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Health Insurance Open Enrollment 2019: What you need to know

By Posted : October 9, 2018

Open enrollment is a time to make changes to your health insurance plan or to buy a different one. 

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When open enrollment is for you depends on how you get insurance. Medicare recipients have to choose between Oct. 15 and Dec. 7. People who get individual insurance or through the Affordable Care Act (ACA) exchanges have between Nov. 1 and Dec. 15 usually. There are a handful of states though that have their own open enrollment period. 

Most people get their insurance through their employer. Open enrollment for businesses varies. The company makes that decision. 

Affordable Care Act open enrollment is usually Nov.1-Dec.15

Open enrollment for plans through the Affordable Care Act starts Nov. 1 and goes through Dec. 15, 2018. In order to get coverage to start on Jan. 1, you'll need to select a plan by Dec. 15 unless you are in the following states, which have these open-enrollment time-frames:

  • California – Oct. 15, 2018-Jan. 15, 2019
  • Colorado – Nov. 1, 2018-Jan. 15, 2019
  • D.C. – Nov. 1, 2018-Jan. 31, 2019
  • Massachusetts – Nov. 1, 2018-Jan. 23, 2019
  • Minnesota – Nov. 1, 2018-Jan. 13, 2019
  • New York – Nov. 1, 2018-Jan. 31, 2019
  • Rhode Island – Nov. 1-Dec. 31, 2018

You can enroll in Medicaid or the Children's Health Insurance Program (CHIP) any time of the year if you are eligible for those programs. See if you are eligible in Medicaid or CHIP.

Medicare open enrollment is Oct. 15-Dec. 7 each year. Information for health plans and prescriptions plans are usually sent for Medicare at the beginning of October. 

What are your health insurance options?

Depending on your situation, you have the following options:

Renew your current policy

During open enrollment, you can renew your current health insurance. You may not have to do anything if you want to keep what you have. But your current plan may be changing. Watch the mail for a letter about any changes your plan intends to make in 2019.

If the changes aren't acceptable to you (your doctor is leaving the network, for example, or your drugs won't be part of its list of covered medications), you will want to look for a plan that better suits your needs. If you need to switch, open enrollment is the time.

Buy an individual policy through a marketplace or directly from an insurance provider

You may want to sign up on the marketplace exchange in your state if you qualify for tax subsidies to help you pay your premiums. Qualifying depends on your family size and income. To qualify, your family income must fall between 100 and 400 percent of the federal poverty level (FPL).

Based on this formula, for 2019 coverage for a family of four, the income bracket between 100 and 400 percent is $25,100 to $100,400. If you or your family are under 400 percent of the federal poverty level, you can find subsidized health coverage. About three dozen states also have Medicaid expansion. Those states let people with incomes 138 percent of the federal poverty level to get Medicaid. 

Make changes to your employer-based group health insurance

If you get your health insurance through your employer, the open enrollment period for the government-run marketplaces and Affordable Care Act plans won't affect you. You need to sign up for coverage during your employer's open enrollment period. Some employers will automatically renew the plan you had this year. Others require that you sign up each year during its open enrollment. Ask your employer its rules so you know what you have to do.

The same advice to watch for changes applies.

Change your Medicare plan

If you are enrolled in Medicare and want to make a change in your plan – such as switching to Medicare Advantage (Part C) or adding prescription drug coverage (Part D) – you must sign up during its open enrollment period. Medicare open enrollment is Oct. 15 to Dec. 7, and coverage starts Jan. 1. Again, open enrollment for the government-run marketplaces would not affect you.

Buy a short-term health plan

Consumers have another option in 2019. Short-term health insurance plans were previously only available to young people or those who couldn't afford any other kind of health insurance. Starting in 2019, all people will have access to short-term plans. 

These plans are not nearly as generous as ACA plans. They don't have to cover basic services, such as maternity, prescription and mental health. So, you need to dig into a plan's specific coverage before going with a short-term plan. 

A benefit of short-term insurance plans is that they're much cheaper than other plans. However, they don't offer as much coverage so you may get stuck paying with more or all of healthcare costs for some services. 

How to select a health plan

If you're buying a health plan through the Affordable Care Act, you have a choice of four metal levels:

  • Bronze
  • Silver
  • Gold
  • Platinum

The amount of money that you must pay out of pocket when you use health services goes down with the metal level. Bronze plans will have the highest deductibles and copays while platinum will have the lowest. However, the premiums for the bronze plans will be the lowest and premiums will be the highest for platinum.Open enrollment

When deciding what's the best plan for you, think about your health and your family's health -- and financial situation.

Do you see a doctor or other health-care provider regularly to help you manage a chronic disease or condition? Do you take costly medications? You may want a health plan that has lower copays and deductibles if you are a frequent user of services.

If you are young and healthy and use few medical services, you may want a plan that costs less in premiums. Of course, you never know what can happen. And you can't change your plan outside open enrollment just because something happened to you.

Look at the out-of-pocket-maximums for the plans you're considering. Could you afford that amount should the unexpected happen? Check out the doctors and hospitals in the plan's network. Are the doctors and hospitals you prefer part of it? Some plans will only pay for those providers in their networks. Some plans will pay if you go to providers who are out-of-network, but at a lower rate than for in-network.

The plans are required to provide a list of drugs that they cover. The list is available on their websites. Check it out if you take medications to manage any conditions. See what you would pay in the different plans you are thinking of enrolling in. It may help you to compare if you make a spreadsheet.

What the health plan will cover

Under the Affordable Care Act, plans must provide at least 10 essential benefits:

  1. Outpatient care and chronic disease management (doctors' offices and clinics)
  2. Emergency room care
  3. Care if you go to a hospital and are admitted or require surgery
  4. Care if you are pregnant and after your child is born
  5. Services for mental health and substance abuse (this includes counseling and psychotherapy)
  6. Medications (though it may be limited and only certain medications)
  7. Rehab services and devices to help with injuries, disabilities and chronic conditions or to recover your physical and mental skills
  8. Blood, urine and other lab tests
  9. Preventive and wellness care
  10. And dental and vision care for children (but not adults)

Insurance plans can offer benefits in addition to the required benefits. The best way to find out what benefits each plan covers is to go to its website and compare.

What if you don't want health insurance?

If you don't sign up for health insurance during the open enrollment period, you may have to wait an entire year to sign up. The exception is if you have a qualifying life event that would spark a special enrollment period. 

Something important to remember: Starting in 2019, you won't get penalized at tax time for not having health insurance. Congress eliminated that mandate for 2019. 

Special enrollment for health insurance

You need to sign up for health insurance during open enrollment, but there are a limited number of ways that you can get health care during other parts of the year. If you don't enroll during open enrollment, you are eligible for a special exception enrollment period if:

  • You get married
  • You get divorced and were getting your health insurance through your spouse's employer
  • You have a baby or adopt a baby or place a child for adoption or foster care
  • Your spouse or partner dies and that leaves you without health insurance
  • Your spouse or partner loses a job and you had coverage through his or her work
  • You lose your job and had coverage through your work
  • Your hours are cut and you are no longer a full-time employee eligible for workplace coverage
  • You are in an HMO and move outside its coverage area
  • You leave jail or gain citizenship

If you voluntarily drop your coverage, you won't qualify for a special enrollment period. The only time you can re-enroll is during open enrollment.

If you apply for a special exception and are rejected, you can appeal the decision to the Health Insurance Marketplace.

What's the difference between an HMO, PPO, HDHP, EPO and POS? Find out here.

Where can you learn more?

HealthCare.gov has a list of important marketplace deadlines and information about eligibility. You also can sign up to get emails about new health insurance options and benefits.

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