Health Care Open Enrollment 2016-2017: Everything to know for non-employer insurance plans

Health Care Open Enrollment 2016-2017: Everything to know for non-employer insurance plans
Source: Shutterstock
Source: Shutterstock

It's that time of year: the health insurance open enrollment period. If you are looking for health care that does not come from your employer — whether through Obamacare, aka plans in the marketplaces established by the Affordable Care Act, or not — it can be overwhelming.

You may have heard that premiums for these Obamacare plans are going up — some by as much as 116%

Do not despair. If you start early and do some comparison shopping, you'll be able to find a plan that fits your budget and your needs, without having to dip into your emergency fund.

Here's how to find your way.

What is open enrollment? How do I enroll?

Open enrollment is the window of time when health insurers take on new participants in their plans and allow current enrollees to make changes to their coverage.

If you don't have insurance through an employer and are buying it on your own you have a few options.

Source: Giphy

You can buy it through HealthCare.gov, which is the coverage offered through your state's marketplace as established by the ACA.

But you can also buy insurance outside the marketplace directly from a health insurance company, from an online insurance aggregator or from a health insurance agent.

There are pros and cons to each of these options and much to consider, including the subsidies you may qualify for through Obamacare, so shop around. 

Who needs to enroll in health insurance?

The law may require that you select a health insurance coverage plan for you and any dependents, depending on a few factors.

You'll need to sign up if you don't get health insurance through your — or your spouse's — employer; if you are over age 26 and can no longer be on your parent's health insurance (until then you can); and if you don't receive other government health coverage such as Medicare, Medicaid or veterans benefits.

When do I need to enroll in Obamacare or other health plans?

Open enrollment begins next week, on Nov. 1. You can research plans, compare and prepare your enrollment until the window closes on Jan. 31, 2017. This window applies to coverage in the marketplace and also to plans outside of the exchanges.

During this time you can enroll in a health plan, change your current coverage, tell your insurer about any changes in your income or household size and learn about any financial help available for you to to lower your health insurance costs.  

Source: Giphy

But the plans don't go into effect immediately, and the earlier you enroll, the earlier the plan will start.

Folks who sign up between the opening on Nov. 1st and Dec. 15 will have coverage starting Jan. 1, 2017.

If you don't enroll until between Dec. 16 and Jan. 15, 2017 your policy will go into effect Feb. 1, 2017.

And if you enroll between Jan. 15 and Jan. 31, 2017, the last day to enroll, your coverage won't start until March 1, 2017.

Why do I need health insurance?

If you're not covered by health insurance, the government will charge you a penalty. The argument for this charge, which is sometimes called an "individual mandate," is that there is an estimated $50 billion lost as a result of unpaid medical bills. 

It also encourages younger and healthier people, who help to keep insurance costs down, from opting out of the system. 

Source: Giphy

For the 2016 tax year, the penalty for not having health insurance for you or any of your taxable dependents (like your spouse or kids) is either 2.5% of your income, or $695 per adult and $347.50 per child, whichever is higher. 

There are some exceptions made for those with very low income, but otherwise everyone needs to get on board. If you don't pay the fee, the IRS will withhold the amount you owe from any tax refunds coming your way. 

How should I choose health insurance?

The question on everyone's mind is: How much are my premiums? Premiums are the monthly cost you pay to have health insurance coverage.

This is particularly true after a recent report showed that premiums are likely to go up for many participants in ACA health care exchanges.

Sure, everyone wants to save money on health insurance — but remember that premiums are not the only cost to consider as you shop around.

Source: Giphy

Unlike with other kinds of insurance, even after you pay your premiums, there can be complicated ongoing costs in health plans.

And as premiums go down, typically other expenses — like what you pay out of pocket — go up. Shopping around means figuring out the right balance for your health.

Here are five factors to consider:

• Your co-pays, or what you pay out of pocket with each visit to a doctor. If you have a chronic condition that requires frequent visits, these can add up quickly and you may want to look for lower co-pays.

• Your deductible, or how much you pay before your health insurance starts to cover a larger portion of your bills. For example if you have a $1,000 deductible, you will need to pay $1,000 before the insurer begins to pay.

• Your co-insurance, or the amount you're responsible for after the deductible is covered. For example, if after you have paid the $1,000 deductible you have 20% coinsurance, you'll be expected to pay 20% of each medical bill. The insurer will cover 80%.

• Your out-of-pocket maximum, or the most you may be expected to pay in one year, out of pocket, for your care. Your health care covers 100% of the rest after you reach that limit — which for 2016 plans sold on the marketplace was $6,850 for an individual and $13,700 for a family.

Source: Giphy

• Your drug benefits. If you regularly take medicine, you will need a robust medicine plan, you will also want to see if there are restrictions around name brand versus generic drugs if you have a preference.

In general, buy only as much insurance as you need. 

If you're not planning to have a baby in the next year, skip the plans with robust maternity offerings. And if you don't care about generic versus name brand medicine, look for cheaper plans that offer only generic drugs. 

What do I need to enroll in a health insurance plan?

The paperwork is annoying, so get organized. Start digging up last year's tax return and your current health insurance policy number.

You'll need to have these handy and more: Here's a list of all the documents you'll need.

Prepare now to be sure you'll be covered in the new year.