What you need to know about Open Enrollment


What you need to know about Open Enrollment

With Open Enrollment just around the corner we thought it important to share a few tips to help you navigate the landscape that is healthcare.  Below are some of the most common questions we get from our clients and potential clients.

Q:  When does Open Enrollment start officially?

A:   November 1 through December 15 for people under 65 individual plans

October 15 through December 6th for over 65 Medicare options

Q:  Once I sign up when does my plan start? When does it end?

A:  ACA Plans that are initiated during the open enrollment period begin on January 1 and expire on December 31 of the following year.

Q:  Are there penalties if I don’t have health insurance?

A:  The mandate to have health insurance is still officially law, but the president did sign a declaration which removed the penalty for not having an ACA qualifying plan. 

Q:  What does it mean to have an ACA qualifying plan?

A:  You will need to have “minimum essential coverage” as defined by the ACA.

Q:  What do I do if I have a pre-existing condition?

A:  Talk to a qualifying consultant to look at options for the best coverage in your specific area.

Q:  What questions do I ask a health insurance agent who is trying to help me with insurance during open enrollment?

A:  Are my doctors in network?

How are my prescriptions covered?

What is my deductible and max out of pocket on this plan for the year?

Are there alternative options available?

Q:  Is ACA the only option for me for health insurance during open enrollment?

A:   There are many options outside of the ACA for coverage.  Especially for those who are healthy and want alternatives away from high deductibles and premiums.  ACA is built for those who have preexisting conditions and need guarantee issue plans. 

Q:  Is open enrollment the only time I can buy health insurance:

A:  Open Enrollment is the only time you can qualify to get on an ACA plan…unless you have a special enrollment period due to a (QLE) qualifying life event such as marriage, divorce, death of spouse, loss of coverage due to job change, loss of coverage due to move, etc…

Q:  How do I know if I qualify for a subsidy?

A: Subsidies for ACA plans are based on 3 factors:  Zip Code, Household Size, Household Income

Q:  How are the plans laid out?  By state, federally?

A:  All carriers must comply with individual state regulations which may or may not affect the makeup of the plan design.  Some states are more stringent than others. Talk to a licensed professional to get specifics about your plan and your state.


For more information call our office at 314-282-7013.