7 Things to Know During Health Insurance Open Enrollment

October 31, 2017 6:00 AM

No one wants to get sick. No one wants to go broke. Which is why going beyond the health insurance headlines to get the facts — and get coverage — is essential.

The news about health insurance this past year has left a lot of people confused. And that confusion is peaking just in time for late fall, when nearly everyone has to decide on their health insurance for next year.

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Here are some key things to know right now, no matter your health insurance situation:

Basic terms: The amount you pay each month to have insurance coverage is called a premium. The amount you pay each time you get care is called a copay. And the share of your health care costs that you have to pay doctors and hospitals before your insurance kicks in is called a deductible.

Resources available: If you need help finding or choosing health insurance (except for employer plans) and you live in Michigan, you can get free help by phone, email or in person from counselors at Michigan Medicine, the University of Michigan’s academic medical center. If you live elsewhere, HealthCare.gov offers a searchable database of certified enrollment counselors everywhere.

Now, skip down to the case that applies to you.

If your job offers health insurance …

Most Americans get health insurance through their employers. For the most part, enrolling in it is a no-brainer.

But during your company’s open enrollment this fall, you may want to pay more attention than usual. To save money, many companies have changed what they offer — usually in a way that makes employees responsible for more of their health costs or that limits which doctors and hospitals they can go to without paying extra.

So take a minute to read through the options. If you choose the plan that takes the smallest bite out of your paycheck (the premium), understand that it may come with a high deductible, high copays or a smaller network of places you can get care. So if you need care in 2018, you may end up paying more out of your own pocket.

SEE ALSO: Want to Save on Prescription or Over-the-Counter Drugs? Speak Up

The good news: You can save for those costs throughout the year by opening a tax-free health savings account (HSA) or flexible spending account (FSA). Talk to your human resources department about these.

Also, if you’re a woman (or you cover a woman or teen girl on your insurance), you may want to read the fine print of your employer’s coverage for birth control. Changes in the law might affect this coverage next year.

If you have Medicare …

Medicare recipients have options right now. Until Dec. 7, you can switch plans, add prescription drug coverage and make other changes for 2018.

Most participants have traditional Medicare, run by the federal government. About a third have a Medicare Advantage plan run by a private company. You can also buy add-on plans to expand your coverage.

You can find trustworthy information about all these options online at Medicare.gov. If you’re not sure what to choose, this tool can help you find the best option.

But beware of scams.

For instance, next year every Medicare participant will receive a new, more secure ID card that has a random number on it instead of your Social Security number. Scammers are already claiming they can “help” you get your card — for a fee, of course. But you don’t have to pay anything to get the new card, and you don’t need anyone to help you. Just wait for it in the mail.

If you’re low-income or disabled …

If you don’t make a lot of money or you have a serious disability, you can get free or low-cost insurance in most states through Medicaid. The Affordable Care Act allowed states to open up the program to more people — basically, anyone whose income is less than 138 percent of poverty level. (That’s about $16,600 for a single person and $34,000 for a family of four.)

So far, 31 states and the District of Columbia have opted in, so anyone with low incomes can get Medicaid in those places.

In the other states, restrictions apply and vary greatly. But children in low-income families in these states may still be eligible for the Children’s Health Insurance Program (CHIP), even if their parents don’t qualify for Medicaid.

Even though 1 in 5 Americans gets their health insurance through Medicaid and CHIP, many people who qualify for these programs still don’t know it. Find out if you qualify
here; you can enroll any time of year.

If you need to buy your own insurance …

The market for individual and family plans opens for business Nov. 1 and closes Dec. 15. That’s a much shorter open enrollment period than in previous years.

HealthCare.gov is still the place to buy these plans. But this year, the site will be down for maintenance on Sunday mornings. You’ll also see less advertising reminding you to sign up and fewer community organizations offering help with choosing a plan and enrolling. Again, HealthCare.gov local resources can help.

You may have also heard that rates for these plans are shooting up, or that some of the funding to support them is getting cut off. But that’s only part of the story.

SEE ALSO: How to Discuss Health Care and End-of-Life Wishes During the Holidays

Don’t let the news headlines confuse you. Here are key things to know before you enroll:

  • Don’t procrastinate. With a shorter enrollment period and not much chance of extending it, you’re better off getting started now. If you leave it until the last minute, you may not be able to get help from overloaded counselors.

  • Don’t assume anything. If you’ve bought insurance for yourself before, the plan you had before may change or not be available for 2018. Other plans may have changed their offerings and costs. So check out what’s available in your area for 2018, and choose carefully. And if you got a health insurance tax credit on the 2017 federal tax return that you filed this year, you need to file a form before you sign up for 2018 coverage.

  • Don’t just look at the sticker price — look at the actual cost to you. Just like buying a car, your final cost might come down because of subsidies, discounts on copays and deductibles, and credits on your income taxes. You won’t know this until you enter some information. But whatever you do, don’t walk away when you see the initial “sticker price.” This tool can help you understand what financial assistance could help you cover the cost.

  • It pays to check all the plans available in your area. Even if you’ve bought a silver-level plan in the past, you should check bronze, gold and platinum ones, too. Because of the wrangling in Washington and a quirk of the law, some insurance companies are setting silver plan rates much higher than last year’s, but they’re keeping the cost of other plans lower. Also, even if a silver plan has gotten much more expensive, if you qualify for payment help, you will get a larger amount to cover the increase if you choose silver.

If your life will change in 2018, figure out now how it will affect your health insurance status. Getting married, having a baby, losing coverage from a job, changing income and other life events may make you eligible for a special enrollment period in 2018. That means you won’t be locked into the choices you make now.

If you’re thinking of going without insurance …

Don’t skip health coverage in 2018 without knowing the penalties and the options open to you.

First, most people still are federally required to be insured. Without insurance, you’ll pay a penalty on your taxes in 2019 — which last year was a maximum of $2,085 per family or about $700 per person. (This calculator from the Kaiser Family Foundation estimates your penalty for going uninsured versus how much you would pay for health insurance coverage on the Marketplace.) 

Plus, paying the bills for one illness or injury could wipe you out financially.

If affordability is the issue, talk to a counselor.

For instance, if you’re under age 30 or buying a Marketplace plan would take up too much of your income, you can buy a catastrophic plan to cover just the worst-case scenario health situations.

If you find that your income is too high to get financial help on the Marketplace plans, you can also contact an insurance company and ask about buying a plan directly. (For example, if you live in Michigan, here are sites where you can find companies and insurance agencies.)

Sure, health insurance is confusing. But with help, you can cut through the noise and find something that works for you.