young happy doctor high fiving little girl after open enrollment

Knowing Your Open Enrollment Options In 2018

Here are some important reminders to help guide you through the 2018 Open Enrollment process.

You may have recently received a letter from your health insurance carrier about the 2018 year. If the letter was confusing, don’t worry—a licensed Benefits Counselor will help you navigate your health insurance elections for the 2018 coverage year.

Need To Know For Open Enrollment 2018

Unlike years past, this year the Open Enrollment period lasts from a start date of November 1, 2017, and ends on December 15, 2017.

In order to obtain coverage on January 1, 2018, you must apply by the December 15, 2017, Open Enrollment deadline.

Plans and pricing will be available for review on November 1, 2017. We recommend that you evaluate your health insurance options every year in order to ensure that you are still receiving the benefits you need.

applying for health insurance on atablet during open enrollmentOpen Enrollment Is The Time For Changes

Open Enrollment is the time to make changes to your current plan.

If you are currently enrolled in a health insurance plan from the exchange, it may automatically renew if it is still available in your area. However, it is still important to review the details of your current plan, as providers may have made important changes that will be implemented for the 2018 coverage year.

If you have received a notice notifying you of upcoming changes to your plan, it is important to take the time to read it and determine what these changes could mean for you and your family. Be sure to check that your preferred doctors and hospitals will still be considered in-network. It is important to note that in some cases, you may not be covered at all should you receive care out-of-network.

It is possible that your prescription drug coverage could also change with the new year. Your plan may no longer cover the essential medications you, or your dependents, require in order to manage chronic conditions. This is why it is of the utmost importance that you review your existing plan’s drug benefits for 2018 before you allow it to renew.

Enroll Now Or Wait Until Next Year

So, what happens if you miss the Open Enrollment deadline? In the event that you miss the Open Enrollment cut-off date and still find yourself without insurance, you may be forced to wait another year until the next Open Enrollment period unless you qualify for a special enrollment period.

A Special Enrollment Period can be classified as a divorce, marriage, birth or adoption of a child, death of a spouse or a partner that leaves you without health insurance, your spouse or partner who has you covered loses his/her job and health insurance, you lose your job and with it your health insurance, your hours are cut making you ineligible for your employer’s health insurance plan, or you are in an HMO and move outside its designated coverage area.

In order to avoid paying a penalty on your taxes, you must have health insurance as per the Affordable Care Act.

Applying For 2018 Coverage

When you are ready to apply, make sure you have the details of your current plan, payment information, and any dependent information (social security number, birth date, etc.) on hand to make the application process easier.

Schedule an appointment with a licensed Benefits Counselor for a simple one-on-one approach to Open Enrollment. Our Benefits Counselors are specially trained to focus on your individual needs in a health plan and find you the best fit.

To schedule an appointment, please fill out our Online Appointment Scheduling form to secure your preferred date and time today!

young female asian doctor treating mother and daughter

What You Need for Open Enrollment 2018

Open Enrollment 2018 is just around the corner and for many, this is the only time to secure health insurance coverage for you and your dependents.

Since the beginning of the Affordable Care Act, the term Open Enrollment refers to the specific period of time each year when an individual can enroll in, or switch, their health insurance plan without the need to qualify for a special enrollment period. This is also when additional eligible members can be added to an existing plan.

Open enrollment only occurs once per year, so keeping an eye on the Open Enrollment deadlines is important in order to avoid losing coverage. This year the Open Enrollment window has been shortened and begins November 1st with a December 15th deadline.

young doctor explaining open enrollment 2018 to coupleKnow The Open Enrollment 2018 Terms

We know that Open Enrollment can seem stressful and completely overwhelming — but it doesn’t need to be! One of the best things you can do to make the Open Enrollment process easier is to know the most frequently used terms:

  • Coinsurance: Coinsurance is your share of the costs of a covered healthcare service calculated as a percent (for example, 20 percent) of the allowed amount for the service. You pay coinsurance plus any deductibles you still owe for a covered health service.
  • Premium: A premium is the amount of money charged by an insurance company for coverage. The cost of premiums may be determined by several factors, including age, geographic area, tobacco use, and number of dependents.
  • Copayment: A copayment, or copay, is a fixed amount you pay for a covered healthcare service, usually at the time of service. The amount can vary by the type of covered healthcare service.
  • Deductible: A deductible is the amount you owe for healthcare services each year before the insurance company begins to pay.
  • Out-of-pocket Maximum (OOPM): An out-of-pocket maximum is the most you should have to pay for your healthcare during a year, excluding the monthly premium. It protects you from very high medical expenses. After you reach the annual out-of-pocket maximum, your health insurance or plan begins to pay 100 percent of the allowed amount for covered healthcare services for the rest of the year. The deductible, coinsurance, copays and prescription drug copays are included in the out-of-pocket maximum.
  • Preventive Care: Rather than waiting for a patient to become sick, preventive care aims to keep people healthy, or at least catch illnesses at their earliest and most treatable stages. Preventive care includes preventive services performed by providers, such as annual physicals or mammograms. Under the provisions of the Affordable Care Act (ACA), policies must cover various preventive services for men, women, and children without sharing the cost for these services through coinsurance, deductibles or copayments. Certain Preventive care services are subject to frequency limitations.
  • Annual Limit and Lifetime Limit: In the past, health insurance carriers imposed Annual and Lifetime limits on the benefits you receive. You are no longer subject to these limitations and there is no maximum to the benefits you may receive.

Asking For Help

Our team of licensed Benefits Counselors are here to help! Schedule an appointment so you can get your questions answered —And don’t forget, Open Enrollment only runs through December 15th for the 2018 season!

Health Insurance Terms

Understanding Health Insurance Terms

Coinsurance:

Coinsurance is your share of the costs of a covered healthcare service calculated as a percent (for example, 20 percent) of the allowed amount for the service. You pay coinsurance plus any deductibles you still owe for a covered health service.

Premium:

A premium is the amount of money charged by an insurance company for coverage. The cost of premiums may be determined by several factors, including age, geographic area, tobacco use, and number of dependents.

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Letter From Member Benefits’ CEO Regarding Health Insurance Delays During Open Enrollment

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Dear Client,

I want to assure you that all of us at Member Benefits completely understand your concern regarding the complications and delays that are occurring in regards to your application for health insurance. I feel privileged that you have chosen Member Benefits to help you with such an important decision to choose and apply for your health coverage.

These are unprecedented times for health insurance carriers. The following will help you understand why all of the carriers are overwhelmed to various degrees:

  • Over 27,000,000 people have newly applied or changed their plans for insurance since 11/01/15.
  • One of our leading carriers informed us that they received more than 10,000 applications on 12/15/15, the deadline date to apply for a 1/1/16 effective date.
  • Several carriers dropped some of their most popular plans for 2016, causing a panic amongst insureds to secure similar coverage with other carriers.
  • Regardless of the reasons, insurance companies underwriting, billing, and issuance systems are overwhelmed with the volume and are not able to deliver approvals, policy documents, and identification cards in a reasonable manner.
  • One carrier is predicting that policies may take as long as March to be issued with a 1/1/16 effective date.
  • Some carriers are asking us to inform insureds that they might need to pay their claims “out of pocket” and request reimbursement once the policy is issued.
  • Although the carriers greatly increased their staff to handle the volume, some carriers stated that they were expecting a 40% increase in customer service needs and actually received an increase of up to 500%.

It is important to me that you know our staff is working tirelessly and is in constant contact with the carriers to expedite the processing of our clients’ applications.

Again, we are all empathetic with your very justifiable concerns. In addition, we are certain that we will be able to satisfy your needs and ultimately deliver to you the product you applied for.

Earl C. “Chip” Trefry, Jr. CLU
President/CEO

 

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