OBAMACARE OPEN ENROLLMENT – WHAT YOU NEED TO KNOW
By Scott Glovsky on November 14th, 2014 in Insurance
Important Things To Know For Obamacare Open Enrollment
This article will highlight some of the pitfalls that you should avoid when choosing health insurance during Open Enrollment. If you are insured through health insurance that you purchase for yourself, as opposed to insurance that is provided to you by your employer, then you will soon select coverage for 2015 as your benefits will end at the end of the year. You will soon have to decide whether to renew your current health insurance or purchase new health insurance for 2015.
Open Enrollment is the time period in which you can choose a new health coverage plan or policy. The Open Enrollment period for 2015 coverage begins on November 15, 2014 and ends on February 15, 2015. If you have not enrolled in coverage by February 15, 2014, then you will not be able to purchase new health coverage until next fall when the Open Enrollment period for 2016 will begin. What follows are hidden pitfalls to consider when enrolling:
THERE ARE VARIOUS TYPES OF PLANS
In order to make an informed decision concerning a new health plan, you need to understand the types of health plans that might be available to you since they provide for very different types of coverage. These types will generally include Preferred Provider Organization (“PPO”), Health Maintenance Organization (“HMO”) and Exclusive Provider Organization (“EPO”) plans.
In PPO plans, members can access a network of contracted providers. Members also have the ability to obtain partially covered treatment from out-of-network providers.
In HMO plans, members can generally receive fully covered treatment, but they have to go to doctors who are in their plan’s network. An additional feature of HMO plans is that members are required to get a referral from their general practitioner before they can see specialists for treatment.
EPO plans function essentially like HMO plans. EPO plan members are restricted to doctors within their EPO network and will receive no coverage generally for out-of-network doctor care. However, in contrast to HMOs, EPOs allow members to seek services from specialists within their network without the need for a referral from their general practitioner.
Keep in mind how these plans differ when it comes time to purchase a new plan.
BEWARE OF MISLEADING INFORMATION FROM INSURERS ABOUT THE TYPE OF PLAN YOU ARE ENROLLING INTO
These days, simply knowing the difference between the types of health plans is not enough to ensure that you will actually enroll in the plan that you want. We have heard from numerous clients who were misled by insurers into believing that they had purchased a certain type of health coverage only to learn after enrollment that the insurer had sold them something completely different. Most commonly, the members believed that they had enrolled in a PPO plan but were shocked to discover that their insurer had actually enrolled them into an EPO plan.
The best way to avoid these scenarios is to enroll in a new plan either online or using a paper form instead of enrolling over the phone or allowing your current insurer to roll you into a new policy by taking no enrollment action. This should prevent you from being tricked into enrolling in the wrong type of plan.
DOCUMENT IN-NETWORK PROVIDER LISTS
It is particularly important to research provider lists for any type of health coverage plan before you enroll in the plan, especially if you are considering an EPO or HMO. However, we have heard from numerous clients who confirmed with their insurer’s phone agents and websites that all of their providers and preferred health care facilities were in-network before enrolling. It wasn’t until after enrollment that our clients learned that none of the providers or facilities were actually in-network. For this reason, it is important to take screenshots of all of the insurer’s web pages confirming the in-network status of your providers and to request written confirmation from all insurer phone representatives that your providers are in-network before enrolling in a new plan. Keep extensive notes, including the names of the people you speak with and the dates and times of those conversations. If your doctors are not available in any available plan’s networks, then you should explore the possibility of enrolling in a group plan.
Look Out For CONFUSING DEDUCTIBLES
When reviewing your health plan options, take careful note of the deductibles offered with the plans. A deductible is the amount of expenses that a health plan member must pay out-of-pocket before an insurer will pay any expenses. It is important to discover what payments each health plan counts towards the deductible as some health plans do not consider all out-of-pocket payments when calculating whether a member has met their yearly deductible. The method the health plan uses to make this calculation can greatly affect the amount of money that you might have to pay for health care services.
Be Wary Of HIDDEN DEDUCTIBLES
A similar consideration is of the types of deductibles that a plan might have. Some plans have various deductibles for different services. For example, some health plans have a deductible for health care treatment and a separate deductible for prescription drugs. Try to find out what kinds of deductibles a plan has before you enroll so that you can adequately compare it to other health plans in your market.
Carefully review PRESCRIPTION DRUG FORMULARIES
Not all insurance plans provide coverage for the same prescription drugs. It is therefore important to explore the different prescriptions that each plan covers before enrolling to make sure that the insurance plan you choose provides coverage for all of your medications. If none of the available plans offer comprehensive medication coverage, consider enrolling in a group plan.
Tax Creidts May Be Lost If You Enroll OUTSIDE OF EXCHANGE
When you purchase health insurance from your state’s health coverage exchange, as opposed to directly from a health insurance provider, you may qualify for a tax credit. The premium tax credit is a tax credit designed for people who have low or moderate income to afford health insurance. You are eligible for the tax credit if you:
- Purchase coverage through the insurance exchange;
- Have a household income that is between 100 percent and 400 percent of the federal poverty limit for your family size;
- Are not able to get coverage from an employer that provides minimum value; and
- Are not eligible for insurance from a government plan such as Medicaid, Medicare, CHIP or TRICARE.
When you apply for insurance coverage through the exchange, the exchange will estimate the amount of tax credit for which you are eligible. However, if you purchase your insurance directly from an insurance company, then you will not be offered the credit. Many insurance providers offer the same exact plans (albeit with different names) on and off of the insurance market place exchanges. Therefore, there is no incentive for you to purchase your plan outside the exchange marketplaces.
ENROLLING EARLY WILL ALLOW YOU MAXIMUM FLEXIBILITY
As you can see from the above pitfalls, there are many different scenarios in which you can end up with a health plan that either was not what you wanted or not what you expected. For this reason, it is a good idea to enroll into a new plan as early as possible, allowing you the time to potentially switch health insurance plans if you discover problems with the plan that you chose.
