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 As of January 1, 2019, the tax penalty known as the individual mandate has been repealed, though some states may still enforce penalties on individuals who don’t have health insurance.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

business man sitting at a cafe discussing his health options on his cell phone

I Missed Open Enrollment and Need Health Coverage — What Are My Options?

The next official ACA Open Enrollment period isn’t slated to begin until November 1, 2019. But depending on your circumstances, you may not have to wait that long to obtain coverage.

Qualifying Life Events and Special Enrollment Periods

Sometimes our circumstances change, and if they change due to specific events, you and your dependents may be able to secure health insurance through a Special Enrollment Period. When this occurs, it is called a Qualifying Life Event, otherwise referred to as a QLE.

There are several types of Qualifying Life Events that may grant you a Special Enrollment Period. Some of the most common examples include:

  • Loss of health coverage
    • Losing existing health coverage – including job-based, individual, and student plans
    • Losing eligibility for Medicare, Medicaid, or CHIP
    • Turning 26 and losing coverage through a parent’s plan
  • Changes in household size
    • Getting married or divorced
    • Having a baby or adopting a child
    • Death in the family
  • Changes in residence
    • Moving to a different ZIP code or county
    • A student moving to or from the place they attend school
    • A seasonal worker moving to or from the place they both live and work
    • Moving to or from a shelter or other transitional housing
  • Other qualifying events
    • Changes in your income that affect the coverage you qualify for
    • Gaining membership in a federally recognized tribe, or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
    • Becoming a U.S. citizen
    • Leaving incarceration (jail or prison)
    • AmeriCorps members starting or ending their service

Non-ACA Health Plans

Haven’t experienced a QLE but still need health coverage? A non-ACA health plan could be the answer. Also referred to as Short Term Medical Plans, recent legislative changes have loosened the restrictions surrounding these plans and have increased their appeal.

Previously, a Short-Term Medical plan could only provide coverage for up to 90 days. But due to recent regulatory changes, these plans can now be continued for up to a year.  Additionally, in some cases applicants may now renew their plan for up to three years.

Because Short-Term Medical Plans are considered non-ACA health plans, it is worth noting that they may not cover all that an ACA health plan would. For example, applicants could be denied coverage due to a pre-existing medical condition, maternity care may not be covered, and there could be an annual dollar limit on coverage. However, these plans are also typically less expensive than ACA plans and could be a good alternative for individuals seeking more affordable options.