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Open enrollment 2019: Answers to five key questions

Open enrollment for the Marketplace and individual health plans is open for 2019.

Last day to make plan selections of changes is December 15, 2018. Coverage will begin January 1, 2019.

Open enrollment for Affordable Care Act (ACA) plans run from Nov. 1-Dec. 15, 2018 in most states for 2019 health plans.

The federal government's rule gives people shopping for 2019 individual health coverage on the federal exchange, or directly with insurers, 45 days to sign up. However, some states that operate their own exchanges offer more the time that people have to buy health insurance for themselves. 

Here are the open enrollment dates:

Open enrollment for the exchanges
Federal exchangesNov. 1-Dec. 15, 2018
States with their own exchanges
CaliforniaOct. 15, 2018-Jan. 15, 2019
ColoradoNov. 1, 2018-Jan. 15, 2019
ConnecticutNov. 1-Dec. 15, 2018
District of ColumbiaNov. 1, 2018-Jan. 31, 2019
IdahoNov. 1-Dec. 15, 2018
MarylandNov. 1-Dec. 15, 2018
MassachusettsNov. 1, 2018-Jan. 23, 2019
MinnesotaNov. 1, 2018-Jan. 13, 2019
New YorkNov. 1, 2018-Jan. 31, 2019
Rhode IslandNov. 1-Dec. 31, 2018
VermontNov. 1-Dec. 15, 2018
WashingtonNov. 1-Dec. 15, 2018

There are important changes for 2019. Most importantly, Americans no longer must have health insurance or face a tax penalty. Congress wiped out the individual mandate penalty as part of its major tax bill in 2017. 

Starting in 2019, you no longer must have health insurance. Of course, having health insurance is one of the most important purchases you make. You still have multiple options. 

If you're not covered through your employer, your employer's spouse or another way like Medicare or Medicaid, you can get an individual health plan through the ACA exchanges or buying directly with health insurance providers to cover you and your family.

Here's what you need to know about open enrollment:

What do health plans cover?

There was a time not too long ago when low-cost health insurance plans offered limited coverage. However, ACA required most health insurance plans to cover essential health benefits, including:

  • Outpatient care
  • Chronic disease management
  • Emergency care
  • Hospitalization
  • Pregnancy and newborn care
  • Mental health and substance abuse services
  • Prescription drugs
  • Rehabilitation services
  • Lab tests
  • Preventive and wellness services
  • Dental and vision care for children

The plans offer more protection for you and your family, but with that additional coverage usually comes a higher price tag than what you would have paid for health insurance just a few years ago when insurers could offer plans with limited benefits.

Health insurers' plans vary greatly based on premiums, out-of-pocket costs, deductibles and provider networks. You can find out the specifics about each plan offered by reviewing the Summary of Benefits and Coverage on each plan's website or your ACA marketplace may provide side-by-side comparisons.

What can you do during open enrollment?

You can keep your current health insurance plan or choose a new plan through the ACA exchanges or with a health insurance provider directly.

If you're enrolled in a marketplace plan, it will automatically renew, but you still want to research plans to see if the insurance company made any changes to the provider network and out-of-pocket costs like copays and deductibles. It's a good idea to review that information to make sure your plan still makes sense for you and that your providers are still part of the plan.

ACA plans are divided into four types: Bronze, Silver, Gold and Platinum. Bronze plans have the highest out-of-pocket costs and the lowest premiums, so you can think of them kind of like high-deductible health plans that have become so common for employer-based health insurance. Platinum has the lowest out-of-pocket costs, but also higher premiums. A good way to look at it is the higher premiums you pay, the lower you'll have to spend on out-of-pocket costs during the year.

The Trump administration is also opening up low-cost, low-coverage health plans to more Americans in 2019. The ACA limited short-term health plans, also called catastrophic health plans, to only young people and those who couldn't afford any other health insurance. However, in 2019, all Americans are eligible for short-term coverage. 

Short-term health insurance were once options for only three months at a time. Starting in 2019, people can have a short-term plan and renew the policy twice. So, in essence, you could have a short-term plan for three years. 

This coverage doesn't protect you like ACA plans. It might not provide maternity or mental health coverage, for instance. So, it's critical you find exactly what short-term plans cover and their out-of-pocket costs before signing up. You don't want to buy a short-term plan and then find out you don't get prescription drug coverage and need it. 

Regardless of what plan you choose, spend the time to review your options and pick the right plan for you and your situation.

Think about the past few years of your healthcare services, as well as the healthcare provided to your spouse and family. Then, think about the year ahead.

Some things to think about?

  • Do you regularly visit your provider for a chronic illness?

  • Have you been dealing with occasional health issues that may require more healthcare services?

  • Do you take costly prescription drugs?

  • Do you plan on starting a family in the next year?

  • Do you have enough money set aside to pay for potentially high deductibles?

That all goes into what's the best plan to choose for your situation. Generally, higher premium/lower out-of-pocket costs like Platinum plans could make more sense if you expect to need healthcare services. However, if you're young and healthy and would rather pay more for using healthcare services than paying a higher monthly premium, then a Bronze plan could be right for you.

It's critical that you give this much thought because you won't be able to change the plan again for a year.

Is open enrollment the same for other types of health insurance plans?

Open enrollment for ACA plans and individual health plans in most states is Nov. 1-Dec. 15, but it's different for other type of health plans.

For instance, if you are covered by your employer, you will likely have a different open enrollment period. There is no standard open enrollment period for businesses. They choose their own. Many are in the fall or winter, but yours may be in the spring. Check with your employer's benefits department to find out your open enrollment.

If you're in Medicare, your open enrollment is Oct. 15 to Dec. 7, 2018. During open enrollment for Medicare, you can keep the same coverage, change Medicare Advantage or Part D prescription drug plans, switch Medicare Advantage plans or even swap from Medicare to a Medicare Advantage plan.

For those who qualify for Medicaid or the Children's Health Insurance Program, there is no open enrollment period. Instead, you can enroll at any time of the year.

What if you miss the open enrollment period?

If you don't sign up or don't make changes during open enrollment, you won't be eligible to switch plans for a year unless you qualify for a special enrollment. Some events that trigger a special enrollment is if you get divorced, married, have a child, adopt a child, your spouse dies, your spouse loses a job or even if you are in an HMO and you move outside its coverage area.

How much are the penalties for not having insurance?

There is no longer an individual mandate penalty, so you won't get penalized for not having a recognized health plan at tax time. Previously, you could pay a nearly $700 penalty per adult and another charge for uncovered children, but Congress wiped out that tax penalty for 2019. 

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