Health Insurance Open Enrollment: Your Questions Answered

Is anyone else confused about health insurance this year? There’s Medicare and Obamacare and possibly an employer’s plan to consider. The health insurance world was perplexing before healthcare reform, and now it’s even more so. The Affordable Care Act requires that Americans carry health insurance this year and the time to sign up is now.

To clear up the confusion about health insurance for you, me, and our patients, I’ve called in an expert. 

Who is this expert, you say? You may not be aware that my husband, Alex Tolbert, happens to be a health insurance guru. His company, Bernard Health, provides non-commissioned, expert advice on planning for health costs. This morning, over coffee at the kitchen table, I’ve asked him a few pressing questions about open enrollment and the 2014-2015 health insurance scene. Here’s what you (and your patients) need to know about open enrollment and health insurance for the coming year.

What are my options when it comes to getting health insurance this year?

There are four ways Americans can receive health insurance. They include Medicare, Medicaid, an individual health plan and/or an employer-based health plan. Some individuals may qualify to receive a subsidy to help pay for a health plan through the Affordable Care Act.

What exactly is open enrollment?

Open enrollment is the one time of year when everybody can make changes to their health insurance. The period of time when you can make these changes depends on your health insurance plan. For Medicare, open enrollment runs from October 15th to December 7th. For individual health plans, open enrollment is from November 15th to February 15th.

Employer-based health plans have their own open enrollment. Dates for employer plans vary based on the company through which the insurance plan is offered. It should be noted that an employer’s open enrollment is in addition to, not instead of, Medicare or individual open enrollment.

What happens if you miss open enrollment?

If you miss the open enrollment period you won’t be able to make changes to your health insurance plan until the following year. Some employers will allow changes to be made for a short period of time after open enrollment ends but this depends on the company. If you don’t have health insurance, you won’t be able to enroll in a plan until next year’s open enrollment period.

This year, there will be penalties for not having health insurance. These are complex and depend on your income. If you don’t have health insurance in 2015 you will pay either 2% of your household income (income over tax filing threshold) or a flat dollar amount, whichever is higher. For the coming year, the flat dollar penalty is $325 for every person in your family over the age of 18 and $162.50 for children under age 18. The maximum flat dollar penalty is $975 per family. For individuals subject to a penalty as a percentage of income, the penalty dollar amount is capped at the national average cost of a ‘bronze’ health insurance plan. These rates have not yet been released for 2015.

What is the best way to compare my health insurance options for 2015?

To choose your health insurance plan, focus on comparing the plan’s network of medical providers, the premium you pay for the plan, and the benefits you get from the plan. Each of these aspects changes from year to year. Making a chart can help you compare plans side by side.

One of the biggest misconceptions I see is that people assume auto-renewing their health insurance plan will save time. People desperately want to avoid dealing with their health insurance each year but this is a mistake. It is generally always worth taking action during your open enrollment period to make sure you get the plan you want.

What can nurse practitioners and their patients do if they are confused about open enrollment and health insurance options for 2015?

Call Bernard Health for a free consultation or request information online. Most insurance brokers are getting out of the individual health insurance business so it can be hard to get your questions answered and to build a high value relationship with someone you can trust. Bernard Health can help.


Thanks to Alex for answering our open enrollment questions!


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