This is a very busy time of year, with the holidays and year end just around the corner. However, it’s also an important time to evaluate your healthcare options. Open enrollment for the Health Insurance Marketplace began November 1, 2015 and ends January 31, 2016. This is the time where you can enroll in a plan or change your existing plan. Many people don’t understand the benefits and options available in the Marketplace or assume they can’t afford coverage. Why should you check out the Health Insurance Marketplace?
There are some valuable coverage enhancements available
Before the Affordable Care Act, individual health insurance policies would normally exclude existing health issues or preexisting conditions. Under the Affordable Care Act, preexisting conditions are now covered. Preventive care, such as annual physicals and mammograms, are covered at 100% of the cost, with no copayment or deductible. Dental and vision coverage for children is now included in the health plans.
You can select a plan that fits your budget based on premium and out of pocket costs
You can choose from four “metallic” plans – Bronze, Silver, Gold or Platinum. The difference between the plans is the amount you will pay out of pocket for a covered service. For example, a Bronze plan will have a lower monthly premium, but on average the insurance company will pay about 60% of the cost of a covered service, such as a hospital stay or a CT scan. The Platinum plan will have a higher monthly premium, but the insurance company will pay, on average, 90% of a covered service. You can select a plan that makes the most financial sense for you based on anticipated usage.
You may be eligible for subsidies for premiums and out of pocket costs
Depending on your income and family status, you may be eligible for a premium tax credit that will reduce your monthly premiums. In addition, you may also qualify for cost-sharing reductions. This means that you would pay less out of pocket for a covered service. To be eligible for cost-sharing savings, you must enroll in a “Silver” plan.
Not enrolling can cost you in a couple of ways
If you don’t enroll in a qualified plan, you may be subject to a tax penalty. Depending on your income level and family status, the penalty may be a flat dollar amount or a percentage of taxable income. However, the more significant costs could be uncovered medical bills. The costs of medical treatment can be substantial, and unpaid medical bills are now the leading cause of bankruptcy.
Here are some important dates to remember. December 15, 2015 is the deadline to enroll in a plan effective January 1, 2016. January 15, 2016 is the last day to enroll in a plan to be effective February 1, 2016. January 31, 2016 is the end of open enrollment, and any enrollments between January 16th and January 31st will be effective March 1, 2016. For more information or to enroll in a plan, visit www.healthcare.gov/get-coverage or www.texashealthoptions.com.