There’s still time to shop for coverage before open enrollment closes March 31. But this year — with the Patient Protection and Affordable Care Act — there’s more to know and understand than ever.
Brokers need to do their best to inform their clients of important information for enrollment time. And giving them a series of easy-to-read shopping tips might be useful.
Ehealth released a list of top five health insurance tips for consumers who are shopping for 2014 coverage during the remainder of the open enrollment period.
1. Know your deadlines. PPACA creates specific deadlines that affect you when it comes to enrolling in coverage and avoiding a tax penalty at the end of the year. Carriers might have their own enrollment deadlines and rules to determine the date on which your coverage becomes effective.
•Feb. 15 — Depending on the rules in your state, this could be the last day to enroll in a health insurance plan if you want your coverage to start on March 1, 2014.
•March 31 — This is the last day of the nationwide open enrollment period for 2014. You need to enroll in health insurance coverage by this date in order to avoid possibly having to pay a tax penalty on your 2014 federal tax return.
You should know that enrolling in coverage in the second half of the month generally means coverage likely will take effect on the first day of the month, two months in the future. So, for example, enrolling by Feb. 15 means that your coverage may start as early as March 1, but enrolling on Feb. 16 means that your coverage may not begin until April 1.
2. Shop outside of public exchanges to explore all your coverage options. Government exchange websites are designed to provide subsidy-eligible consumers with access to plans specially qualified for purchase with a subsidy. Not all plans are. Some major carriers have opted not to sell plans through the exchanges. Consumers who want to choose from the broadest selection of plans and find the best match for their needs and budget also should consider plans available off the exchange through licensed online agents. These plans will still meet the coverage requirements of the law and keep you from having to pay a tax penalty, so long as you maintain your coverage during the year without a gap of more than three consecutive months.
3. Understand the true cost of any health plan you’re considering. The true cost of any health insurance plan is about more than your monthly premiums. It’s also about how costs are shared when you actually receive medical care. Look at your annual deductible, copayments, and coinsurance — and your annual out-of-pocket maximum. Understand how different forms of cost-sharing may apply to different kinds of medical care. Read the fine print, and talk to a licensed agent for personal help understanding your coverage details.
4. Make sure that government subsidies will work for you. PPACA allows some people earning less than 400 percent of the federal poverty level (about $46,000 per year for a single person or $94,000 for a family of four) to receive subsidies to help with their monthly premiums, depending on the cost of coverage for the benchmark plans in their area. Be aware that your eligibility is based on your projected earnings for 2014 rather than your past earnings, and only the government can make the final determination on your subsidy eligibility. If your income fluctuates or changes during the year, your eligibility for a subsidy may also change. If you earn more than expected in 2014, you may have to repay all or a part of any subsidy you received when you complete your 2014 federal tax return.
President Obama signs PPACA bill in the East Room of the White House in Washington, Tuesday, March 23, 2010. (AP Photo/Charles Dharapak)
5. Pay attention to doctor and hospital networks. People who already had self-purchased coverage in 2013 might find that their list of network providers is different in 2014. Just because your favorite doctor accepts a specific insurance company doesn't mean that he or she is a preferred provider for all plans sold by that insurer. Provider networks may have changed on January 1, and some plans limit your access to providers to help keep costs in check. Make sure that the doctors or hospitals you like best — or the ones close to your home—are preferred providers under your new health plan in 2014.
Photo: Jason Redmond/Associated Press