What is open enrollment?
Generally, you can only enroll in a marketplace or switch plans during the open enrollment period, unless you qualify for a special enrollment period because of special circumstances in your life, such as losing your health insurance because of divorce, a spouse’s death, unemployment or a change in income. In these circumstances, you’re allowed to enroll in a new plan or switch plans without waiting until the next open enrollment period. If you are eligible for Medicaid or the Children’s Health Insurance Program (CHIP), you can enroll at any time of the year. Medicare’s open enrollment period for existing policyholders is October 15, 2018 to December 7, 2018. If you will soon become newly eligible for Medicare because of age, you can sign up during a seven-month period that starts three months before the month you turn 65 and ends three months afterwards. If you are under 65 and disabled, you can sign up for Medicare during the seven-month period that starts three months before your 25th month of getting benefits and ends three months after your 25th month of getting benefits.
When is the next open enrollment period?
2018 open enrollment is over. Still need health insurance? You can enroll in or change plans if you have certain life changes, or qualify for Medicaid or CHIP.
Can I get coverage outside of the open enrollment period?
If you or someone in your family experiences certain qualifying life events you may be eligible to buy a new health plan or switch plans through the ACA marketplace outside of the usual open enrollment period for a limited period of time (typically, within 60 days from the time of the event).
Qualifying life events may include the birth or adoption of a child, loss of coverage due to death of a family member or divorce, a move to another part of the country or the loss of a job. A more comprehensive list is available here.
If you received incorrect information from an official source such as HealthCare.gov or your state’s insurance marketplace, you may be eligible for a special enrollment period during which you can switch plans.
Do I have to wait for open enrollment to enroll in Medicaid?
No. You can apply for Medicaid at any time, all year long. If you qualify, you can enroll immediately.
If I already have coverage, do I need to do anything?
If you are happy with your current plan and nothing else in your life has changed, such as your income or family size, your plan will automatically re-enroll you for 2018 if you live in a state using the federally facilitated marketplace. If you live in a state operating its own marketplace, you should check with the marketplace in your state. If you qualified for a premium tax credit in 2017, that will also automatically renew in most cases. You do not have to do anything else.
In addition, it’s a good idea to review your plan and ask your health insurer if it is making any changes to the plan, which is common from year-to-year. We suggest that you look for changes to the plan’s benefits including the premium, deductible, and cost sharing as these changes may impact how much you must pay for your care. We also suggest that you ask about changes to the provider network and confirm that your doctors and other health care providers you may want to consult are still in your plan’s network in 2018. You should also make sure any prescriptions you currently take will still be covered under your plan’s formulary in 2018 and find out what level of cost sharing you will be required to pay.
Before the open enrollment period begins, your insurance company will send you information about your plan, including any changes to premiums and benefits.
Separately, your state’s marketplace will send you information about the amount of subsidy you are receiving. However, you should check with your state’s marketplace or consult a navigator or other patient assistor program recognized by your marketplace to find out if it makes sense to update your application for premium tax credits (subsidies) or to consider changing your health plan.
If you experience a change in income or household size, you must report this information to your insurance company so that you can get the right premium tax credit. If you don’t update this information, you’ll get the same premium tax credit you got in 2017 (or the amount that has been reconciled through taxes), even though you might qualify for a larger credit. Conversely, if you are now eligible for a smaller credit because your income has gone up or your household size has gotten smaller and you haven’t reported these changes to your insurance plan, you may owe money when you file your 2017 tax return in 2018. For information on how ACA insurance coverage affects your taxes and what you need to know when filing your taxes, click here.
Even if your income and family size haven’t changed, the amount of subsidy you can get next year may change. For example, the premium for your current plan will probably increase somewhat. If your income hasn’t gone up and you reapply through the marketplace, your subsidy may rise to cover that increase.
If I have a plan now, will I automatically stay enrolled for next year?
If you are in a state using the federally facilitated marketplace, and you are happy with your current plan and want to keep it, your plan will automatically re-enroll you for next year. You do not have to do anything else. If you live in a state operating its own marketplace, you should check with the marketplace.
However, you should review your plan and ask your insurance company if it is making any changes to the plan for next year. We suggest that you look for changes to the premium, deductible, cost sharing and copayment rules, as this may impact how much you must pay for your care. We also suggest that you ask about changes to the provider network and confirm that your doctors and other health care providers are still in your plan’s network for next year. You should also make sure any prescription drugs you currently take will still be covered under your plan’s formulary next year and find out what level of cost sharing you will be required to pay. And if your income or family size have changed, you should review all of your options to see if a new plan might be better for you.
Why does my plan cost more this year, or why have my benefits changed and what can I do?
Insurance companies are allowed to increase (or reduce) the cost of insurance premiums every year. This happens with all types of private insurance plans, not just those purchased through the federal and state marketplaces. If you purchase your insurance through the health insurance marketplace and are not happy with your plan for any reason, including its cost, you may switch plans during the open enrollment period or during a special enrollment period, if you qualify.
Your insurance company may also make other changes to your benefits for next year so it is a good idea during the open enrollment period to look at what benefits your plan will cover next year. Make sure that your doctors are still in the plan’s network and that any prescription drugs you are taking are covered and affordable to you. It is also important to make sure that your income and family size information is up-to-date with the marketplace, as that could impact how much you pay for coverage and health services.
What do I do if my current plan is not offered next year?
Insurance companies sometimes change the plans they offer from one year to the next. This means they could add new plans and eliminate old ones. You may learn that you are in a health plan that your insurance company won’t continue to offer next year. If this happens to you, we recommend that you review all the plans available, just as you would if you did not have coverage. If you would like help doing this, you can reach out to a navigator or assister. In many cases, HIV clinics have someone on staff who is knowledgeable about insurance options and open enrollment.
If you do nothing, however, your insurance company will automatically enroll you in a similar plan. This will ensure that you continue to have coverage, but the plan it selects may not be the best fit for your needs or have the same benefits as your previous plan.
What if I do not like my current plan and want to consider other options?
If you do not like your current plan and do not have access to insurance provided through your job or a family member, you have two options:
- You can look for a different plan offered by the same insurance company with which you are currently enrolled. Or, you can choose a new health plan from a different insurance company through your state’s marketplace or on HealthCare.gov. Levels of coverage sold through the marketplaces are categorized by the name of a metal. Plans are labeled bronze, silver, gold or platinum, with the level of benefits – and cost – typically the lowest for bronze and highest for platinum. Bronze plans offer the least generous benefits whereas platinum plans offer the most generous benefits, with silver and gold falling in between. A person whose income is low enough to qualify for assistance with his or her premiums (also called premium tax credits) can enroll in any level of coverage and still get that help. However, a person whose income is low enough to also make him or her eligible for help with cost sharing (also called cost sharing reductions or CSRs) must select a silver plan to gain access to those subsidies.
If you would like help doing this, you can reach out to a navigator or assister. In many cases, HIV clinics have someone on staff who is knowledgeable about insurance options and open enrollment.
- You can buy a new plan outside the marketplace. This is not a good option for most people. If you buy a plan outside of the marketplace, then you will NOT be eligible for assistance with premiums and cost sharing that makes coverage more affordable for many people.
How do I decide if I should switch plans?
If you are unhappy with your plan for any reason, you should consider whether a different plan might work better for you. You might consider switching plans if you cannot afford your current plan or if a new plan is offered next year that is even more affordable or provides better coverage. You might also consider changing plans if the doctors you wish to see are not included in your plan or if your plan’s formulary does not include medications you need to take. You may also decide to change plans if your cost sharing for services you need, such as medications or lab tests, is too high. While you will likely face some cost sharing in most plans, the amount can vary considerably.
If you are considering switching plans, you should contact a navigator, patient assistor, or certified enrollment counselor in your state (or through HealthCare.gov) to help you to select a better plan. In addition, many community-based HIV organizations have staff members trained to help people with HIV navigate the enrollment process, and they may have special insights into the experience of people with HIV with the plans offered in your area.
What happens if I lose my coverage or experience other major changes in my life after the open enrollment period has closed?
Check with your state’s marketplace to see whether your experience qualifies you for a special enrollment period.