middle aged couple discussing health insurance options at home table

4 Myths About the Individual Health Insurance Open Enrollment Period

We’ve heard a lot of Open Enrollment myths over the years and want to set the record straight.

Myth #1 “There are fewer insurers to choose from.”

Many carriers who initially fled the federal exchange have returned and now offer plans alongside others who have entered the marketplace. This increase in the number of plans being offered has allowed many individuals and families to re-examine their needs and adjust their coverage amounts accordingly.

Myth #2 “The premiums are too expensive.”

Now that the federal exchange marketplace has stabilized, there may be lower-cost options for ACA-compliant health plans than past Open Enrollment periods. For example, Blue Cross Blue Shield has filed for a 2.03% decrease in premiums in Texas.

Even if your coverage needs remain the same, you may be able to find a lower premium being offered by a different insurer. We recommend always reviewing the health insurance options available to you during the annual Open Enrollment period.

Myth #3 “You’ll be penalized at tax time for not having insurance.”

In previous years, if an individual did not have health insurance for more than 2 months of the year and did not qualify for an exemption they would face a tax penalty of $695 or 2.5% of their taxable income (whichever amount was greater). As of January 1, 2019, the tax penalty known as the individual mandate has been repealed, though some states may still enforce penalties on individuals who don’t have health insurance.

Myth #4 “Applications are processed instantly.”

On average, our team will process an enrollment application within 24 business hours and submit it to the carrier. Once the application is with the carrier, their team will take over and require an additional 10-15 business days to process the application.

The carriers often get overwhelmed with applications during the Open Enrollment period, so we recommend enrollees submit their health insurance applications as early as possible.

Securing ACA-Complaint Coverage for 2020

This year, Open Enrollment runs from November 1 through December 15 with a coverage effective date of January 1, 2020. This is the one time of year where individuals and families can enroll in ACA-compliant health insurance plans.

happy family on couch browsing health insurance options on tablet

Getting the Most out of Open Enrollment

With 2020 Open Enrollment period in full swing, families across the country are reviewing their current insurance coverages and seeing what other options may be available to them. Below are a few tips to help you navigate the process.

  1. Learn the Language

Insurance jargon may be enough to make some people’s heads spin but learning just a few key terms could help you pick the best health coverage for you and your family. To make it easy, here are a few words we feel you should know:

  • ACA-compliant” refers to plans that follow all the guidelines and regulations in the Affordable Care Act. These plans are only available during the annual Open Enrollment period or through a Special enrollment period, if you have a qualifying event.
  • Non-ACA plans” also known as short term health plans do not adhere to all of the Affordable Care Act’s guidelines and regulations.
  • Deductible” the amount of money you must pay out of pocket before your insurance kicks in
  • Premium” the amount you pay to your insurance company every month
  • In-network” refers to a provider that has a contract with your insurance provider
  • Out-of-network” refers to a provider that does not have a contract with your insurance provider
  1. Think of the Future

No one can predict the future, but you may be able to take an educated guess as to what the next 12 months could hold. Thinking about the coming year could help you determine how much coverage is right for you and your family. Have you had any health issues in the past year? Are you taking any medications? By examining your current health status and concerns you may be able to narrow down your health insurance plan options.

  1. Know Your Deadlines

Like last year, the annual individual health insurance Open Enrollment period began on November 1 and will run until December 15. For those who enroll in one of these ACA-compliant plans, you can expect an effective date of January 1.

Non-ACA plans typically do not follow the ACA open enrollment period dates and are available in most states year-round

young african american man needing health coverage outside of open enrollment

What Are My Options if I Lose Healthcare Coverage?

Maintaining health insurance coverage is a vital step in your plan to remain financially secure. However, there are times in life when your health coverage may be interrupted. When this happens, it’s imperative that you find affordable health insurance coverage quickly in order to protect yourself and your family.

Why Would My Coverage Be Cancelled?

There are a few factors that could contribute to the loss or interruption of health insurance coverage. If an individual does not pay their premium, their policy may be canceled. This is not always a result of poor money management; if there has been a significant change in income or other pressing financial obligations, it is easy to redefine financial priorities and let those monthly insurance premiums slide. It is also possible that individuals can lose their coverage when a grandfathered plan is canceled. However, the loss of a job which provided insurance coverage is the more likely reason someone may lose their benefits.

These factors are very hard to foresee, and therefore can be very stressful when you learn that your health insurance coverage is going to be affected. However, as soon as you find out your coverage is being canceled, there are steps you can take quickly to make sure you maintain health insurance coverage for you and your family and protect your financial stability.

Option #1: Continue Existing Coverage through COBRA

COBRA is a Federal law that makes it possible for individuals who were covered under company health insurance plans to maintain those existing plans following a job loss. In order to take advantage of COBRA benefits, the individual must pay the full monthly health insurance premium amount. These amounts are usually substantially higher than what you were previously paying because in most cases the employer was paying a portion of your monthly premium. The COBRA plan, however, does ensure that your existing policy will stay intact for up to eighteen months following a job loss. This is crucial for many individuals who have severe health problems and would be in financial jeopardy if they lost their coverage for even a short amount of time.

Option #2: Purchase a New Plan on the Insurance Exchange

If an individual loses health insurance coverage due to the loss of a job, purchasing a new health insurance plan on the insurance exchange could be better, and more affordable, answer to your problem. The Insurance Exchange is a multi-carrier private exchange offering a wide range of health insurance choices for individuals and their families.

These types of benefits are time-sensitive, so it is best to begin the process before losing your insurance coverage. Although insurance exchanges usually have set open enrollment periods (running from November to February), those who suffer from a job loss are offered a Special Enrollment Period to allow them to obtain coverage within a specific time frame after the job loss occurs.

Which Do I Choose?

The most cost-effective solution for most people is to seek a new plan entirely. Insurance plans on the exchange offer generally lower monthly premiums than what you’d pay for your existing plan under COBRA. However, it is crucial that you do not waste time, as the special enrollment period for these plans is 60 days from the qualifying event or last date of coverage. It is important to act quickly to get the best selection of plans and ensure you are able to obtain coverage within the required time frame.

Young biracial woman in business attire smiling on a cell phone on an overcast day

Need Health Insurance and Miss out on Open Enrollment?

Your Guide to Understanding Qualifying Life Events and Special Enrollment

Life happens, and when it does, it is very likely that your health insurance coverage may need to change. When you encounter a qualifying life event that impacts your insurance needs, it is important to know that you can take advantage of a special enrollment period – since most people are unaware that they may enroll outside of open enrollment.
This guide is created to help you understand everything you need to know about qualifying life events and the special enrollment period. You will learn whether or not you qualify and what documents you will need prior to enrolling and shopping for coverage.

#1 Loss Of Coverage

Due To:

  • Termination of group coverage
  • Reduction of hours to part-time status
  • Loss of employer contribution
  • COBRA ending
  • REQUIRED PROOF: Letter from employer, Certificate of credible coverage

#2 Marital Status Change

Due To:

  • Marriage
  • Divorce
  • Legal separation
  • REQUIRED PROOF: Marriage Certificate or divorce/separation court documents, Certificate of credible coverage.

#3 Dependent Status Change

Due To:

  • Birth of a child
  • Adoption
  • Aged out of dependent status
  • REQUIRED PROOF: Child’s DOB, Legal adoption paperwork, Certificate of credible coverage.

#4 Moving

Permanently move to another state and/or no longer live in the existing/prior plan’s service area.

REQUIRED PROOF: New Mortgage Bill/Renter’s Agreement and drivers license, utility, Postal Service change of address receipt.

#5 Death

Your primary policy holder passed away leaving you with no coverage.

REQUIRED PROOF: Death Certificate, Copy of termination letter from prior insurance company.

#6 Income Change

That makes you newly eligible or ineligible for a tax credit.

REQUIRED PROOF: Copy of certificate of creditable coverage OR a copy of the termination letter from prior Insurance Company and/or federal or state agency.

#7 Non-Calendar Year

Your current plan ends on a non-calendar year basis.

REQUIRED PROOF: Copy of termination letter from prior insurance company OR Certificate of Credible Coverage Anytime that you enroll in a plan you will be asked to provide the following information:

  1. What was your qualifying event?
  2. What was the date of this event?
  3. You’ll be asked to submit supporting documents.

So how long is this special enrollment period? Typically, you only have 60 days from the QLE to enroll in a new plan due to ACA law, carriers are very strict on enrollment timelines.

open enrollment 2018 member benefits graphic

Reminder: Individual Marketplace Enrollment Deadlines Approaching

Enrollment Deadline in Most States is Dec. 15

Individuals are reminded that the deadlines to enroll in health insurance coverage through HealthCare.gov or a state Marketplace are quickly approaching. To obtain coverage that will begin January 1, 2018, individuals in the states below must sign up for coverage by the following dates:

  • Connecticut: December 22
  • Massachusetts: December 23
  • Minnesota: December 20
  • Rhode Island: December 23
  • All Other States: December 15

Note: Some states may still be able to extend their 2018 open enrollment deadlines. In addition, certain states may provide extended deadlines for returning customers. Individuals are therefore advised to consult their state’s Marketplace for the latest updates.

Visit our Health Insurance Exchanges (Marketplaces) section for more information on the Marketplaces.