If you want your new health insurance to start on January 1st then you must enroll before December 15th. You can still enroll until January 15th, but your policy won’t start until February. We know you’ve been hearing OEP over and over the last few months, but that’s because we can’t stress enough how important it is. Not only is this the only time you can enroll in a new plan. This is the only time you can review your current plan and make sure you have all of the coverage you need within your budget. You’re in control of your health and there’s plenty of plan and carrier options out there ready to help you stay in control.
Guaranteed Coverages
The Affordable Care Act (ACA) brought a lot of change to the health insurance industry. All of which center around making sure everyone has access to affordable coverage. The ACA introduced the “10 essential benefits”. Which are 10 health care benefits that every marketplace plan must cover regardless of tier, plan type, cost, or provider.
Ambulatory patient services
Emergency services
Hospitalization
Laboratory services
Mental health and substance use services
Pregnancy, maternity, and newborn care
Prescription medications
Preventative and wellness services and chronic disease management
Pediatric services
Rehabilitative and habilitative services
Not only are health plans required to cover these benefits. Insurers are also prohibited from denying or charging more for a plan based on pre-existing conditions. So thanks to the ACA you are guaranteed to get a plan that covers all of your basic needs without having to pay an arm and a leg.
Your Options
You’ve got nothing but options during the OEP, from plans to plan tiers to possible subsidies and then some. Let’s go over the basics and give you a good starting point in your search.
The first thing you have to do is choose a plan type. While every Marketplace plan is legally required to cover the “10 essential benefits”. Plans can offer extra benefits and they can all be structured differently. So, this step is a big one because it sets the foundation for the coverage you have.
HMOs offer you the option of choosing from a local network of participating physicians, hospitals, and other healthcare providers and facilities. As part of these health insurance policies, you must choose a primary care physician (PCP) from this network. Your primary care physician (PCP) will get to know you and help you organize all of your medical care. They are also responsible for referring you to any specialists. Without this recommendation, your HMO would not cover a specialist visit. A HMO plan’s out-of-pocket costs are frequently lower than those of other types of health plans as long as you stay in-network. In general, an HMO may make sense if you prioritize lower expenses and don’t mind using a PCP to oversee your treatment.
PPOs offer a vast network of participating providers, so you can choose from a wide range of hospitals, clinics, and healthcare facilities. Unlike HMOs, PPOs provide some coverage for providers outside of their network, but not as much as they would for an in-network provider. Another significant distinction between PPOs and HMOs is that you aren’t required to choose a PCP and you can see a specialist without a referral. A PPO is often a smart option if you want more control over your options and are willing to pay extra for it. It would be especially useful if you travel frequently because you would not have to see a primary care physician.
Exclusive Provider Organization (EPO)
EPOs also allow you to choose from a network of participating providers. Except in cases of emergency, most EPO plans do not cover care outside of their network. As a result, if you see a provider or facility that is not part of the plan’s local network, you will most likely be paying for the whole cost of services. As for PCPs, EPOs can go either way, some require you to choose a PCP and others don’t, it just depends on the insurance company you choose. In either case, as long as the specialist is in the plan’s network, you will not require a referral from your primary care physician. If you need cheaper monthly rates and are ready to pay a larger deductible when you need medical treatment, an EPO plan may be for you.
Point of Service (POS)
POS plans combine the benefits of PPOs and HMOs. A POS’s provider network, like an HMO, is often smaller than a PPO plan, and in-network care expenses are typically lower, as with a PPO. In POS plans, you must select a primary care provider (PCP) from a network of physicians and other primary care specialists. If you need to see a specialist, you have to get a referral from your PCP.
However, just like with PPO, you have the option of seeing in-network or out-of-network experts. However, if you visit an out-of-network provider, your part of the costs will be higher, and you will be responsible for submitting any claims. POS insurance plans are a terrific option for many people, especially if you’re looking to save money and don’t need out-of-network healthcare services. If you are prepared to coordinate your care through a primary care physician, a POS plan may be perfect for you.
Health Expense Accounts
There are also separate savings plans you can buy to help you save up money specifically for medical costs.
An HRA, or health reimbursement arrangement, is a form of health expense account provided and owned by your employer. Because they own the HRA, your employer is the only one who can contribute to it. They can also determine if you can roll over unused cash to the next year. The money in it is used to pay for eligible expenses including medical, pharmaceutical, dental, and vision care, as defined by the employer.
A health savings account (HSA) is a bank account that you can use to pay for qualifying health care bills or to save for retirement. An HSA is available when combined with a qualified high-deductible health plan (HDHP), which has lower premiums/plan contributions and greater deductibles than a regular health plan. If you have an employer-sponsored health plan, the account is opened through the HSA provider chosen by your company. You, your employer, and others can contribute to your HSA up to a yearly limit determined by the IRS.
Flexible Spending Account (FSA)
An FSA is an employer-sponsored savings account that helps manage out-of-pocket healthcare bills. FSAs are tax-advantaged accounts, which means you can contribute to them before taxes and spend the money tax-free. FSAs allow account holders to save for eligible healthcare expenses by deducting pre-tax money directly from their paychecks. FSA funds can be used to cover deductibles, co-pays, and medical visits for you, your spouse, and any qualified dependents. Employers may contribute to their employees’ FSAs, but they are not obligated to do so.
Health Insurance Subsidies
Marketplace plans have two types of subsidy. The first type, known as the premium tax credit, lowers your monthly insurance costs. The cost sharing reduction (CSR) is a sort of financial aid that reduces your deductibles and other out-of-pocket payments when you visit the doctor or stay in the hospital. To get either sort of financial aid, you must enroll in a health insurance Marketplace plan.
Premium Tax Credit
A premium tax credit, sometimes known as a premium subsidy, is a tax credit that reduces or eliminates the amount of money that you would otherwise have to pay for getting individual or family health insurance. Unlike other tax credits, the premium tax credit can (and typically is) given upfront and all year. Each month, the IRS gives money to your health insurer, so you don’t have to pay as much yourself. Your tax return is then compared with the premium tax credit the following spring. You can also choose to pay full price for a health plan in your state’s exchange and then get the full premium tax credit on your tax return. Few people do this, however, because the cost of coverage without the advance premium tax credit is often out of reach for those who do qualify for the premium tax credit.
You must apply for coverage through the Marketplace and give information about your age, residence, household size, citizenship status, and expected income for the following year in order to receive the premium tax credit. Following the submission of the application, you will receive a decision indicating the amount of premium tax credit you qualify for. You can then choose to have the tax credit paid in advance, claim it later when filing your tax return, or a combination of the two.
Who’s Eligible?
To be eligible for the premium tax credit beginning in 2024, you must meet the following requirements:
Have a household income of at least the Federal Poverty Level (FPL), which is $14,580 in 2024.
Lack of affordable coverage through a workplace (including a family member’s employer)
Not be eligible for Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP).
Have U.S. citizenship or proof of legal residency (Lawfully present immigrants with household incomes less than 100 percent FPL may also be eligible for tax subsidies through the Marketplace if all other eligibility standards are met).
If you’re married you must file your taxes jointly.
Cost Sharing Reduction
Cost sharing reductions are the second type of financial aid available. When you utilize covered health care services, cost sharing reductions reduce your out-of-pocket costs related to deductibles, copayments, and coinsurance. Cost sharing reductions are available to anyone who qualifies for a premium tax credit and has household incomes ranging from 100 to 250 percent of the poverty line. Cost sharing reductions (CSR) are only available through silver plans, as opposed to the premium tax credit, which can be applied to any metal level of coverage. CSRs are applied to a silver plan for qualified individuals, basically making deductibles and other cost sharing more comparable to that of a gold or platinum plan. Individuals earning between 100 and 250 percent of the FPL can use their premium tax credit to any metal level plan, but they can only receive cost sharing subsidies if they choose a silver-level plan.
Health Plan Tiers
When you buy health insurance through the federal or state Marketplace, the plans available are divided into four metal tiers: bronze, silver, gold, and platinum. The metal tiers allude to the portion of your medical treatment that each tier will cover, not the quality of care you will receive with one of these plans. Which plan tier you pick determines the amount of the bill you pay. The higher the coverage, the higher the cost, but the less you will have to pay out of pocket.
Bronze plans will cover 60% of costs; you will pay 40%
Silver plans will cover 70% of costs; you will pay 30%
Gold plans will cover 80% of costs; you will pay 20%
Platinum plans will cover 90% of costs; you will pay 10%
Why You Need Health Insurance
The most important advantage of having health insurance is having access to the care you need. Health insurance provides you with access to a vast network of doctors, specialists, hospitals, and laboratories. This network collaborates with you and with one another to assist you in focusing on prevention and wellness. In fact, the majority of healthcare plans provide free preventative services, such as immunizations and testing. To help you stay healthy and avoid illnesses and their consequences.
Furthermore, the Affordable Care Act requires Marketplace plans to cover pre-existing diseases. This means that even if you have a pre-existing condition, you can receive care without being rejected coverage or charged extra because of it. Because you’ll have regular access to the doctors and experts you need, your healthcare plan will also help you manage your care for any chronic illnesses you’re living with.
Your health insurance covers all of the greatest strategies to maintain your health. Having access to this type of continuous care can essentially lead to a longer and better quality of life. According to the National Library of Medicine, persons between the ages of 17 and 64 who did not have health insurance had a 40% higher mortality risk than those who did!
How EZ Can Help
Working with an agent saves you time and stress because you won’t have to decipher legal language or read fine text. Agents handle all of the legwork. So, you may rest assured that your coverage will best match your financial and medical requirements. Not to mention, EZ agents can save you hundreds of dollars on your health insurance premiums each year. We accomplish this by scouring the market for the most affordable plans, both on and off the market. In addition to locating and utilizing any available savings.
We don’t only assist you in finding a plan, we also assist you in keeping it up to date. When the time comes, we are also here to help you in filing claims with your insurance company and renewing your policy. To begin, enter your zip code in the box below. Alternatively, contact 877-670-3557 to speak with one of our licensed agents.
By now you know that the Open Enrollment is the only time where you can enroll or change your health insurance plan. But what you might not know is why the Open Enrollment Period exists. The short answer is that it prevents adverse selection. Which is when people only buy health insurance when they’re sick or need it. However, there is a lot more that went into the creation of the Open Enrollment.
To fully understand how the open enrollment period began you need to understand how health insurance came to be. This way you can see the series of events that shaped open enrollment’s creation and the reasons it was needed. Health insurance as we know it today has been around since the 1850’s. Back then, people who worked on the railroads and steamboats did their jobs in dirty, often dangerous places where serious injuries and illnesses were common occurrences. Even though these jobs paid well, workers were essentially risking their lives every day to the point that many became unable to work at all. And in turn couldn’t provide for their families. So the concern of the general population was, if the worst happens, how would they pay for their care while maintaining a household which often held a spouse and several children.
That’s where health insurance came to be. In 1850 the Franklin Assurance Company of Massachusetts became the first company to offer workers’ accident insurance. This set the standard for other companies in the years to come. Workers could now protect themselves financially from major injuries by putting money into an accident insurance “pool”. Everyone put money into the pool and when claims arose the money for their care was taken from the pool. This meant that healthy workers were helping to pay for injured worker’s care. While knowing that if they were ever in that situation the other workers would be helping to pay for their care.
History Of Open Enrollment
Let’s hop in the Delorean and time jump to 1949 when President Harry S. Truman finally set up the national health care system. This creation would eventually lead to the idea of open enrollment. During World War II, companies started offering health insurance to their workers as a way to draw in more people in a tight job market. This practice of offering health insurance as an employee perk ran rampant, every company wanted in on the trick. So, people started signing up for health insurance in such large numbers that the program’s financial future was in serious trouble if something didn’t change.
This is because unhealthy people had more reason to sign up then immediately start making claims. Which would crash the system because more money was coming out of the insurance company than going into it. This is what led to insurance companies starting to only let people enroll during specific times of the year. Doing this gave the insurance companies the ability to:
Manage their risks by limiting the number of enrollees at any given time.
Handle their cost basis by understanding how many people would enroll and what their health status would be.
Simplify the entire health insurance process by only reviewing applications or updating policies at a certain time of year.
Track their coverage levels so they could manage their ability to fulfill their current policy offerings.
During open enrollment insurance companies were also able to improve ties with other insurance companies. They could now take the time to strengthen the insurance contracts they currently had, make new partnerships, and improve healthcare all around. Most importantly, open enrollment helped health insurance grow a sense of shared duty. Companies could now pool their resources, share the best practices and ideas, as well as figure out how to navigate all the rapid new changes to the industry and market.
What Is Adverse Selection
Okay, now that the history lesson is over everyone back to the Delorean- we’re headed home. Well actually, we’re headed back to the beginning of this article where we mentioned open enrollment discouraging adverse selection. This is what health insurance companies nicknamed the trend in people only buying health insurance when they’re sick. When only sick people buy policies the insurance companys’ risk skyrockets. This is because they end up having to pay out more money than they have because there’s more claims than premiums. Health insurance companies only stay in business if they get more money from premiums than they give out in claims. So, it needs more healthy people than sick ones to properly pay out claims as well as pay to keep the company running smoothly.
Here’s what we mean. Let’s say that a health insurance company charges an annual premium of $4,200. Brianna is a member of this plan and she gets sick and her care costs $10,000 for that year. Brianna’s premiums aren’t enough to cover those costs by themselves. So, the health insurance company has to tap into the premiums of healthy policyholders who haven’t needed any healthcare that year to cover the difference for Brianna’s care. If there isn’t enough available money from healthy premiums. Then Brianna’s care comes out of the business’ pocket and their company as a whole goes into the red. This would lead to the health insurance company having to shut down or raise their premiums to supplement their loss. Both hurt everyone across the board.
Consequences of Adverse Selection
At the end of the day, health insurance companies are businesses. And adverse selection is a surefire way to bankrupt said business. In addition to paying out claims, insurance companies also have other expenses. Things such as employee wages, building rent, utilities, taxes etc. are all a part of running a healthy business. Not to mention health insurance is private in the U.S. Meaning these companies also have to make money after paying out claims and bills. Otherwise, the business closes its doors. So, what makes it so harmful to not only the companies, but also the general public as a whole?
Lack of Competition
The more health insurance companies close the more other companies begin to hold a monopoly on the market. When an insurance company has a hold on the market it has no competition so there’s no reason for them to try to improve their policies or create new upgraded ones. They can also charge whatever they want because other companies aren’t around offering cheaper options to pull customers away from them.
Less Accessibility
If health insurance companies start going the way of dinosaurs, there’s a chance that you won’t be able to get health insurance at all. Health insurance companies tend to focus on specific areas like certain states, counties, and even cities. So, if the health insurance companies in your area go out of business, you won’t have access to a plan that you want or need. If you do manage to get a plan from another area that’s extended its coverage a little, you may end up having to travel long distances to reach their in-network providers.
You Leave Yourself Vulnerable
If you wait to get health insurance until you’re sick, your medical bills might end up not even being covered. The point of health insurance is to protect you in case of something happening. It helps pay the costs for the unexpected injuries and illnesses. The thing about health insurance is that coverage doesn’t start right away. It usually begins at the beginning of the month after you enroll or even at the beginning of the next year, whichever comes first. So if you try to get coverage because you need it right then it most likely won’t be covered because your policy will not pay for anything before it’s active.
How Open Enrollment Prevents Adverse Selection
Health insurance companies can’t entirely erase adverse selection, but they can lower the risk of it happening by only accepting applications once a year. Everyone who wants health insurance can sign up or make changes to their plans during the open enrollment. This keeps healthy people from assuming that they can just wait until they’re sick to get insurance because it’s always available. They won’t be able to sign up for health insurance when they’re sick unless they happen to get sick during the open enrollment period. As we noted above, the open enrollment period comes with a waiting period between enrolling and your coverage beginning. This keeps people from signing up for health insurance on their ride over to the hospital in the hopes that their new plan will cover the bill.
The Affordable Care Act did originally have a plan to stop adverse selection. There was an annual fine for anyone who had access to affordable health insurance and didn’t enroll. The federal fine was removed in 2018 though. However, California, Massachusetts, New Jersey, and Rhode Island all have their own health insurance laws that penalize people that don’t have health insurance. They only get fined if they don’t qualify for an exemption on their state or district tax returns. These states keep this fine in place not to be harsh, but because they believe it’s a useful tool in preventing adverse selection in the health insurance market. In turn it keeps these state’s insurance premiums lower for their population.
Find Health Insurance With EZ
Because there are so many factors to take into account when organizing your own health insurance, it can be frustrating. No one enjoys reading hours of different plan benefits and premiums, so why not let a professional do all of the hard work for you- for free! There is a way to get affordable health insurance without all the hassle. A licensed EZ insurance agent can outline the benefits and drawbacks of each plan and assist in creating the plan that will work best for you.
Working with an agent saves you time and stress, no more trying to decode legal jargon or reading fine print. Agents do all the heavy lifting while you rest easy knowing that your coverage will be the best fit for your financial and medical needs.
Not to mention EZ agents can save you hundreds of dollars every year on health insurance premiums. We do this by having the ability to search both on and off the market for the most affordable plans. We’re also able to find and apply any discounts you may qualify for. Furthermore, we don’t stop at just finding you a plan, we help maintain your plan after the fact too! We can help you file claims with your provider and even help renew your policy when the time comes. To get started, simply put your zip code into the box below or give one of our licensed agents a call at 877-670-3557.
Americans can make changes to their health insurance plans every year starting on November 1st. It’s important to take advantage of this because a lot can happen in your life over the course of a year. Like having a child, getting married, or changing jobs. All of which could mean that you need to change your health insurance plan. But what if you haven’t gone through any big changes? Do you have to sign up for a new health plan every year? It depends. If you’re happy with your current plan, you might decide to do nothing at all during the Open Enrollment Period. On the other hand, if you’re not happy or aren’t sure if you should make changes, doing nothing can have some costly consequences.
Getting Stuck In Your Current Plan
If you’re happy with your current plan, this may not necessarily be a negative thing for you. However, if your plan isn’t meeting your needs and you miss the Open Enrollment Period, you’re going to be locked in for another year until the next Open Enrollment Period. If you don’t take the opportunity to review your current plan and do nothing during the Open Enrollment Period, you won’t be able to change your plan. What this really means is that your health insurance might:
Not provide enough protection for the coming year, which will result in additional costs.
Include coverages that you don’t actually require, which would mean that you’d be paying for protection that you wouldn’t use.
Be too expensive. If you don’t change your plan during the Open Enrollment Period, you’ll be stuck with the higher rates and costs.
Inability To Get Health Insurance
The Open Enrollment Period is for people without health insurance to enroll. For example, adults who just turned 26 and have to get off their parent’s coverage. If you miss this opportunity, you may not be able to enroll at all until the next Open Enrollment Period. Without health insurance, you may have to pay for your medical expenses out-of-pocket. Which can be financially difficult especially for major medical procedures or ongoing treatments. Missing the Open Enrollment Period can lead to delayed or inadequate healthcare, potentially impacting your overall health and well-being.
You Could Face Tax Penalties
At first, the Affordable Care Act did have a penalty in place for missing the Open Enrollment Period. Anyone who could get cheap health insurance, but didn’t sign up had to pay a fine every year. The federal fine was taken away, though, in 2018. However, California, Massachusetts, New Jersey, and Rhode Island all have their own rules that penalize people who don’t have health insurance. The amount of the fine depends on your income level and the tax rules in that state.
Less Options
If you don’t have health insurance and want to sign up for a plan, but you don’t do anything during the Open Enrollment Period, you won’t be able to get a Marketplace or exchange health insurance plan, or an ACA-compliant health plan. Even if you miss the Open Enrollment Period, you do have other choices. But you should know that there are only a few options and they come with limits.
Special Enrollment Period
Outside of the Open Enrollment Period, one of the only ways to get a reasonable health insurance plan that complies with the ACA is to be eligible for a Special Enrollment Period. People can only use a Special Enrollment Period if they have a qualified life event, such as:
Marriage – If you get married, you can choose a new plan by the last day of the month. And service will start the first day of the next month.
Children – If you give birth, adopt, or foster a child you can enroll within 60 days of the event and coverage would backdate to the day of the event.
Moving – You are eligible for a Special Enrollment Period if you moved to a new ZIP code or came to the U.S. from another country. You are also eligible if you moved to or from school, a place where you live and work seasonally, a shelter, or other temporary housing.
Losing Coverage – Losing your current health insurance plan due to a divorce, quitting a job, losing coverage through a family member, or losing Medicaid eligibility, qualifies for coverage during a Special Enrollment Period that lasts for 60 days after you lose coverage (or, in some states, 60 days before you lose coverage). After you choose a plan, your plan will start on the first of the following month.
Those are the main events that trigger a Special Enrollment Period, but there are other circumstances. For example, you can get special enrollment if you became a U.S. citizen, got out of jail, or finished a certain service program. If you were hurt or couldn’t sign up because of a FEMA-designated natural disaster, like COVID-19, you have 60 days after the end of the disaster to sign up for a Marketplace plan. Incapacitation can happen if you have a temporary mental condition or if you are in the hospital during open enrollment. You can ask for your plan to start when it would have, if the event hadn’t happened.
Also, if you weren’t able to enroll or get the help you were eligible for because someone helping you did something wrong, gave you bad information, lied to you, didn’t do anything, or because of a technical error, you are eligible for a special enrollment time.
Exceptions
There are a few people who have different rules for the Special Enrollment Period. Native Americans can sign up for a health plan through the exchange at any time, without having a qualifying event. People whose household income is less than 150% of the government poverty level can sign up for health insurance at a special rate until at least 2025. The Basic Health Program covers people who live in New York or Minnesota and don’t make more than 200% of the poverty level all year long. Oregon wants to have a Basic Health Program by the middle of 2024. Like New York and Minnesota, Oregon would let people sign up for the program at any time of the year.
Why You Need To Use The Open Enrollment Period
The last few years have been, to say the least, unpredictable. Covid-19 has caused hundreds of thousands of illnesses and deaths. As well as job loss and financial problems that many people even now, two years later, are still recovering from. As a consequence, it’s more important than ever to make sure you and your family are protected. Now is the time to do that. The Open Enrollment Period for the Affordable Care Act is here, which means you can find a great plan or change the one you already have. Don’t put it off, especially since you need to pay attention to the Open Enrollment Period this year for so many reasons.
More Options
One of the most important reasons to shop around during the Open Enrollment Period is that you might not know about all the plans and savings choices that are available to you. The Affordable Care Act (ACA) is always changing and growing. As a result, more Americans now have health insurance than ever before. This is because more people can get subsidies and some health insurance companies are expanding into new areas and giving new plans all over the country. That means you have more choices than you did before. So, you might be able to find a better, cheaper health insurance plan that covers you better.
Health Insurance is Necessary
The outbreak showed just how important it is to have health insurance. Even though the Covid-19 situation is over, what if you or someone you care about needs to go to the hospital? Without insurance, you or a member of your family could get hospital bills for Covid. Or any other illness that you or they were treated for. This could put you tens of thousands of dollars in debt. If you had the right health insurance, you could avoid that. Also, what if, like millions of other Americans, you lost your job? If you did, you probably lost your health benefits along with your job. However, just because you lost your job doesn’t mean you can’t still find cheap health insurance with the help of an EZ agent.
Don’t Wait
Look at plans! There’s no reason not to check out your options and compare plans before the Open Enrollment Period ends. But we know that researching all the different plans can be a pain, so we’re here to help! Our competent agents will talk with you and explain all of your choices in detail. When you’re ready to sign up, they’ll look through all the plans in your area to find the best one for you. Making sure it meets your needs and fits your budget. You will always have your own personal agent with EZ. So you don’t have to worry about jumping from agent to agent or getting a lot of sales calls. Not to mention all of our services are FREE. Enter your zip code in the box below to start. Or call 877-670-3557 to talk to an agent right away.
The health insurance Open Enrollment Period (OEP) is coming, and you might feel a little lost. It can be hard to sort through all of the different health insurance options in your area, but you know that you and your family need health insurance to stay healthy. Don’t worry though. You can always work with a licensed EZ agent, who will help you find a plan that fits your budget and your needs. Before you do that, let’s look at everything you need to know about the OEP.
What Is The OEP?
The Open Enrollment Period (OEP) is the only time of the year when you can change, cancel, or buy a new health insurance plan. Depending on which state you live in, it starts on November 1st and goes until mid-to late-January. Now is a good time to look at your current health insurance plan, see if it will change in the new year, and decide if it will meet your needs in the future or if you need a new plan.
When Is The OEP?
The open enrollment period for Obamacare plans is from November 1, 2023 to January 15, 2024. Any plan you buy by December 15 will cover you starting on January 1, 2024. If you buy a plan during open enrollment, which is between Dec. 15 and Jan. 1, it should take effect by Jan. 15, 2024, as long as you pay your first premium on time. Also, if you buy a plan between Jan. 1 and Jan. 15, your plan should start on Feb. 1, 2024. Some states’ open enrollment periods are longer than others, but this can change. At the moment, these states have longer periods for signing up:
California – November 1st, 2023, to January 31st, 2024
Idaho – October 15th, 2023, to December 15th, 2023
Maryland – November 1st, 2023, to December 15th, 2023
Massachusetts – November 1st, 2023, to January 23rd, 2024
New Jersey – November 1st, 2023, to January 31st, 2024
New York – November 16th, 2023, to January 31st, 2024
Rhode Island – November 1st, 2023, to December 31st, 2023
If you get your health insurance through your job, your employer can choose when your open enrollment period is.
Marketplace Plan Tiers
Since the Affordable Care Act (ACA) went into effect in 2010, most people buy traditional health insurance plans on the insurance marketplace during the OEP. When you buy plans this way, they come in four levels called “metal tiers.” Bronze, Silver, Gold, and Platinum are the tiers. The plans in these tiers are different in terms of price and how much you’ll have to pay out of pocket, not in terms of the quality of care you’ll get.
Bronze
The monthly premiums for bronze plans are the cheapest, but you have to pay the most out of pocket. With these plans, your insurance company will pay 60% of each of your medical bills. The other 40% will be your responsibility. Also, the deductibles for these plans, which are the amount you have to pay out of pocket for medical costs before your insurance plan starts to pay for them, can be in the thousands of dollars each year. Bronze plans are a good choice if you don’t use medical services very often but need a low-cost plan to protect yourself against the worst-case medical scenarios, like getting sick or hurt badly. Your monthly premium will be low, but since the deductible and cost-sharing percentage are both so high, you will have to pay for most of your routine care.
Silver
The monthly premiums and out-of-pocket costs for silver-tier plans aren’t too high or too low. These plans cover 70% of the cost of your medical care. You pay the other 30%. The deductibles for this tier are often lower than those for Bronze plans, so if you’re willing to spend a little more to have more of your routine care covered, these plans are a great choice. When you qualify for cost-sharing discounts, you have to choose a Silver plan to get the extra savings. If you are on the Silver plan and stop getting cost-sharing reductions, you will have a Special Enrollment Period. If you want to switch plans, you can sign up for the Bronze, Silver, or Gold plan that fits your needs and budget the best.
Gold
Even though the premiums for Gold plans are high, the out-of-pocket costs of care are lower than for the plans above it. These plans have low deductibles, and your plan will pay for 80% of your care while you only pay 20%. If you need a lot of medical care, a Gold plan might be a good choice for you because it will cover more of your care.
Platinum
Platinum has the highest monthly premiums of all the tiers. While the premiums will be high, your out-of-pocket costs will be the lowest of any type of plan, and since the deductibles are so low, your insurance company will pay more of your costs throughout the year. Since these plans cover 90% of all your medical costs, they can be a good deal for people who need a lot of medical services.
In addition to the different types of metal tiers, there are also different types of plans to choose from during the OEP. Some plans only let you choose from a small number of doctors, hospitals, pharmacies, and other health care providers, or they force you to use only those in their network. On the other hand, some plans will pay a bigger share of the bill for healthcare providers outside of the plan’s network. Depending on where you live, you might find plans in any or all of these categories at each metal tier level:
Health Maintenance Organization (HMO) – A type of health insurance plan that usually only pays for medical services from doctors who work for the plan or have contracts with it. Most of the time, out-of-network care is not covered, unless it is an emergency.
Preferred Provider Organization (PPO) – A type of health plan that has a network of providers but doesn’t force you to only see those providers. But your out-of-pocket costs will be lower if you use providers in the network. You can use medical professionals, facilities, and suppliers outside the network if you pay extra and don’t have a referral.
Exclusive Provider Organization (EPO) – A managed care plan is one in which treatments are only covered if you go to doctors, hospitals, or other healthcare providers in the network, unless it’s an emergency.
Point of Service (POS) – A type of plan where you pay less if you go to hospitals, doctors, and other healthcare providers in the plan’s network. To see a specialist, you need to get a referral from your primary care doctor.
How To Buy Health Insurance During The OEP
If your employer gives you health insurance, they should tell you when and how to choose coverage for the next year. If you don’t get health insurance through your job, you can use the marketplace to look for and buy a plan. Another way to buy health insurance during this time is to work with an EZ agent who can help you shop through all of the plans available and help you enroll. Most states use the federal marketplace, healthcare.gov, but 17 states and Washington, D.C., have their own state-based marketplaces where people can buy coverage. States that run their own health insurance exchanges may also offer longer sign-up periods. These are the states that have their own insurance markets where people can buy plans for 2024:
Residents of all other states should shop for and sign up for their next health insurance plan on the federal exchange.
Things To Consider During The OEP
As Open Enrollment for Individual and Family Health Insurance in 2024 gets closer, there are a few important steps to take when choosing your plan.
Review Your Current Plan
If you already have health insurance, look it over to see if it still meets your needs. Think about any changes in your health, finances, or lifestyle recently that might mean you need a different health insurance.
Explore Options
During Open Enrollment, it’s important to look at different plan options to find one that fits your healthcare needs and budget. Look for plans that have a network of doctors and hospitals that fit your needs and preferences.
Consider Subsidies
As you look at and compare insurance plans on the Marketplace, make sure to update your personal information, especially your financial information. If you make less than a certain amount of money, you may be able to get health insurance subsidies that can lower your monthly premium by a lot. Also, Silver Marketplace plans offer cost-sharing reductions, which can lower your out-of-pocket costs by lowering your deductible, copays, and coinsurance.
Consider Additional Coverages
Even though Marketplace health insurance plans cover a wide range of medical services and include prescription drug coverage, you may want to think about getting more coverage, like dental and vision plans, to make sure your health is well-rounded.
What If I Miss The OEP?
If you miss the Marketplace’s Open Enrollment Period, you might not be able to sign up for an ACA health insurance plan unless you qualify for a Special Enrollment Period. With a Special Enrollment Period, you can sign up for a plan outside of the Open Enrollment if you have a qualifying life event. This is an event that affects your current coverage, like losing your job or getting divorced. You might also be able to sign up for a health plan through your employer. Some plans offered by employers have their own enrollment periods that may differ from the Marketplace. Also, if you change jobs, you may be able to sign up for your new job’s health plan outside of the normal enrollment period.
Need Help?
The best way to find a cheap plan with the right level of coverage for you is to compare plans. Come to EZ first before you start comparing things on your own. We’ll make the process faster and easier by letting you compare plans in your area in just a few minutes. Our licensed insurance agents work with all of the best insurance companies in the country. They can talk to you about your budget, needs, and help you choose the best plan for you and your family. We compare plans and give you advice for free. Enter your zip code in the bar above to get free quotes or call 877-670-3557 to talk to a real person.
So, you’ve decided it’s time to cut ties with your health insurance plan, but can you cancel your policy? The answer is both yes and no. You can cancel your health insurance, but if you do it at the wrong time or without a backup plan ready to go you could face fines or massive coverage gaps.
When To Cancel Your Health Plan
It’s best to cancel your health insurance policy once you have a replacement ready to take its place. If you don’t, you will have coverage gaps, leaving you vulnerable in the event of a health emergency. If you are looking to make the switch,Open Enrollment Period (OEP) is the best time to look into a different health insurance plan. The only time you can switch to a new health insurance plan outside of the OEP is if you qualify for a Special Enrollment Period (SEP). You qualify for an SEP if:
You just got married
Filed for divorce
Just had a baby
You or your spouse got a new job, losing your group health insurance coverage
You’re moving outside of your coverage area
Your current plan is no longer offering coverage in your area
Your current health insurance company is out of business
The Right Way To Cancel Your Private Health Plan
It’s important to cancel your health insurance plan properly so that there is no confusion or loose ends. Below are the steps you can take to cancel your plan the right way.
Call your health insurance company
If you have health insurance through the Marketplace, you can login to your account and terminate the plan’s coverage. If you need help canceling your plan online, you call their customer service line. When you’re canceling a private health insurance plan, you can contact your insurance company directly. Your health insurance company’s phone number is printed right on your policy, health insurance card, and premium bills. Your health insurance provider may let you cancel over the phone. Occasionally, they may request that you fax or mail them additional documentation such as a confirmation letter.
Follow Your Plan’s Cancellation Process
Every health insurance provider has a cancellation procedure you must adhere to, such as ensuring your policy end dates are accurate to avoid a lapse in coverage. During your online or phone cancellation, an insurance agent will confirm the steps you have to take to successfully cancel your health insurance plan. Note the name of the representative and any cancellation confirmation numbers. This is important in the event that there are any procedure errors during the cancellation you’ll be able to quickly prove when the policy was ended.
Ask About Premium Refunds and Check Your Bank
If you paid your plan in full for the year and want to cancel it before it expires, ask your health insurance company if it will reimburse you for the months you’ve already paid for but have not used yet. Many insurers will issue a refund for the remaining time on your policy. Check your bank statements after your new health insurance coverage begins to ensure that the canceled plan is no longer in effect and charging your account. You’ll also want to make sure that the new policy is active and has taken the first payment if you have one.
Check Your Active Health Coverage
Don’t cancel your old policy until you’ve gotten a new one and reviewed the coverage start date. Make sure the active coverage periods don’t overlap, as it’s illegal to submit claims to two separate major medical policies. You’ll also want to check your monthly health allowance if your employer reimburses you for your insurance premium or other out-of-pocket medical expenses through a health reimbursement arrangement (HRA) or health insurance stipend. This amount may affect your desired premium payment and the types of medical expenses you may get. Additionally, check the type of HRA your company offers. Integrated HRAs supplement employer-sponsored health insurance plans by helping to pay for deductibles, copayments, medical services, and other out-of-pocket costs, but cannot reimburse health insurance premiums.
Know Your Rights
Every state has consumer protection laws and insurance regulators who can help you with questions or complaints regarding your individual coverage. Your state laws may address health coverage requirements, prompt payment of claims, access to specific specialists, and certain treatment coverage. These protection laws apply to all plans, whether individual coverage or employer-provided health insurance, in order to safeguard your access to health services. If you submit false information on your health insurance application, your policy could be canceled. However, they cannot terminate your coverage if you made an honest error on your application. If you have unpaid premiums, your provider can terminate your coverage. In the majority of instances, your health insurance provider must give you at least 30 days notice before canceling your coverage due to missed monthly payments. This notice affords you the opportunity to appeal the decision or find a more cost-effective alternative.
How To Cancel Your Group Health Plan
You may need to cancel your employer-sponsored health insurance plan, even if you remain employed with the company. For example, your spouse or domestic partner’s employer may offer a more affordable plan option. Canceling an employer-sponsored plan is fairly easy if you follow these steps:
Contact HR – Your company’s human resources department will be able to answer your questions and will be your primary contact through the entire cancellation process
Ask about dates – Make sure you know the cancellation date, and make sure your new coverage will begin on or right after that date. You don’t want your plans to overlap.
Complete the paperwork – If you’re opting out of your group plan early, there will likely be a bunch of paperwork that comes with it. Make sure you complete, sign, and submit these forms on time
Cancellation Penalties
In most instances, there is no fee for canceling a health insurance policy. However, some insurance providers do charge a cancellation fee. This would be specified in your plan’s terms and conditions, so you are aware of this policy before you buy it. While the federal government no longer imposes a tax penalty for not having health insurance, some states do. The District of Columbia, California, Massachusetts, New Jersey, and Rhode Island have penalties for not having health insurance. Each state has its own system of fees. Check your state’s regulations before you cancel your health insurance, as you may qualify for an exemption from the tax penalties.
When Can’t I Cancel My Health Plan?
There are very few circumstances where you’re not able to cancel a health plan early. Some employer group health plans are paid for out of your paycheck prior to taxes being taken out. These plans are called Section 125 plans. They can be an excellent way to save money on insurance and taxes. If you have one of these plans, however, you can only change or cancel it during the Open Enrollment Period, or if you have a qualifying life event. Your HR department will be able to let you know if that’s the case with your group plan.
Additionally, if you are under 30 and have a short-term or catastrophic insurance plan, you may not be able to cancel your coverage early. Many of these plans are bought for a specific period of time and can’t be canceled early. Make sure you understand the terms and conditions of these plans before enrolling.
Why You Need Health Insurance
So far we’ve talked about how to switch health insurance plans, but we haven’t mentioned people canceling health insurance with no plans to get another plan. We know that sometimes when money is tight you start cutting expenses and health insurance is one of the first things to go. Especially if you’re healthy you think “well, I don’t use it, I don’t need to pay for it”, but that way of thinking can be detrimental. While being healthy is great, the objective here is to maintain that health throughout one’s life. Unfortunately, neither disease nor accidents can be predicted. Without health insurance, you are responsible for all of your medical expenses. Which poses a substantial threat to your financial and medical stability.
Health Benefits Of Health Insurance
The greatest benefit of health insurance is access to necessary medical care. Health insurance provides access to a comprehensive network of physicians, specialists, hospitals, and laboratories. This network collaborates with you and each other to help you prioritize wellness and prevention. In fact, the majority of healthcare plans include free preventative services, such as immunizations and screenings, to help you stay healthy and avoid illness and its consequences.
Additionally, the Affordable Care Act requires Marketplace plans to cover pre-existing conditions. This means that even if you already have a chronic illness, you will not be denied coverage or charged more for your pre-existing condition. Since you’ll have regular access to the necessary doctors and specialists, your healthcare plan will also assist you in managing the care for any chronic illnesses you may be living with.
Your health insurance provides you with the most effective means of maintaining your health. Having access to this type of continuous care can ultimately result in a longer and healthier life. In fact the mortality rate of adults between 17-64 without health insurance is 40% higher than those without insurance, according to the National Library of Medicine.
Financial Benefits of Health Insurance
Health insurance protects not only your health but also your finances. With an insurance plan, you will have less out-of-pocket healthcare costs, as your insurance will cover your medical services for a monthly premium. You will also be healthier, which will lower your out-of-pocket costs. Consider how much you would pay out of pocket for an unexpected medical emergency Which could easily cost you thousands of dollars.
Working With An EZ Agent
It can be frustrating to organize your own health insurance because there are so many variables to take into account. Why not let a professional do all the hard work for you, for free? A licensed EZ insurance agent can describe the advantages and disadvantages of each plan, and help you choose the best plan for your needs. EZ agents can save you hundreds annually on health insurance premiums. This is accomplished by our ability to search both on and off market for the most cost-effective plans. We can also locate and apply any discounts you may be eligible for. And we don’t stop at finding you a plan; we also assist with plan maintenance after the fact! We can assist you in filing claims with your insurance company and renewing your policy when the time comes. To begin, enter your zip code in the box below or call one of our licensed agents at 877-670-3575.
Ah – life is just full of surprises isn’t it? It would be so much easier if we had a crystal ball telling us exactly what kind of health insurance we should get and when. Who wouldn’t want to not pay for insurance until it was needed?
There may be years, even decades, where you don’t need to go to the doctor or have an injury, and you think you don’t need insurance. Sadly, life happens and unexpected things and accidents occur. Let’s just say you’re going about your day and you get some pain and have to rush to the hospital. Once there you find out you have appendicitis and need an appendectomy. A few weeks later a bill arrives in your mailbox for thousands of dollars. If you don’t have a health insurance plan this trip to the hospital could wreak havoc on your bank account and credit. Hopefully you never find yourself in this scenario but it makes you wonder…what if you don’t have health insurance? What do you do? Can you retroactively be covered if you buy a plan after you leave the hospital? Let’s find out.
Since you can’t predict the future, be sure you have a health insurance plan that fits your needs.
The Short Answer
Getting health insurance after an injury will not cover bills that have already been incurred.
Sadly if you do not have insurance at the time of an accident you cannot sign up for health insurance coverage after being injured and incur a bill from a healthcare provider. It makes sense that this is not possible because otherwise no one would buy a health insurance policy unless it was absolutely necessary. There is an open enrollment period in the fall where people can enroll in a health insurance plan for the next calendar year. There are exceptions to this if you qualify for a Special Enrollment Period. Some life events such as getting married or having a baby would qualify you to enroll outside of the open enrollment period, but in general you should get a plan during open enrollment to cover yourself in the event of an accident or to get coverage for wellness checks.
Finding a Plan That’s Right For you
Talk to an EZ Agent today to find a health insurance plan that works for you.
Opting out of health insurance is extremely risky. With one accident you could put yourself in financial distress for years to come. This is why health insurance, even a basic plan with a high deductible would be better than nothing. At EZ we have agents that work with top-rated insurance companies in the nation and are able to find a plan that works for you. Don’t find yourself in a position that would create financial hardship because of an accident. Simply enter your zip code in the bar above to get free, instant, no obligation quotes, or to speak to a local agent, call 888-350-1890.
