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When can you change your health insurance?

Here's what you need to know...

  • Open Enrollment runs from November 1, 2015, through January 31, 2016.
  • Persons enrolled in a plan can change plans at any time during open enrollment.
  • After Open Enrollment, consumers cannot change plans unless they qualify for an exception.
  • The exceptions after the Open Enrollment are government extensions of enrollment and special enrollment periods.
  • Life Events create special enrollment periods.

For many Americans, the Obamacare Open Enrollment period for 2016 is an opportunity to review and change their insurance plans. Those who make no changes can be re-enrolled in the same plan or placed in a similar plan. Start comparing health insurance rates now by using our FREE tool above!

Reviewing Options

Open Enrollment is an opportunity to apply experience under an Obamacare plan to improve coverage and find the best fit for an individual or family. Obamacare encourages consumers to compare plans, and they emphasize premiums and the percentage of coverage. Comparison shopping will reveal the best plan by focusing on the parts that matter most. These can include convenient locations, specialists inside the network, and individual preferences for services. Comparison shopping is the best way to find the right plan.

Enrollment and Changes

The open enrollment period and the opportunity to change plans have similar deadlines. During Open Enrollment, purchasers can select and change plans as often as they wish. The last day of Open Enrollment is also the last day to change plans. The exceptions to this rule are essentially two: enrollment extensions and special enrollment periods. Special enrollment periods are part of the rules and required by the ACA. This exception reflects the needed flexibility to accommodate changes in status that occur after Open Enrollment.

Government Extensions

In 2015 and in a few other circumstances, the government announced extensions to the enrollment period. These extensions covered those who had begun but not completed enrollment. State marketplaces have also used extensions to help applicants complete their enrollments.

The Types of Obamacare Plans

Obamacare uses a system of metal plans, these are groups of plans with similar percentages of insurance paid benefits versus consumer paid benefits.Obamacare groups plan by the percentage of coverage or actuarial value. The list below describes the values of the metal plans:

  • Platinum Plans- cover about 90 percent of costs leaving ten percent for the consumer on average. These plans require higher premiums and offer lower out of pocket expenses.
  • Gold Plans – cover about 80 percent of plan costs and have nearly all have higher premiums than Silver or Bronze.
  • Silver Plans- cover about 70 percent of plan costs and provide payment assistance to those with qualified incomes in the range of 150-250 percent of the federal poverty guideline.
  • Bronze Plans- pay sixty percent or more of covered services. These plans offer low premiums and high out of pocket expenses and deductible thresholds.

Life Events

The rule is that consumers cannot purchase health insurance plans on the Obamacare exchanges after Open Enrollment. The last day to purchase plans for the calendar year 2016 is January 31, 2016. An exception exists for changes in status that require a new opportunity to get insured. These changes include loss of insurance from a job or status as a dependent of someone who loses coverage. The list of Life Events includes the below-described changes.

  • Marriage
  • Divorce
  • Birth of a child
  • Adoption
  • Moving to a different state
  • Losing insurance from a job
  • Losing Insurance as a dependent

Enroll or Pay Penalty

Everyone must enroll in a qualified health plan or pay a shared responsibility tax. In 2016, the penalty for an individual will be the greater of 2.5 percent of annual income or $695 per adult. Those who do not enroll will not get qualified health coverage after the Open Enrollment period inside the Obamacare system of federal and state marketplaces unless they qualify for an exception or Life Event. Some plans will automatically renew coverage.

Automatic Re-enrollment

The existing plan insurer and the federal or state marketplace provide notices near the end of the year about renewal and getting new coverage. Renewal options allow consumers to keep a plan they like and accept any increase or decrease in premiums and changes in the terms of coverage. Some plans will not continue into the next year, and participants will need to find a new one.

Changing Outside of Open Enrollment

There is no legal prohibition against insurers offering qualified health plans outside of Open Enrollment, but they do not because the prices, coverage, and terms apply to particular markets and are based on conditions that existed prior to November 1, 2015. It is very unlikely that consumers will find any available qualified plans after Open Enrollment with the possible exception of plans offered but not completed before the last day of the sign-up period.

Changing Outside of Obamacare

Obamacare reformed the health insurance industry. It stopped many practices that had harsh effects on consumers such as denials of coverage for pre-existing medical conditions. While Many people will not qualify for Obamacare premium and payment benefits because their incomes exceed the limit for financial assistance, they get the essential health benefits wherever they buy coverage.

Persons near or above the 400 percent threshold should shop outside of Obamacare for the best available plans.

Insurers offer plans to the public that are not available on the Obamacare exchange. The only way to access the complete range of plans is to shop outside of Obamacare.

Making the Best Selection

Comparison shopping is an excellent tool for making the best selection for health insurance coverage. Whether selecting a new policy or changing from an existing plan, comparison shopping puts the focus on the features that matter most. Comparison shopping can look deeper into the plan features than price, premiums and out of pocket expenses. This method can highlight the features of particular importance to the individual or family such as locations of facilities, and use of out of network specialists. Start comparing health insurance rates now by entering your zip code in our FREE tool below!

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