Open enrollment is your chance to review your health coverage and decide whether it still meets your needs. Answering these key questions before you enroll, renew or switch plans can help you compare coverage with confidence.
We do a lot of things on autopilot. Making the bed, brushing your teeth and scrolling through social media are a few. But choosing health insurance shouldn’t be one of them. Even if your current health plan worked well this year, your health needs or budget may have changed.
That’s why the annual Affordable Care Act (ACA) Open Enrollment Period (OEP) is a good time to take a fresh look at your options. Here are nine key questions to ask before choosing a plan.
1. How have my health needs changed?
Many events can affect how much (or how little) coverage you need for the year ahead. Think about changes such as:
- A new health condition
- Planned surgery or treatment
- Pregnancy or family planning
- Changes in mental healthcare needs
- New medications
- Marriage or divorce
- Having or adopting a child
2. How much healthcare did I really use this year?
One of the best ways to estimate healthcare costs for next year is to look back at this year.
Review your:
- Doctor visits
- Specialist appointments
- Emergency care
- Prescription drug costs
- Lab work and imaging
- Ongoing treatments
If you rarely needed care, a plan with lower monthly premiums and higher deductibles may be worth exploring. If you used healthcare frequently, you might consider a plan with a higher monthly premium and a lower deductible.
3. Are my doctors and medicines still covered?
Health plan networks and drug formularies can change from year to year. Before renewing coverage, verify that:
- Your primary care provider is still in-network
- Your preferred specialists are covered
- Nearby clinics and hospitals participate in the network
- Your prescriptions are included on the plan’s drug list
This important step can help prevent unexpected bills and disruptions in care.
Need help choosing a health insurance plan that fits your needs? Call 844-306-8319 to speak with a licensed insurance agent and explore available plans.
4. What can I afford in premiums and out-of-pocket costs?
Everyone’s budget is different. When you compare health insurance plans, look at all the costs associated with coverage. Try to avoid focusing only on the amount you’ll pay each month. These may include:1
- Monthly premium: what you pay each month to keep your coverage active
- Deductible: the amount you pay for care before your plan starts paying for covered services
- Copayments: fixed amounts you pay for certain services, such as doctor visits or prescriptions
- Coinsurance: your share of the cost for covered services after you meet your deductible
- Out-of-pocket maximum: the most you’ll pay for covered healthcare services during a plan year, including deductibles, copays and coinsurance
It’s important to review all potential costs before enrolling in a plan.
5. Do I qualify for an ACA subsidy?
A subsidy is financial assistance provided by the government.
The Affordable Care Act (ACA) offers premium tax credits (a subsidy) to eligible individuals who purchase coverage through the Health Insurance Marketplace.2 If you qualify, these tax credits can help lower the amount you pay for your health insurance premium.
It’s worth checking your eligibility even if you didn’t qualify in the past. Changes in income, household size or other circumstances can affect how much financial assistance you may receive.
6. Should I use an HSA or an FSA for healthcare expenses?
It depends on your coverage and employment situation. It can help to take a closer look at how these accounts are different.
What is a Health Savings Account?
A Health Savings Account (HSA) is a type of savings account that lets you set aside pre-tax money for qualified healthcare expenses.3
The money can be used for:
- Deductibles
- Copays
- Coinsurance
- Other eligible medical costs
To contribute, you generally must be enrolled in an HSA-eligible high deductible health plan.
What is an FSA?
A Flexible Spending Account (FSA) lets you set aside pre-tax money for eligible healthcare expenses. It is typically offered through an employer.
Unlike an HSA, unused money may be lost if you don’t use it within the allowed timeframe. It’s important to check your employer’s plan rules.4
7. Is my current plan still the best fit?
Many people allow plans to auto-renew without reviewing new benefits, networks or costs. Taking a few minutes to compare options each year could reveal:
- Lower premiums
- Better provider networks
- Improved prescription coverage
- Different deductible levels
- New plan choices
Even if you decide to keep your current plan, you’ll know you’ve made an informed decision.
Need help filling a gap in coverage between major health insurance plans? Short term health insurance may be an option. Call 844-306-8319 to speak with a licensed insurance agent and explore available plans.
8. What's the difference between ACA, short term and extended short term plans?
The main differences between these three plans are the length of coverage and the benefits they offer.
ACA plans
With ACA plans, your coverage will typically begin January or February 1 (depending on when you enroll).5 Regardless of when your ACA coverage begins, all ACA coverage expires on December 31 of the plan year.6
By law, ACA plans are required to cover the 10 essential health benefits:7
- Outpatient care
- Hospital services
- Emergency services
- Pregnancy, maternity and newborn care
- Mental health and substance use disorder
- Prescription drugs
- Rehab services and devices
- Lab services
- Preventive care
- Pediatric care
Short term health insurance
Short term health insurance offers coverage for up to 12 months (less one day), depending on state.8 It’s designed to help bridge temporary coverage gaps between major health insurance plans, such as when you start a new job and have to wait for your employer-sponsored coverage to begin.
Most short term health insurance plans do not cover pre-existing conditions, and they have minimal coverage for preventive care. Specific coverage will vary by plan.
Short term health insurance does not meet all federal requirements to qualify as “minimum essential coverage” and the plans do not include all the essential health benefits.
Extended short term plans
Extended short term insurance is a type of short term insurance available in some states. These plans can last nearly three years.8 They are designed to provide coverage for a longer period than traditional short term plans, but generally do not offer the same level of coverage as an ACA plan.
9. What happens if I don’t sign up during the annual ACA Open Enrollment Period?
For most people, missing the annual ACA Open Enrollment Period means waiting until the next Open Enrollment Period to enroll in or change to a Marketplace plan.
However, you may still be eligible for coverage if you qualify for a Special Enrollment Period (SEP). To qualify for an SEP, you must experience a qualifying life event such as:9
- Getting married
- Having or adopting a child
- Moving
- Losing your current coverage
Services like Medicaid and the Children’s Health Insurance Program (CHIP) accept applications year-round.5
And depending on where you live, you may also be able to consider short term or extended short term health insurance plans.
Frequently asked questions
What is a qualifying life event?
A qualifying life event is a significant life change that may allow you to enroll in or change healthcare coverage outside of the ACA Open Enrollment Period. Common examples include:9
- Getting married
- Having a baby
- Moving
- Losing other health coverage
Can I change my health insurance plan outside of the ACA Open Enrollment Period?
If you qualify for a Special Enrollment Period because of a qualifying life event, you may be able to enroll in or change coverage outside the standard ACA Open Enrollment Period.
What is the difference between a deductible and an out-of-pocket maximum?
A deductible is the amount you pay for a covered service before your plan starts paying for covered services. An out-of-pocket maximum is the most you will pay for health coverage during a plan year. Once you meet your out-of-pocket maximum, your plan pays 100% of the cost for covered services.
Do I need to re-enroll in my health plan every year?
Some plans may auto-renew.10 Even so, reviewing your coverage during the OEP can help make sure your plan still meets your needs and budget.
Is short term health insurance ACA-compliant?
No. Short term health insurance isn’t ACA-compliant, meaning that it does not meet all federal requirements to qualify as “minimum essential coverage” and the plans do not include all the essential health benefits. But that’s the trade-off for lower cost and flexibility. It’s designed to help cover temporary gaps in coverage between major medical insurance policies, such as between jobs or while waiting for other insurance to begin. These plans are available year-round and have different benefits and coverage rules than ACA plans. Coverage, eligibility and costs vary by plan and state.
Have more questions about the ACA Open Enrollment Period? Call 844-306-8319 to speak to a licensed insurance agent about your options.
For informational purposes only. This information is compiled by HealthMarkets Insurance Agency and does not diagnose problems or recommend specific treatment. Services and medical technologies referenced herein may not be covered under your plan. Please consult directly with your primary care physician if you need medical advice.
