Ten Things You Need to Know about Open Enrollment

Open Enrollment 1
Open enrollment: what you need to know for open enrollment and your health insurance. 10 Things to keep in mind during open enrollment.

As you’re probably well aware, if you are a US citizen, you are required to have health insurance that meets the government’s standards; if you don’t, you face penalty fees when you file your Federal tax return.

With that in mind, below are ten things you should know about what open enrollment is, and some key takeaways from it.

1. Open Enrollment is (typically) your only chance to get Health Insurance for the following year.

“Open enrollment” under “Obamacare”/Affordable Care Act, is a term you’ve also probably heard many times. Each year, this is only permitted during a specific time—the one-and-a-half month period from November 1 to December 15 (except California, which starts October 15). Of course, all plans sold during this open enrollment period for 2019 start on January 1, 2020. It is important to note that if you don’t obtain the coverage by December 15, you can’t get coverage for 2020 unless you qualify for a Special Enrollment Period (see number 9).

2. Your Health Insurance must meet certain requirements.

To qualify, the plan must include: ambulatory patient services; emergency services; substance use disorder services; prescription drugs; rehabilitative and habilitative services and devices; preventive and wellness services; and pediatric services.

3. There are different kinds of Health Insurance plans.

Your plan type will depend on your individual situation. You may have health insurance provided by your employer or if you are a senior citizen over the age of 65, you are eligible for Medicare.

4. There are different levels of Health Insurance.

Health insurance splits medical costs between the consumer and the insurer, over four tiers of premiums, called “bronze”—lowest, in-between one, in-between two, and highest.

5. Your premium affects your coverage.

Health insurance costs will differ depending on the type of plan and many other factors. A common mistake is going for the “cheapest premium” plan, because this can cost much more in out-of-pocket costs.

6. Several factors go into determining your premium.

There are five factors that go into determining your premium: age, location, use of tobacco products, whether you are an individual or family, and your plan category.

7. Health Insurance does NOT cover everything.

Typical health insurance plans won’t cover everything, as dental and vision will likely be separate and rarely covered under health insurance.

8. Open Enrollment only happens once a year.

As above, there is only one open enrollment period, from November 1 to December 15, except in California, which starts October 15.

9. You may also qualify for Special Enrollment.

You might be eligible for a Special Enrollment Period under certain qualifying events, such as you turn 26, have a baby, or move to a new zip code.

10. Your state of health affects your month payment.

Your state of health, or how often you require medical attention, is a huge determining factor in what kind of premiums you want to pay and what deductibles you choose.

Because this is so important, and has so many variables to it, it really is imperative that you speak to a knowledgeable and experienced, licensed agent who knows and can help you understand what’s available for you. Call us today at (870) 523-6771, or stop in to see us at 105 Laurel Street, in Newport.