Tips for health plan open enrollment

Rick Notter

If you’re under age 65 and don’t have health insurance through an employer, you may need to purchase your own. The Affordable Care Act requires nearly all Americans to have health coverage. If you can afford health insurance but choose not to buy it, you will have to pay a penalty unless you have an exception.

Each year there’s a window of time, called “open enrollment,” where individuals and families can buy insurance directly from private insurance companies, like Blue Cross Blue Shield of Michigan, or through the Health Insurance Marketplace. Exact dates vary from year to year, but this year’s open enrollment to get coverage for 2016 started on Nov. 1 and continues through Jan. 3. For coverage starting on Jan. 1, 2016, you must enroll by Dec. 15, 2015. Otherwise, you may have a gap in your coverage, leaving you vulnerable to health and financial risks.

If you need to buy health insurance this open enrollment period, here are a few things you need to know:

■Financial help is available. While the health care law increased the value of health insurance plans in America, it also increased the opportunities to get financial help. According to the latest report by the Centers for Medicare & Medicaid Services (CMS), 78 percent of those who selected a plan through the Marketplace received financial assistance. You can estimate your subsidy amount on bcbsm.com/subsidy. You will be asked a few questions to determine your eligibility.

■The penalty fee for not having insurance has increased. If you don’t have insurance in 2016, you may have to pay 2.5 percent of your yearly household income or $695, whichever is higher. So if your household income is $100,000, you may face a penalty of $2,500 at tax time. Aside from the penalty, there are lots of other reasons to get covered. Health insurance protects you from high and often unexpected health care costs. What’s more, insurance plans now include benefits to help you stay healthy, preventing these costs in the first place.

■Think about how you’re really using your plan. Make a list of what health care services you used last year, including any prescriptions you and your family need filled on a monthly basis. Do you or anyone in your family have a chronic condition? How often do you and your family see the doctor? What’s your preferred doctor or hospital affiliation? These are all good things to consider when determining what plan will best fit your needs.

■Gather all your information ahead of time. You should gather the following information before calling or going online: number of dependents; Social Security numbers (or document number for legal immigrants); employer and income information; current health plan and policy numbers.

■Do your homework. There are new plan options, so shop around. When comparing costs, make sure you look at total costs, not just the monthly payment. You can shop, get a quote and sign up for plans for individuals and families online at bcbsm.com/myblue. You can also call a health plan adviser at 888-899-2968 or connect with an agent. They’ll help you find the right plan and get you enrolled.

■ Sign up early to avoid long wait times. Just like Christmas shopping, the longer you wait to shop for health insurance, the longer you’ll likely wait in line. Last year there were extremely high call volumes during the last two weeks of open enrollment. Dec. 15 is the last day to sign up for coverage effective Jan. 1, 2016. As the deadline approaches, you can expect to spend more time on the phone enrolling for coverage.

■Don’t opt for automatic enrollment, especially if you receive financial assistance. If you enrolled in a health plan during last year’s open enrollment and do nothing by Dec. 15, you will be automatically re-enrolled in the same or similar plan in 2016. Even if your household income stayed the same, you might qualify for more savings, or could end up owing money if you don’t report changes.

Rick Notter is the director of Individual Business Marketing and Distribution at Blue Cross Blue Shield of Michigan.