If you have health insurance — whether it’s Medicare, Obamacare or coverage from your employer — you have some decisions to make.
Open enrollment season is upon us, and the big things to look for this year include premium costs; rising costs of deductibles; changes in drug coverage; and whether your network still includes your doctor — or at least a good selection of potential new providers to choose from if not.
“Often people kind of passively go along with what they had before, and they don’t realize that their premiums may have gone up,” said Whitney Griggs, consumer education specialist with Georgians for a Healthy Future, an advocacy group that helps people gain insurance. “It’s really important to shop around.”
Even people who choose to go without health insurance — even though they can afford it — also have new considerations this year. The Affordable Care Act’s penalty for remaining uninsured is increasing to at least $695 for 2016 and could be even higher depending on income.
Sunday marks the start of open enrollment for the Obamacare online health insurance marketplace at HealthCare.gov. It runs through Jan. 31. Meanwhile, open enrollment for most employer-sponsored plans is either underway or will be within the next few weeks, and it’s already open for Medicare, the government health program for Americans 65 or older.
Morgan Kendrick, CEO of Blue Cross and Blue Shield of Georgia, said consumer choice is one of the biggest trends in health care this year
“Consumers want convenience and transparency,” Kendrick said. “They are looking for things that make their lives easier.”
For example, Blue Cross customers may look up the cost of an office visit or procedure beforehand and also see quality metrics of providers.
To help make a wise choice, here are some tips and some questions to consider as you navigate open enrollment. Remember: Deadlines are important. Don’t forget to gather information such as your health care expenses for the past year and, if you are buying insurance through the Obamacare marketplace, your tax returns.
- Obamacare enrollment: Nov. 1 - Jan. 31; must enroll by Dec. 15 for coverage to take effect on Jan. 1
- Medicare enrollment: Now through Dec. 7
- Employer-sponsored plans: Some companies have already started open enrollment, so check with human resources
- Medicaid enrollment: All year, if you meet the criteria
THINGS TO CONSIDER
Insurance through your employer: First, look for any new plans your company may offer. Second, look at the premium, the deductible and other out-of-pocket costs. Your premium — what you pay for your insurance each month — may be close to the same as last year, but your deductible could have jumped so much that another policy would be better for you. Jay Savan, a partner with benefits management company Mercer, said insurers typically try to keep premiums low but may raise deductibles. Savan suggests opening a health savings account if you have a high deductible. HSAs enable you to set aside income, before taxes, to pay for medical expenses. The 2016 limit for an individual is $3,350, which includes your personal contribution to the account as well as any amount your employer may contribute. Families can contribute up to $6,750. Any unspent money can be carried over from year to year.
Flexible spending accounts are still a good way to put money aside (also pretax, as with HSAs), but often you can’t carry over any money into the next year: spend it or lose it. FSAs also have a lower limit — $2,550 in 2016. Different rules apply for the two accounts, so ask your benefits manager for specifics.
Medicare: Open enrollment started Oct. 15 and runs through Dec. 7. By now, you should have received materials, including your “annual notice of change” letter, for your health or prescription drug plan. If not, call 1-800-MEDICARE (1-800-633-4227). When considering your choices, remember that you can choose a Medicare Advantage plan or Original Medicare. As you review your plan, make sure any medications that you take routinely are still covered. Also, make sure your doctors are still in-network. You may qualify for help paying for Medicare. Visit medicare.gov for more information.
Obamacare: Open enrollment begins Nov. 1 and lasts through Jan. 31. Gather your health care information and 2014 tax return, and begin to assess your health care needs. Remember, even if you enrolled last year or the year before, experts advise that you shop around. Look at these things: how much did you spend last year for your deductible? Is it likely to be the same this year? How much did you spend on medications? Do you need dental coverage? Do you have chronic illnesses, such as diabetes, that require careful management? How much did that cost?
Individual insurance, without an Obamacare tax credit: Act now; most people still have to buy insurance during the enrollment period that runs from Nov. 1 to Jan. 31. This is a requirement of the Affordable Care Act, and it irks some people, such as the self-employed, who were buying insurance on their own for years. Generally speaking, you cannot get caught up in the hustle and bustle of the holidays and wait until February or later to buy health insurance for the rest of the year. If you want coverage for 2016, you must enroll by Jan. 31. And remember: if you wait until Jan. 31, your coverage will not begin until March 1.
If you have Medicaid or may be eligible for it: You could be eligible for Medicaid if your income is very low and meets certain criteria. For example, if you are blind or disabled, and if you are the parent or guardian of a child younger than 19, you may will be eligible for Medicaid. There is no deadline to enroll. Visit: www.compass.ga.gov
If you do not have health insurance: If you can afford to buy health insurance but do not buy it, you will pay a higher penalty in 2016 than in 2015.
You will pay the higher of:
- $695 person, (or $347.50 per child under 18), with a maximum family penalty of $2,085
- 2.5 percent of your yearly household income above the tax filing threshold of about $10,150. Thus, if your income is $50,000, the penalty would be based on 2.5 percent of $39,850,or $996.25.
If you do not have insurance for two months or less, you will not have to pay a penalty. For periods longer than that but shorter than a year, your penalty will be assessed for each month you are uninsured.
If you would like health insurance but cannot afford it, you should still check with HealthCare.gov, Griggs said. If you are not eligible for any assistance to pay for insurance, there are still a few low-cost options should you fall ill. Georgia has several federally qualified health centers (FQHCs) and community health centers that provide free care or care on a sliding scale.
Sources: Georgians for a Healthy Future, Kaiser Family Foundation, Mercer, Blue Cross/Blue Shield of Georgia, U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services.
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This article was prepared in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.