In the first half of 2020, 43.4 percent of U.S. adults ages 19 to 64 were inadequately insured, according to the Commonwealth Fund Biennial Health Insurance Survey. Joining me is Mihaela Vincze, the Program Specialist for nonprofit Transamerica Center for Health Studies, here to discuss Open Enrollment season amid this public health crisis.
What exactly is “Open Enrollment”?
Mihaela: Open enrollment is a period each year when individuals who are 19 to 64 years old — who are not eligible for Medicare, Medicaid, and are without access to employer-sponsored health insurance— can sign up for a health plan or make changes to the health plan which they’re already enrolled in, through the Health Insurance Marketplace or “exchange.”
Al: When is the Open Enrollment period?
Mihaela: The 2021 Open Enrollment period for most states, including Maryland, runs from Sunday, November 1st to Tuesday, December 15, 2020. Note that some states allow for more time. Although open enrollment begins November 1st, you can begin reviewing options as early as October 23rd.
Al: What happens if you fail to enroll during this time?
Mihaela: If you miss the Open Enrollment period, you will be unable to obtain coverage through the Marketplace unless you have a qualifying event. A qualifying event includes getting married, having a baby, losing your health coverage, or moving to a new home.
Al: It seems like it is crucial that we do not miss this window— how do we enroll?
Mihaela: You can use Healthcare.gov to apply and enroll in health coverage, however, some states, including Maryland, require that you go to their state-run website to enroll.
Al: Good to know. For those listening who may not have much experience shopping for health insurance, what can they do to begin learning more about the process?
Mihaela: A few things! A good first step is to make sure you understand health insurance lingo, such as “deductible”, “premium”, and “out-of-pocket maximum”. By understanding these terms, you will be more likely to make an informed decision.
Al: So once you learn the basic health insurance lingo, how do you begin comparing different health plans in the marketplace?
Mihaela: First, consider the benefits covered— you may want to ensure that the health plan you select helps pay for the 10 Essential Health Benefits required by the Affordable Care Act. Second, review the “provider directory,” which lists all the doctors that participate in the plan’s network, to confirm that any specific doctors you prefer are covered. And lastly, consider the cost that you are willing to pay.
Al: Speaking of cost, are there any options to make your monthly cost or premium more affordable?
Mihaela: Yes— you can apply for an Advanced Premium Tax Credit to lower your premium. You do this by applying for coverage through the Health Insurance Marketplace, where you provide an estimated expected income for the year. If you are eligible for a premium tax credit, you can apply the credit to lower your monthly premium payments.
Al: That is great. Where can listeners go to learn more?
Al: Thank you again for joining us, Mihaela. This has been another episode of ClearPath Radio – Your Roadmap to Health & Wealth. I’m your host Al