If you don't buy health insurance through work, this is an important time of year for you. "Health insurance marketplaces" are poised for open enrollment for individual and family health plans starting Nov. 15 and running through Feb. 15, 2015. This open enrollment period is the only time you can sign up for health insurance unless you have a "qualifying life event" such as marriage or divorce, birth of a child or loss of coverage because you or your spouse lost your job. This open enrollment applies only to individual and family plans that people purchase on their own. If you buy health insurance through your employer, your employer will announce its open enrollment dates. If you bought an Obamacare plan for 2014, it will end with the calendar year. To continue coverage next year, you can renew your current plan or choose a new one during 2015 open enrollment. Check to see if your plan automatically renews -- some do, some may not. If you want to switch plans or buy new coverage, open enrollment is the time to do it, says Carol Taylor, a benefits advisor for D&S Agency in Roanoke, Virginia, a United Benefits Advisors partner firm. Here are 10 essential facts to know for open enrollment for individual and family plans. Below are important considerations when deciding where to buy a plan.
Penalties increasing for not having health insuranceIf you don't have health insurance in 2015, you may have to pay a fee come tax time. The fee for not having health insurance will be higher for 2015 than it is this year. In 2015, it will be whichever is more: 2 percent of your income or $325 per adult and $162.50 per child. (In 2014, the numbers were 1 percent of income or $95 per adult and $47.50 per child, or whichever was greater.)
You can buy a health plan through your state's health insurance marketplace, through a health insurance agent, from a website that offers plans from multiple insurers, or directly from a health insurer.Where you live will determine if the marketplace is run by your state government or by the federal government. Most states will rely on the federal government to run their marketplaces again next year. If you buy a health plan through the marketplace between the 1st and 15th days of the month, your coverage will start on the first day of the following month. If you enroll in coverage between the 16th and the end of the month, your coverage will start on the first day of the second following month. The earliest coverage you buy on the marketplace for 2015 can start is Jan. 1. But is a state marketplace the best place to buy a health insurance plan?
Income determines whether health insurance marketplaces are best for youThere's one big reason to shop from a marketplace and it's an important one, says Lisa Zamosky, a Los Angeles-based writer and author of "Healthcare, Insurance and You: The Savvy Consumer's Guide." If your income is low enough that you qualify for a subsidy to help you pay your premiums, the only way you can get the subsidy is to sign up on a state marketplace, Zamosky says. Don't assume you are not eligible for the subsidy without some research, Zamosky advises. "I talked to many consumers who assumed they were not eligible for a subsidy but were," she says. Unless you are 100 percent sure your income is too high to qualify, go to healthcare.gov and see if you're eligible. The website has a chart to help you determine your eligibility for subsidies. To qualify for a subsidy, your income must be less than 400 percent of the federal poverty level for your family size. The more people in your family, the more you can earn and still qualify. The government has said it could go after people who were granted subsidies but did not qualify for them and ask that the money be returned.
You also can get help with deductibles, copayments and co-insurance if your income level qualifies.
Provider networks may be larger for plans not on marketplacesIf you don't qualify for a subsidy, there's no particular reason to go to the marketplace to buy health insurance, Taylor says. You won't get better prices on the marketplace than by buying the same plan directly from an insurer. However, you may have a wider choice of plans outside the marketplace and therefore may find a better plan for you and your family that costs less and has a less restrictive provider network, Taylor says. "There are a few plans that offer larger networks off the marketplace."
Technical difficultiesAlso, if you're not eligible for a subsidy, you might not want to put up with the hassle of shopping on a health insurance marketplace website, she says. Last year, the federal government had to extend the open enrollment period for people who tried but were unable to sign up on the marketplace because of technical difficulties.
Group health insurance is probably a better dealYou can buy individual and family health insurance plans on the marketplace even if your employer offers you the opportunity to buy health insurance through work. But chances are the insurance your employer offers is a better deal, Zamosky says. Also, if your employer contributes to the premium for the workplace plan, you lose that by declining group health insurance at work.
Marketplaces sell only private health plansYou can't shop the marketplaces if you have your insurance through a public program including Medicare, Medicaid or the Veterans Administration. The marketplaces do not sell Medicare plans, nor do they sell life insurance or long-term care insurance. If you work for the federal government, you don't need to shop through a marketplace either. You will get your benefits through the Federal Employees Health Benefits Program.
If you find that a health insurance marketplace is right for you, you can find your state's marketplace through Healthcare.gov. If you need help finding a plan or understanding your options, Healthcare.gov has a page listing resources.More from Insure.com Customer satisfaction scores for health insurance companies 10 essential facts for 2015 open enrollment When to reject the health plan at work