Open enrollment for 2017 health plans begins next week! From November 1, 2016, through January 31, 2017, you can enroll in a health plan through the Health Insurance Marketplace. If you need to make changes to an existing insurance plan, you can also do that during this time.
There is a special enrollment period for certain individuals who qualify. This enrollment period can take place anytime outside of the yearly open enrollment dates (listed above). You may qualify for this special enrollment if you have any of the following qualifying events:
- Recently got married
- Became a U.S. citizen
- Had or adopted a child
- Lost other health coverage
- Moved to an area where new health plans are available
- And more
You must enroll in a plan 60 days following the qualifying event, and provide proof of your qualification. If you do not enroll within that period of time, you’ll need to wait until Open Enrollment begins. So, if you were counting on one of these events to give you an opportunity to enroll outside of the open enrollment period, make sure you haven’t passed the 60-day limit. If so, you’ll want to enroll in a health plan next month.
There are a few more exceptions outside of those who qualify for a special enrollment period and that includes those who can enroll for a health plan year-round. This includes:
- Those enrolling in Medicaid
- Children who need the Children’s Health Insurance Plan (CHIP)
- Native Americans
- Alaska Natives
Where Can I Get a Health Plan?
There are several ways to acquire a health plan:
- Find one on your state’s exchange or healthcare.gov
- Call the marketplace call center at 1-800-318-2596
- Go to an insurance provider’s website
- Talk to a local health insurance broker
While you can get a plan using one of these four options, it is important to note that only through the exchange and healthcare.gov can you get any tax credits to lower monthly premium payments, if you qualify.
What If I Have Health Insurance Through My Employer?
Enrollment periods for employer-sponsored health insurance plans may vary. These typically occur in the Fall around this time, but they do not necessarily occur from November 1st through January 31st like individual health plans found on the exchange and elsewhere.
The open enrollment dates for employer-sponsored health insurance are determined by the employer and health insurer. These enrollment periods are typically shorter than other plans because there aren’t as many options.
And while most employees are satisfied with their employer’s plan, you can buy a different plan than what your company sponsors. Keep in mind though that if you decline your employer’s plan, you won’t be able to get tax credits for a marketplace plan if you qualify and company plans are usually much less expensive than a plan you might find on a public exchange. This is because employers generally cover a portion of the premiums for their employees.
If you are looking to decline or cancel insurance with your employer, you’ll want to do that during their open enrollment period but you will only be able to sign up for another plan during open enrollment. Voluntary loss of coverage will not qualify you for a special enrollment period.
How Do I Cancel a Health Plan?
Most plans will automatically discontinue after the year is up, but not all of them do. If you want to cancel a plan you got from the exchange, make sure you do that by December 31st.
Will I Face a Penalty if I Don’t Have Health Insurance?
Yes. Anyone who does not have a health plan–whether that is found on your state’s exchange, the marketplace, directly from an insurance provider or through an employer–will have to pay a penalty on their next tax return. The cost of that penalty varies depending on the person who has to pay it.
According to NerdWallet, you’ll either need to pay a percentage of your total household adjusted gross income or a flat rate. You’ll be required to pay whichever one is greater. And the longer you go without health insurance, the more you may have to pay. The penalty cost increases each year you go without having it.
Is Dental Insurance Included in Open Enrollment?
You can purchase dental insurance at any time. There isn’t a special enrollment period for these plans. However, there are some health plans on the exchange that include dental coverage. These can only be added or changed during open enrollment. You will have the option to choose dental coverage only after you have chosen your health plan. It will show you whether dental is included or give you the option to select another dental plan after you have chosen your health plan.
Dental Insurance is not required by the ACA. Dental coverage has to be offered to children ages 18 and below as an essential health benefit, but no one is required to have it. There won’t be a penalty if you don’t have dental insurance.
We recommend that everyone have some type of dental coverage, whether that is through a dental insurance plan you buy with your health plan on the exchange, a plan you purchased directly from an insurance provider or a discount dental plan (which is not insurance, but can save you a significant amount on your dental work all the same).
Can I Get Vision Insurance on the Exchange?
Typically, you will not find vision insurance on the exchange, and it’s not something that is required by the ACA as a benefit you have to have. It is still very important for your health and basic vision benefits must at least be offered for kids ages 18 and younger as an essential health benefit on the exchange, much like dental.
These plans will typically include annual examinations and glasses or contact lenses.
Vision plans can be canceled at any time unless it is apart of a health plan you purchased on the marketplace. You will need to wait to change your plan during open enrollment.
As this is an election year, a lot could change with open enrollment next year, or very little. Time will tell how our healthcare system will evolve. Stay tuned for next week’s blog post: How Will the 2016 Presidential Election Affect Healthcare.
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Great summary, thanks for your help. It answered some key questions I had.