Open Enrollment is here!

Posted by Phil Dougherty
November 19, 2014

The first annual open enrollment period since the implementation of health care reform has started and it’s time to evaluate plan options for 2015.  For those who have existing individual or family coverage and want to consider a change, are enrolled in group or COBRA insurance and want to compare their current plan with 2015 marketplace plans, or are without health insurance and entering the market for the first time, now is the time to consider a change.

Although open enrollment runs through February 15, 2015, you have until December 15, 2014 to make a change for a January 1, 2015 plan start date.   Other possible effective dates are February 1, 2015 and March 1, 2015.

When evaluating your plan choices, please carefully consider the following points before making your final decision:

  • Provider choice and network shrinkage caused a major disruption in the healthcare marketplace this year and, because of this, consumers are particularly sensitive on the subject.  Major carriers like Anthem Blue Cross and Blue Shield will continue to offer PPO plans but still with significant “holes” in them.  Carriers offering PPO plans with large networks (Healthnet and Assurant) are increasing premiums on new plans by 10%-15% or more.  Consumers will have to weigh the savings in premium against provider access limitations.
  • Provider search tools from most carriers aren’t particularly user friendly.  Don’t rely entirely on the results of a search. It’s important to check directly with your provider and ask if they accept the plan you are considering.
  • Be wary of EPO. EPO stands for “Exclusive Provider Organization”. As an EPO member you receive no benefits when seeing out-of-network providers (except for an emergency). Also, EPO provider networks are typically smaller than a carrier’s PPO network.
  • Be sure your current providers accept EPO coverage and that any provider you may want to access in the future is participating in the EPO network as well. Many EPO plan participants didn’t realize a provider or facility didn’t take their plan until treatment was needed.  Be sure and conduct a general search of the providers in the various specialties within the EPO.
  • 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 by the carriers to keep plan premiums down is to include mostly lower cost generic medications  in their formulary as opposed to more expensive generic and brand name drugs.
  • Check the plan for out-of-state coverage. Most plans now treat out-of-state providers as out-of-network and cover only emergencies.  Assurant Health and Blue Shield PPO plans are the only plans offering clear descriptions of their nationwide access to providers with in-network benefits for more than just emergencies. Anthem Blue Cross PPO and EPO plans, and Blue Shield EPO plans, do not include their BlueCard coverage for access to out-of-state providers. Those of you with college students out-of-state should consider purchasing the college insurance plan if benefits back home don’t follow your student to school.

Anyone who does not obtain coverage next year (and doesn’t have a qualified alternative) may face a penalty of $325 per adult/$162.50 per child or up to 2% of household income, whichever is higher.  Since several of the healthcare reform deadlines and mandates have become “soft”, many are counting on a reprieve in this initial year’s open enrollment. 

ENROLLMENT DEADLINE:  December 15, 2014 for a January 1, 2015 start date.

A Word about CoveredCA

This is the public marketplace where one can enroll and receive financial assistance if they qualify in the form of a subsidy and cost sharing reductions. Eligibility is based in part by household income. If you want to consider coverage through CoveredCA you can use their Shop and Compare tool to get an estimate of the assistance: If you wish to enroll through this market you can do so on their website or by contacting CoveredCA directly at 800-300-1506.

The private market does not offer the subsidies but does include more carriers and plan options in each benefit category.  It’s also a simpler enrollment process since there is no financial disclosure or IRS income verification.  Please visit my website to read more on various health insurance topics:

How OnlyHealthInsurance Can Help

If you are considering individual or family health insurance, have decided to enroll in a private exchange plan, or are not sure what type of plan you’re eligible for, we hope you will contact us for assistance. After understanding your personal circumstances and health insurance needs, we can make an assessment and recommendation for the most appropriate solution.

Phil Dougherty