from 16.0% in 2010 to 9.1% in 2015.”

ahc_openenrollment_separates_5

12.7 million Americans Have insurance through the Marketplace

20 million Americans Have insurance through the Marketplace, Medicaid expansion, young adults staying in their parents plan and other coverage provisions.

Chapter 2:

What’s Covered by the Affordable Care Act?

The Affordable Care Act benefits all Americans by creating new consumer protections, improving healthcare quality, lowering costs and ensuring access to care. All Americans receive:

  • Ten Essential Healthcare Benefits, regardless of their insurance plan
  • Coverage for pre-existing conditions
  • Preventive care services for all adults, women and children

It doesn’t mean, however, that you won’t pay any money out-of-pocket.

10-essential-aca-benefits

10 Essential Healthcare Benefits

Now, no matter which healthcare insurance plan you choose, you will know that it covers these ten essential benefits.

  1. Ambulatory (or outpatient) services. These are services that you receive in a doctor’s office, clinic or even emergency rooms where you are treated but not admitted.
  2. Emergency services. Care in the emergency room for critical conditions that can’t wait until a regular doctor’s office or urgent care clinic is open.
  3. Hospitalization. Hospitalization services include surgeries and overnight stays for care and observation.
  4. Care for you and your child before, during and after birth. Learn more about pregnancy, maternity, and newborn care coverage
  5. Treatment for mental health and substance abuse, including counseling and psychotherapy. Learn more about mental health and substance use disorder services.
  6. Prescription drugs, specifically medications prescribed by your doctor to treat certain conditions. This benefit does not include over-the-counter drugs like aspirin or cough medicine.
  7. Rehab services.  Learn more about services to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills.
  8. Laboratory services, for things like blood tests
  9. Preventive care, wellness services and chronic disease management
    Amazing Tip Amazing Tip! The service coverage varies for adults, women and children.
  10. Pediatric services, including dental and vision care.
    Amazing TipAmazing Tip! Dental and vision care are essential benefits for children only, not adults.

Amazing Tip Amazing Tip! It’s important to note that these benefits do not mean they are free to all Americans, nor are they without limits. You have to know and understand the details of each insurance plan to understand the scope of these benefits.

Coverage for Pre-Existing Conditions

Insurance plans must include treatment for pre-existing conditions. This requirement means any medical condition you have, regardless of whether or not you’ve been diagnosed, must be covered under your healthcare plan. You can’t be rejected, and you can’t be charged more because of your condition. As well, your insurance coverage can’t raise your rates because of your condition either.

Preventive Services for all Adults, Women, and Children

There are three sets of free preventive services. All plans offered through the ACA must include these services without charging a copay or coinsurance.

Amazing Tip Amazing Tips!

Select the links in the table headings below to see a list of covered services for each group on healthcare.gov:

Summary of Preventive Services for Adults, Women and Children
Covered by the Affordable Care Act

All adultsWomenChildren
Some benefits vary by age or other factorsAdditional benefits must be provided to pregnant women or women who may become pregnantThese benefits vary by age
  • Abdominal aortic aneurysm
  • Alcohol misuse screening and counseling
  • Aspirin use
  • Blood pressure screening
  • Cholesterol screening
  • Colorectal cancer screening
  • Depression screening
  • Diabetes (Type 2) screening
  • Diet counseling
  • Hepatitis B and C screening
  • HIV screening
  • Immunization vaccines
  • Lung cancer screening
  • Obesity screening and counseling
  • Sexually transmitted infection (STI) prevention counseling
  • Syphilis screening
  • Tobacco Use screening and cessation interventions
  • Anemia screening
  • Breastfeeding support and counseling
  • Contraception
  • Folic acid supplements
  • Gestational diabetes screening
  • Gonorrhea screening
  • Hepatitis B screening
  • Rh Incompatibility screening
  • Syphilis screening
  • Expanded tobacco intervention and counseling for pregnant tobacco users
  • Urinary tract or other infection screening
  • Alcohol and drug use assessments
  • Autism screening
  • Behavioral assessments
  • Blood pressure screening
  • Cervical dysplasia screening
  • Depression screening
  • Developmental screening
  • Dyslipidemia screening
  • Fluoride Chemoprevention supplements
  • Gonorrhea preventive medication
  • Hearing screening
  • Height, weight and body mass index (BMI) measurements
  • Hematocrit or hemoglobin screening
  • Hemoglobinopathies or sickle cell screening
  • Hepatitis B screening
  • HIV screening
  • Hypothyroidism screening
  • Immunization vaccines
  • Iron supplements
  • Lead screening
  • Obesity screening and counseling
  • Oral health risk assessment
  • Phenylketonuria (PKU) screening
  • Sexually transmitted infection (STI) prevention counseling and screening
  • Tuberculin testing
  • Vision screening

Does This Mean All My Healthcare Is Free?

In fact, no. Healthcare is in the top five expenses across all income levels and, according to the Hamilton Project, has grown by 28-60 percent for low-to-middle income households in the past thirty years.

You pay for healthcare through a mix of premiums, deductibles, copayments and out-of-pocket expenses.

TermDefinition
PremiumUsually a monthly payment, a premium is the amount of money you must pay to keep your health insurance. You must pay your premium, even if you don’t go to the doctor’s office or take any prescriptions.
DeductibleThe amount of money you must pay – through copayments and out-of-pocket expenses – before your insurance starts to pay for services.
Copayment(s)Also known as copays. The amount of money you pay every time you go to the doctor’s office, urgent care clinic, emergency room or hospital. The amount of the copay will vary based on where you receive services.
ConsuranceA type of insurance in which you (the insured) are responsible for paying a share of the cost made against an insurance claim.
Out-of-pocket expensesThe money you must pay (for deductibles, co-pays and coinsurance) for covered services and all costs for any services that aren’t covered. Different healthcare plans offer different levels of out-of-pocket expenses.
Out-of-pocket maximumThis is the most money you have to pay in any given plan year. If you reach this amount, any additional healthcare expenses are covered 100% by your insurance company.

Each of the “metal” plans requires a different mix of premiums, deductibles, copays and out-of-pocket expenses.

Chapter 3:

Are You Eligible for Obamacare?

According to healthcare.gov, to be eligible to enroll in health coverage through the Marketplace, you must meet the following conditions:

Are you eligible to purchase insurance through the Marketplace?
You are a U.S. citizen or nationalahc_openenrollment_separates_3
You are a lawfully present U.S. residentahc_openenrollment_separates_3
You have insurance through your employer*ahc_openenrollment_separates_4
You are over 65 and have Medicare Parts A and B, or Cahc_openenrollment_separates_4
You are in jailahc_openenrollment_separates_4

(*) Read this article if you have job-based insurance and are considering a Marketplace plan

A Word About Penalties

If you choose not to buy insurance and don’t have another form of coverage (like through your employer, Medicare or Medicaid), then you will owe a penalty, which is taken from your tax refund.

You will owe a penalty for yourself, and everyone in your household not covered by insurance. The penalty is calculated two ways, and you have to pay whichever is higher.

By a Percent of IncomeBy a Flat Fee
  • 2.5% of household income
  • Maximum: Total yearly premium for the national average price of a Bronze plan sold through the Marketplace
  • $695/adult
  • $347.50/child under 18
  • Maximum: $2,085

Beginning in 2017, the flat fee will adjust for inflation.

What If My Eligibility Changes in the Middle of a Plan Year?

If you get married, divorced, have a baby (including adoption), or lose existing health insurance coverage on your own or through a family member, you are eligible for a Special Enrollment Period.

It’s easy to figure out if you qualify. Go to https://www.healthcare.gov/screener/ to be guided through a series of questions.

Learn more about other circumstances that might qualify you for a Special Enrollment Period on healthcare.gov. https://www.healthcare.gov/screener/marketplace.html

Amazing Tip AMAZING TIP! If you haven’t been to the healthcare.gov website, or only heard horror stories about it from the beginning, take a fresh look. It’s friendly and easy to navigate.

You can also apply for CHIP (Children’s Health Insurance Program) and Medicaid at any time.

Chapter 4:

7 Easy Steps to Prepare for Open Enrollment

Step 1: Document Your Medical Needs

Before you start looking at options, it’s a good idea to document your medical needs for the past year or two, to get an understanding of what kind of health coverage you’ll need.

List all Known Medical ConditionsList All Medications# Doctor’s Visits in the Past 12 Months# Emergency Room Visits in the Past 12 Months
Me
My Spouse
Child #1
Child #2

Step 2: Look at Your Current Healthcare Costs

It’s also a good idea to look at your total healthcare costs.

If you’re super-organized, or use a personal finance tool like Quicken or Mint, you may easily be able to total your costs over the past year. If not, then use the chart below to create a baseline for you and your family.

Remember to look at all your Explanation of Benefits documents (EOBs). These documents from your current insurance plan list which service(s) you or a family member received, how much each service cost, and how much you and the insurance company would pay. Add them up and fill out the chart below.

ExampleCurrent Plan
Monthly premium x 12$300/month x 12 months
Annual Deductible$1,000
Copay - primary care$20 x 5 visits
Copay - specialist$40 x 2 visits
Copay Urgent/ER care$120 x 0 visits
Prescription drug copay*($2/month x 12 months) + ($40/month x 12 months)
Co-insurance$XXXX
Other**$325
Total costs$XXXX

*Prescription drug copays will vary depending on the prescribed medication, whether it’s generic or brand-name, et cetera. Pricing has been simplified for this example.

**Other medical costs might include covered medical supplies or equipment

Amazing Tip Amazing Tip!  It’s important to remember that some medical expenses are not covered, or covered for a limited amount. For example, elective surgery may not be covered and chiropractic care and physical therapy may be covered but only for a limited number of visits.

Amazing Tip Amazing Tip! Take the time to do your research! Once you purchase a plan, you cannot change it unless you qualify for a Special Enrollment Period.

Step 3: Determine Which Metal Plan Is Right for You

Good news: All healthcare plans must provide the ten essential healthcare benefits. To make comparison shopping easier, all Marketplace plans are grouped into one of four “metal” categories: bronze, silver, gold and platinum.

Bad news: You have to read the fine print of each policy to understand the differences between two plans at the same “metal” level.

aca_health_plans

Amazing Tip Amazing Tip! Typically, Bronze plans have the lowest monthly premiums but require the highest out-of-pocket expenses. Platinum plans, on the other hand, have high monthly premiums but lower out-of-pocket expenses. Use the worksheet in Step 2 to compare the total cost of insurance (premiums, copays and co-insurance) when you evaluate different plans

The Metal Plan that’s Best for Me and My Family Is: ___________________________. (Choose 1: Bronze, Silver, Gold, Platinum)

Amazing Healthcare Consultants makes it easy to take control of your personal healthcare.

Download our FREE Amazing Guide to Open Enrollment Planning Workbook to help you find a balance between affordability and quality healthcare in your insurance coverage.

Prioritize your needs, compare plans and avoiding common mistakes.

Click here to download your planning tool today!

Looking to store your healthcare information online? Amazing Healthcare Consultants has an exclusive offer for our readers. Store your information online and access it on the go with CareSync. Use promo code AMAZING16 for 10% off of any CareSync plan. Offer expires 12/31/16

ahc_open_enrollment_workbook

Step 4: Determine Which Insurance Type is Right for You

In addition to determining what percentage of healthcare costs you’re willing to pay, you’ll need to determine the best type of insurance for you and your family.

Each plan has pros and cons: consider your options based on your individual and family needs.

CodeName of PlanCan you see doctors out-of-network?Can you see a specialist without a referral?Best for consumers who want…
HMO

Health Maintenance Organization

A health plan that offers lower costs for using “in-network” doctors. Typically, a patient’s assigned primary care physician coordinates all care.

No, unless in case of emergencyNoLower cost in exchange for more limited choice
PPO

Preferred Provider Organization

A health plan where you pay less if you see any doctor “in- network” (contracted by the insurance company) and don’t need a referral from your primary care physician to do so.

YesYesA lot of flexibility in choosing physicians
EPOExclusive Provider Organization A health plan where you can only use the network’s physicians and hospitals but don’t need a referral to do so. Amazing Tip Amazing Tips! No, unless in case of emergencyYesTypically lowest cost for most limited choice
POSPoint of Service A health plan where you pay less if you see a doctor in the provider’s or underwriter’s network.Yes, in a limited mannerNoFlexible options, so long as you see a specialist that your primary care doctor refers

The Type of Insurance Plan that’s Best for Me and My Family Is: __________________. (Choose 1: PPO, HMO, EPO, POS)

Step 5: Determine Whether You’ll Be Eligible for Tax Credits and Cost-Sharing Reductions

Tax credits, or subsidies, are available for qualifying Americans. With a tax credit, you’ll have a lower monthly premium for your health insurance. Your income determines your eligibility, so you’ll need to check in the Federal or state Marketplace to know for sure. Check online to see if you’re eligible for premium tax credits.

How can you save money with a tax credit? It can be a bit complicated.

Cost-sharing reductions are additional savings for deductibles and copays. Learn more about cost-sharing reductions here.

Step 6: Research Specific Insurance Plans

Once you’re confident you understand the types of plans that are available, it’s time to start thinking about your personal situation: are you buying insurance for yourself or your family? Are you relatively healthy? Do you have current medical conditions that require ongoing treatment? What prescription drugs, if any, do you (or people in your family) take?

Use your worksheet from Step 1, and your answers from Steps 2, 3 and 4 and let’s go online.

You might also want to review the information listed in this handy Marketplace checklist.
The healthcare.gov Marketplace (or equivalent state exchanges) will guide you step-by-step through the process. Here’s what you would have seen in 2016:

2016-health-insurance-plans-prices

Amazing Tip Amazing Tip! New for the 2017 enrollment year, you’ll be able to add your preferred doctors, medical facilities and prescription drugs so you’ll know right away if your preferences are covered by the plans you’re evaluating. Check out 2017 enrollment dates here!
Start researching plans as soon as they are available in the Marketplace.

Step 7: Sign Up, Re-Enroll or Change Insurance

Open Enrollment 101

Open enrollment is an opportunity to enroll, update or change insurance plans. Although you may have heard horror stories about long waits or unresponsive websites, the Marketplace continues to improve every year.

Amazing Tip Amazing Tip! Don’t wait until the last minute to sign up. You’ll enjoy shorter wait times and less harried customer service agents.

Open Enrollment Dates

November 1, 2016 – January 31, 2017

If you sign up during this timeframe…Your coverage will begin:
November 1 - December 15, 2016January 1, 2017
December 16, 2016 - January 15, 2017February 1, 2017
January 16 - January 31, 2017March 1, 2017

Sign Up for Insurance

You can sign up online, in person, using a paper form or over the phone.

Ways To Enroll In Marketplace

Re-enroll in Your Current Insurance Plan

If you don’t proactively change plans, you will be automatically enrolled in the same plan as the current year. Unless you qualify for a Special Enrollment Period, you will not be able to make changes after open enrollment ends.

Amazing Tip Amazing Tip! Even if you’re satisfied with your current healthcare plan, look carefully at the details. Specifics about premiums, deductibles, copays and who’s in (or out) of network frequently change from year to year.

Trying to cancel or disenroll in a policy you inadvertently re-enrolled in can be laborious and time-consuming. Be sure to know your coverage dates, and make changes before automatic re-enrollment happens.

Change to a Different Health Insurance Plans

During Open Enrollment, you are free to change to another health insurance plan.

Check the dates carefully. Be sure that you have full coverage, and that your plans do not overlap or create gaps in your insurance status.

Congratulations!

You’re now one of the 90% of Americans with health insurance. But don’t stop there. Be sure to eat healthy, exercise regularly and take care of yourself.

[callout1]Still struggling to find the best insurance plan for you and your family? Amazing Healthcare Consultants can help you evaluate plans to maximize your benefits and shield you from hidden costs. Connect with us at info@amazinghcc.com or 888-568-0011.[/callout1]

Chapter 5:

AMAZING HEALTH INSURANCE GLOSSARY

Do you know your health insurance vocabulary? Check out our glossary before you go shopping for health plans online.

Types of Insurance Payments

TermDefinition
PremiumUsually a monthly payment, a premium is the amount of money you must pay to keep your health insurance. You must pay your premium, even if you don’t go to the doctor’s office or take any prescriptions.
DeductibleThe amount of money you must pay – through copayments and out-of-pocket expenses – before your insurance starts to pay for services.
Copayment(s)Also known as copays. The amount of money you pay every time you go to the doctor’s office, urgent care clinic, emergency room or hospital. The amount of the copay will vary based on where you receive services.
ConsuranceA type of insurance in which you (the insured) are responsible for paying a share of the cost made against an insurance claim.
Out-of-pocket expensesThe money you must pay (for deductibles, co-pays and coinsurance) for covered services and all costs for any services that aren’t covered. Different healthcare plans offer different levels of out-of-pocket expenses.
Out-of-pocket maximumThis is the most money you have to pay in any given plan year. If you reach this amount, any additional healthcare expenses are covered 100% by your insurance company.

Types of Insurance Plans

CodeName of PlanCan you see doctors out-of-network?Can you see a specialist without a referral?Best for consumers who want…
HMO

Health Maintenance Organization

A health plan that offers lower costs for using “in-network” doctors. Typically, a patient’s assigned primary care physician coordinates all care.

No, unless in case of emergencyNoLower cost in exchange for more limited choice
PPO

Preferred Provider Organization

A health plan where you pay less if you see any doctor “in- network” (contracted by the insurance company) and don’t need a referral from your primary care physician to do so.

YesYesA lot of flexibility in choosing physicians
EPOExclusive Provider Organization A health plan where you can only use the network’s physicians and hospitals but don’t need a referral to do so. Amazing Tip Amazing Tips! No, unless in case of emergencyYesTypically lowest cost for most limited choice
POSPoint of Service A health plan where you pay less if you see a doctor in the provider’s or underwriter’s network.Yes, in a limited mannerNoFlexible options, so long as you see a specialist that your primary care doctor refers

About Amazing Healthcare Consultants

Founded in 2011 by Dr. Carol DeVore and Rachel Decena, Amazing Healthcare Consultants provides clear sightlines into your loved one’s healthcare through personal patient advocacy and insurance advocacy. Making confident and educated healthcare decisions is the ultimate peace of mind, and as an independent agency, Amazing Healthcare Consultants puts the patient first and fights for the best care and coverage possible.

To learn more about Amazing Healthcare Consultants or to schedule a free consultation, request a call from us.