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Open Enrollment 2019 & Health Insurance – Your Guide




It’s that time of year when millions of Americans are starting to look into their health insurance coverage options ahead of the 2019 Open Enrollment period. With the relatively short sign-up period for coverage under the Affordable Care Act (ACA), also known as Obamacare, it’s important to get organized and understand what you need to select the plan on the health insurance marketplace that’s best suited to your needs and those of your family.

Last year, there were 8.8 million sign-ups via HealthCare.gov, the federal ACA exchange, with a further 3 million Americans picking health coverage from a state-based health insurance marketplace. Whether you decide to simply renew your existing insurance or explore the other coverage options available, we are here to bring you helpful enrollment tips and the key information you need for the 2019 Open Enrollment period.

Open Enrollment Dates and Deadlines: What you need to know…

In 2018, the Trump administration changed the open enrollment deadlines, reducing the sign-up period from 12 weeks to six weeks. For the majority of states, it is the same this year, with residents given a six-week window to get their health coverage arranged on the federal health insurance marketplace. However, several states with their own health insurance marketplace have opted for extended open enrollment dates…

  • November 1, 2018 - Open Enrollment period starts

  • December 15, 2018 - Final day to enroll or change your health insurance plan 

  • January 1, 2019 - Start date of your new health insurance plan

Notable exceptions:

All states using the health insurance marketplace HealthCare.gov use the annual open enrollment periods detailed above, but a small number of those with state-run exchanges have slightly longer Open Enrollment periods. In some states, such as California, enrolling after a certain date pushes back the start date of your cover, so make sure you check if you live in one of the states listed below.

  • California - October 15, 2018 to January 15, 2019 

  • District of Columbia - October 15, 2018 to January 31, 2019

  • Massachusetts - November 1, 2018 to January 23, 2019

  • Minnesota - November 1, 2018 to January 13, 2019

  • Rhode Island - November 1, 2018 to December 31, 2019

What is the Special Enrollment Period?

There are two ways to enroll or change plan options outside the official 2019 Open Enrollment period: via Medicaid or the Children’s Health Insurance Program (CHIP), which you can apply for at any time; or during a Special Enrollment Period, which you may be eligible for if you have experienced a significant life event. 

You may qualify for the Special Enrollment Period at any point in the year if you or anyone in your household have had a significant life event. However, you usually only remain eligible for 60 days after the significant life event, so it is still important to be proactive in sorting out your health insurance under these circumstances.

Do I qualify for the Special Enrollment Period?

Life changes that may qualify you for Special Enrollment include: 

  • Marriage - if you have recently tied the knot, pick a plan by the end of the month and your cover will start on the first of the next month.

  • Having a baby, adoption, or placing a child in foster care - if you enroll in a health insurance plan within 60 days, your cover will begin on the day of the life event.

  • Divorce or legal separation with loss of health insurance - you will only qualify if this life event results in you losing coverage.

  • Death - if someone on your marketplace plan passes away leaving you without a health plan, you will be eligible for the Special Enrollment Period.

  • Moving house - if you move to a new ZIP code or county, move to the United States from overseas or a United States territory, are a student moving to or from school, are a seasonal worker moving to or from where you live and work, or move to or from a shelter or transitional housing, you may qualify for the Special Enrollment Period. 

  • Loss of health insurance - if you lose health coverage or expect to lose coverage in the next 60 days, you may be eligible.

There are other cases in which you may qualify for the Special Enrollment Period so if your circumstances are not listed above, it does not mean you will not be eligible. For example, during the 2018 Open Enrollment Period, all Florida residents received an exceptional circumstances Special Enrollment Period following the hurricanes that swept across the state. For more details, check the Special Enrollment Period resources on the HealthCare.gov website.

What has changed since last year?

No more individual mandate or penalties

The Trump Administration abolished the individual mandate and the associated fine. This means you will no longer be fined for not having ACA-compliant health insurance, for instance, if you opt for short-term plans. However, two states do still have a state-imposed penalty so make sure to check whether these could apply to you. These are:

  • Massachusetts - 2019 is the first year the state’s penalty will apply in full. You will only be penalized if you can afford health insurance but choose not to enroll.

  • New Jersey - Those without the minimum essential coverage may have to pay a penalty. Certain people are exempt, for instance, if you object to health insurance for religious reasons.

If you live in Vermont or the District of Columbia, you will not be subject to penalties in 2019, but be warned that this may change in 2020. If you do not plan on enrolling this year, ensure you check whether you will be subject to penalties before making your decision.

The new rules from the Centers for Medicare and Medicaid Services (CMS) also introduced other criteria for exemption, for example, if you live in a county where no health insurance companies offer coverage or where there is only one insurer.

Greater flexibility for insurance companies means more options

The new CMS rules allow states greater flexibility and capability to build their own Essential Health Benefits. Under the ACA, there were ten Essential Health Benefits that all plans on the health insurance marketplace needed to meet the federal government and state regulations. 

From this year, states can choose from 50 Essential Health Benefit benchmark plans, potentially giving insurance companies more flexibility and hopefully providing more options for you, the consumer.

What information do I need for the 2019 Open Enrollment?

To ensure you select the best health coverage for you and your family, it’s important to make a few basic preparations and get some key pieces of information together ahead of the 2019 Open Enrollment period… 

Your expected household income for 2019

The amount you pay for health insurance depends in part on your household income, so having these figures to hand when it comes to choosing a health plan can help you save money, as you may qualify for a premium tax credit or other savings on out-of-pocket costs, such as deductibles or copayments.

Note that these figures are based on the projected household income for the coming year, so if your estimates prove significantly different from your actual earnings, it is important to update these details over the course of the year. If your earnings are lower, you may be eligible for cheaper premiums, but if they are higher, you may be required to repay some of the tax credits or discounts.

Details of your current health insurance plan 

If you are unsatisfied with your existing cover, you may want to consider what other plans are available that may better suit your needs. Understanding the cover you already have will make it easier to compare alternative health plans and establish what changes need to be made and which benefits you need to add to ensure your family gets the best available cover.

Details of any changes to your healthcare needs

If you or someone covered by your policy has new healthcare needs, for example, if they need prescription medication they did not require last year, it is helpful to have this information to hand when selecting your plan. 

While you may decide to use the same plan as you have in previous years, if your health requirements have changed, there may be an alternative plan offering better cover or a lower price. 

It may also be worth visiting your physician for a medical to check whether you will need any further treatment or new prescriptions in the coming year. This will help guide you when selecting your health plan. 

Can I still use RxSpark with insurance?

We will continue to provide useful information on the 2019 Open Enrollment period, but RxSpark can also help you reduce your healthcare costs, even if you have insurance. If your medication is covered by your insurer’s formulary this may be the cheapest option, but it is always worth checking the cash price and the discounts available with RxSpark, as this may still be cheaper than the copay. 

However, if you are one of those whose medication is not covered by your insurer’s formulary, your RxSpark prescription discount card could help you save up to 80 percent on the cash price of your medicine. 

Check in with the RxSpark blog in the coming weeks for more articles and information on the coming 2019 Open Enrollment period.