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- The open season for health insurance is an annual period in which everyone can purchase qualified health insurance
- For marketplace plans available on state exchanges or healthcare.gov, the open enrollment is the time when everyone can purchase coverage.
- For employer-sponsored plans, the open season may be different from the November through January window.
- The open enrollment for 2016 calendar year was November 1, 2015, through January 31, 2016.
The Affordable Care Act changed health insurance with many important reforms. The annual open enrollment is a vital part of the design of health care; it gives everyone a chance to meet the individual mandate with qualified coverage on the first day of the new calendar year. In the open enrollment period, one can perform the below-listed functions for getting the right insurance coverage.
- Add a new plan
- Qualify for subsidies
- Renew existing coverage
- Select a plan, then cancel, and switch to another plan
Shopping for a Plan
The open season is the time to select a plan. One can often renew an existing plan, but with new offerings and prices, one can have a better-informed choice by reviewing available options. Insurers offer plans that they do not sell on the state or federal exchanges. These can be of particular interest to those with high incomes, and that receive little or no subsidy.
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Open Season Is the Best Time to Buy
Open enrollment provides the greatest flexibility in plan selection. One can add, cancel or switch plans and make the final choice that meets the individual mandate and provides the coverage that one needs. Comparison shopping helps every subscriber find the best value for their individual situation or family group. After open enrollment, the options for getting health insurance shrink down to two. One can get an extension or a special enrollment period. The other method of meeting the requirements of the law involve exemptions for hardship and other causes.
After Open Enrollment
During open enrollment, every eligible person has a right to purchase affordable health insurance. This includes plans that cost 8 percent or less of the household income per year. After open enrollment ends, one cannot purchase qualified health plans without an extension or a special enrollment period. For those who qualify, Medicaid and CHIP are excellent choices for meeting the mandate.
Both state and federal health care agencies can extend the open enrollment. They have authority to adjust the closing dates for reasonable causes that interfere with the normal application process. This is an administrative practice that can help consumers in the below-listed situations
complete partial applications
- Make up for last minute overcrowding
- Provide relief from conditions that interfere with enrollment such as weather conditions, power outages, floods, and other unpredictable occurrences.
Special Enrollment Periods
The consumer’s status determines the ability to participate in a given plan. Plans take into account the consumer’s age, location, and smoking status. When a consumer buys a policy but then changes location, the agreed upon services may no longer be available. This change in status is so important to the workings of the policy that the consumer must have a new opportunity to buy. When policyholders have changes in status, the ACA provides for a sixty-day period for getting a new policy. The changes in status are life events.
Life events are changes in status that require a new opportunity to purchase health insurance after the close of the open enrollment period. They are unpredictable changes that affect the basic purpose of the health coverage. For example, giving birth to a child changes the nature of the coverage to include the infant and the post-natal care for the mother. A new policy selection period provides the best opportunity to get the right coverage. The approved list of life events that qualify for a special enrollment period include the below-described circumstances.
- Childbirth or adopting a child
- Moving to a new location
- Loss of coverage as a dependent due the 26th birthday
- Loss of coverage as a dependent due to job loss as employee
- Loss of coverage as a dependent due job loss as dependent
Affordable Health Insurance
There are two instances of affordability in the Act. The first involves employer-sponsored health plans. These plans may not exceed 9.5 percent of the employee’s household income. If the cost exceeds 9.5 percent, the employee can reject the policy and purchase a policy in the state or federal marketplace. The second instance is the cost of a policy purchased directly by the consumer. These may not exceed 8 percent of the employee’s household income.
Essential Health Benefits
Qualified health insurance meets the requirements of the Affordable Care Act by providing the 10 essential health benefits. Consumers can buy qualified policies on and off the state and federal marketplace. They may purchase them at any time during the open enrollment. Essential health benefits bring the advantages of early detection and treatment of serious diseases and conditions.
Metal Tiers and Selection
The ACA groups policies for easy comparison by the value of insurance-paid benefits. For example, all Platinum policies average ninety percent insurance paid benefits and ten percent for the consumer. Actuarial value is an excellent way to find a policy. Comparison shopping can use particular features of plans as the measuring factor. For example, one in need of extensive physical therapy can rate plans on the basis of rehabilitation services in-network
After Open Season Using Exemptions
The individual mandate applies to everyone not exempt from the ACA. This includes persons with no reportable income such as those receiving Supplemental Security Income. Some exemptions come from the operation of the law itself. For example, if one cannot find a qualified plan that costs less than 8 percent of family income then one can claim an exemption.
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