When the initial open enrollment period winds up at the end of March, the opportunity to purchase an ACA-compliant plan will close until the next open enrollment, which runs from October 15 through December 7th, 2014, for an effective date of January 1, 2015. In the meantime, a “Special Enrollment Period” is available to change plans, or enroll for the first time, for those with a life changing event. These include marriage, divorce, birth or adoption of a child, or loss of a job.
We’ve all learned a lot since the initial enrollment kicked-off in 2013. Here are some observations, comments and concerns:
- Provider choice is a major change and concern in the new health care marketplace.
– “Obama said I could keep my doctor”. It’s not that the President lied, it’s that he and other bureaucrats don’t know how insurance works. The provider networks of some main carriers are “slimmer” this year which is a logical maneuver by insurance companies to keep premiums down. They lowered fees paid to providers and fewer providers accepted their contracts.
– Don’t assume your provider is in your plan even if they show up on provider search lists. Some providers have changed their participation since the launch of new plans and lists aren’t up to date.
- If prescription drug coverage is important to you, be sure and check the formulary drug list of the plan before you enroll.
– Another cost cutting maneuver to keep premiums down. Some generic and brand name medicines may not appear in favor of lower cost alternatives.
- Be wary of EPO coverage.
– EPO stands for “Exclusive Provider Organization”. As an EPO member you receive no benefits when visiting out-of-network providers. One carrier (Blue Shield) carried it further and does not provide benefits when seeing non-EPO providers.
- Check the plan for out-of-state coverage.
– Many plans now only cover emergencies out-of-state. For some carriers (Anthem Blue Cross and some Blue Shield plans) this is a major change. Those of you with college students out-of-state should consider purchasing the college insurance plan if you haven’t already.
- Anyone who does not obtain coverage this year (and doesn’t have a qualified alternative) may face a penalty of $95 or up to 1% of household income, whichever is higher.
– Since many of the laws deadlines and mandates have become “soft” many are counting on a reprieve in this initial year. With a critical November election this may prove true. Stay tuned.
ENROLLMENT DEADLINE MARCH 31 – MONDAY
For subsidized coverage, California is allowing those enrolling through CoveredCA to at start an application by 11:59 pm Monday, March 31. They will give them until 11:59 pm on Tuesday, April 15 to complete it. Go to www.CoveredCA.com to learn more.
We’ll be in the office to help any latecomers. We work in the private market and, although no subsidies are possible, it is an easier process. Happy to send you a quote and enrollment instructions.