By Pamela Camey, CLTC, Healthcare Solutions Team
Open enrollment begins November 1, 2015. How do you pick an insurance plan that will best fit your needs as an individual, family, or as a small employer? This article provides insight on how to address those concerns, as well as information about available high-quality health and dental plans.
Should I use a Navigator or a Broker when I look for insurance in the Market Place?
Healthcare purchases continue to be complex, and customers continue to look for guidance from professionals. It’s truly in your best interest to use a broker/agent who has been vetted by the department of insurance in each state in which they are licensed. Licensing, testing and continuing education indicate that a broker/agent is knowledgeable in the insurance field.
A broker/agent can explain the insurance policy of each carrier they represent. They are able to explain plan options and how each will perform for the consumer. A broker/agent will ask you who your doctor or specialist is to make sure that your physician is in a plan’s network. A consumer taking a few prescription medications should also have their medications looked up on the plan’s drug formulary to determine the tier rating and cost for each drug the consumer is on.
Navigators will be available when the federal and state exchanges open up in November. A navigator will not have an insurance license to discuss products. As a consumer, do you really want to sign up for a plan with unanswered questions about how that plan works? Enroll American found that consumers who had utilized in-person assistance were twice as likely to enroll as someone who only went online.
Have a heart-to-heart discussion with your broker/agent. Discuss your concerns. The cheapest monthly premium may not always be the best. There are solutions available to fit your needs.
Important dates for 2016 enrollment:
- November 1, 2015: Open Enrollment starts — first day you can enroll in a 2016 Marketplace plan
- January 1, 2016: First date 2016 coverage can start
- January 31, 2016: 2016 Open Enrollment ends
If you don’t enroll in a 2016 plan by January 31, 2016, you can’t enroll in a health insurance plan for 2016 unless you qualify for a Special Enrollment Period.
Medicaid, CHIP, and SHOP — apply any time
- There’s no limited enrollment period for Medicaid or the Children’s Health Insurance Program (CHIP). You can apply any time.
- There’s also no limited enrollment period for small businesses to enroll in SHOP coverage for their employees. You can apply any time.
What is a Special Enrollment Period?
Special Enrollment Period is a time outside of the open enrollment period during which you and your family have a right to sign up for health coverage. In the marketplace, you qualify for a special enrollment period for 60 days after certain life events, such as change in family status (for example, marriage or birth of a child) or loss of other health coverage. Job-based plans must provide a special enrollment period of 30 days. It is always best to shop around for plans after the loss of a job. Cobra may or may not be in your best financial choice. Speak to a broker/agent if you have questions, and determine what is in your best interest. In most cases, individuals may see a significant savings by going through the marketplace.
If you can afford health insurance but choose not to buy it, you must have a health coverage exemption or pay a fee (the fee is sometimes called the penalty, fine, individual responsibility payment, or individual mandate). If you don’t have coverage in 2015, you’ll pay the higher of these two amounts:
- 2% of your yearly household income. (Only the amount of income above the tax filing threshold, about $10,150 for an individual, is used to calculate the penalty.) The maximum penalty is the national average premium for a Bronze plan.
- $325 per person for the year ($162.50 per child under 18). The maximum penalty per family using this method is $975.
If you don’t have coverage in 2016, you’ll pay the higher of these two amounts:
- 2.5% of your yearly household income
- $695 per person ($347.50 per child under 18)
In future years, the penalty fee is adjusted for inflation. You’ll pay the fee on the federal income tax return you file for the year you don’t have coverage.
For more Information, contact Pamela Camey, CLTC and Licensed Insurance Agent for Healthcare Solutions Team, at 815-579-2266 or 309-761-8090. Email pcamey@myhst.com. Go to www.healthcaresolutions.com/agent/pamela-camey/ or www.healthcaresolutionsteam.com.
Sources available upon request.
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