Open Enrollment for Individual Plans: Tips, Truths, and Considerations

Open Enrollment for individual health plans is underway, but the political climate has created much confusion and angst for consumers.  Below is a list of tips, considerations, and truths for this open enrollment period, which runs from November 1, 2017 through December 15, 2017, and through January 31, 2018 in California.  You can also download our guide to buying insurance.

1. There is no such thing as “Trumpcare.” Congress did not repeal the Affordable Care Act (ACA or Obamacare) and replace it with “Trumpcare.”  But the Trump Administration DID make some changes to the existing ACA law, and those changes may affect plans, cost sharing reductions, and open enrollment periods, so check with an agent in your state. And be wary of websites or other offers that promise an Obamacare alternative. There are no compliant alternatives, so these offers are often scams.

2. The ACA, Obamacare, and Covered CA are not different laws. The ACA, sometimes referred to informally as Obamacare, established state marketplaces to sell insurance, such as California’s Covered CA.   You are not covered by a different law in each state.  For example:  if you are offered affordable coverage at work, you are not eligible for premium tax credits, regardless of what state marketplace you would use to purchase an individual plan.

3. Open Enrollment is the time you can purchase an individual or family plan through a state marketplace. If you miss this period, you cannot purchase a plan until the next Open Enrollment period unless you experience a qualifying event, such as losing coverage at work.  The dates for open enrollment are a source of great confusion this year, because the Trump Administration has shortened the open enrollment period. Some states have disregarded that shorter period, keeping last year’s time-frame.  In California, Open Enrollment will run through January 31, 2018.

4. The individual mandate of the ACA remains in effect for 2018. This is the part of the law that requires individuals to have and maintain qualifying health coverage for themselves and their dependents throughout the entire year. An individual who fails to maintain coverage for the year will be assessed a tax penalty, absent certain limited exemptions.

5. There may be plans available outside of the marketplace in your state, and if purchased during the Open Enrollment period, they will still comply with the guidelines set forth by the ACA, such as including Essential Health Benefits. Insurance carriers can offer “on exchange” and “off exchange” plans, so they meet the requirements of the law.  An agent can guide you through which plan is right for you.

6. Be a wise consumer of health care. Health insurance is a payment method, and at the end of the day, what you are buying is health care.  There is a tremendous variation in price for doctors, practitioners, and hospitals. Ask questions, do research, and ensure that the price you are being charged for services is representative and not exorbitant.

Last truth to be told: DO NOT WAIT UNTIL THE LAST MINUTE TO ENROLL.  Seriously, don’t do that.