7 Things to Know as Obamacare's Open Enrollment Period Approaches

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Photo: Nancy Pelosi, Flickr

Obamacare isn't for everyone. You may be covered by health insurance through your employer, for instance. But for those who have been without health insurance, Obamacare offers the chance to buy your own coverage, and more than 7 million  Americans are doing so. Signing up and paying for it isn't all that's involved, though. Once a year there's an open enrollment period, in which you can select and switch into another plan -- and it's coming up soon. (It's also a perfect opportunity to sign up for the first time.)

Below are some things to keep in mind during open enrollment. 

Dates, deadlines, and details

First off, here are the important dates: Open enrollment for 2015 coverage through the U.S. government's Heath Insurance Marketplace begins on November 15, 2014, and ends on February 15, 2015. You might not want to wait until February to make your move, though: If you want your new plan to begin covering you on January 1, 2015, you'll need to sign up by December 15, 2014. Later enrollees will have later start dates.

So where should you go to shop for and buy your coverage? Most states are using the federal government's exchange -- HealthCare.gov -- for their Obamacare offerings. Even if your state has its own health insurance exchange (as Rhode Island and a few others do), you can start at HealthCare.gov and it will redirect you.

Prices and policies

When you explore the health insurance exchange for your state, you'll find a range of policies available to you from a variety of vendors. Some states have only a few different insurers participating, while others have much more competition. The plans are sorted into five tiers - catastrophic, bronze, silver, gold, and platinum. The tiers with more costly premiums offer lower deductibles and co-pay amounts. Bronze plans will generally cover 60% of your healthcare costs, having you pay 40%. The corresponding ratios are 70%/30% for silver plans and 80%/20% for gold plans. Platinum plans, not available everywhere, feature 90% coverage. Catastrophic plans are for those under 30 with low incomes.

Note that there are subsidies offered for those with low incomes. People earning less than 400% of the federal poverty level (FPL) may qualify for advanced premium tax credits, which will lower the cost of premiums. Those earning even less may qualify for further help in some circumstances, such as lowered out-of-pocket expenses and Medicaid. Note that prices will vary according to your age and where you live, but they can no longer be more costly for women than men and pre-existing conditions can no longer mean that you're charged more or are denied coverage.

Source: HealthCare.gov 

They're all the same - sort of

All the plans offered to you must cover  the same minimum set of services, such as ambulatory patient services (outpatient care you get without being admitted to a hospital), emergency services, hospitalization, maternity and newborn care, mental health and substance use treatment services (this includes counseling and psychotherapy), prescription drugs, rehabilitative and habilitative services and devices, lab services, preventive and wellness services, chronic disease management, and pediatric services. They must cover the same set of preventive services and screenings, too, such as blood pressure screening, breast cancer screening and mammography, cervical cancer screening, cholesterol screening, colorectal cancer screening, contraceptive services, depression screening, hypertension screening, obesity screening, and counseling. Adult immunizations such as flu shots, hepatitis A and B, and pneumonia shots are also covered.

What's right for you

As you compare among the plans available to you, think about your particular needs and preferences. If you're young and healthy, you might choose a lower-cost plan, as you expect few doctor visits or other healthcare needs. If you're expecting a child or see some major surgery in your near future, you might want a plan with lower deductibles and co-pays. If you expect a lot of doctor visits and many prescription medications, factor that into your decision, too. It can help to make a list of all your medical conditions and the kinds of services you use to find the best-suited plan.

You will probably be able to choose between health maintenance organizations and preferred provider organizations, or HMOs and PPOs. Read up on the differences and see which you prefer. HMOs, for example, tend to offer smaller networks of doctors, but simpler accounting and billing. PPOs include more doctors and the ability to self-refer to specialists but can have more complicated billing systems.

Source: HealthCare.gov.

Not optional

It's no longer OK to go without health insurance. The Affordable Care Act, otherwise known as Obamacare, stipulates that those choosing to remain uninsured can be whacked by a penalty. For 2015, the penalty is 2% of your household income above the tax-filing threshold (capped at the average national cost of a bronze-plan premium) or $325 per person in the household, whichever is greater. (There are a few more details to know, if you think you'll be in this category.)


The three months of the open enrollment period are your only chance all year to change your plan or sign up for Obamacare -- unless you have recently had a certain experience, such as getting married or divorced, having a baby or adopting a child, turning 26 and getting ejected from your parents' healthcare coverage, relocating to a region where your current coverage doesn't work, losing your employer-provided health insurance (such as through the loss of a job), or getting out of prison.

You can do nothing

If you're already in an Obamacare plan, if you do nothing during the open enrollment period, you'll be automatically re-enrolled in the same plan. If you chose it carefully and nothing much has changed in your life, that might be fine. Still, it's smart to make sure there are no new, more appealing plans available for 2015. 

It's not too early to start thinking about whether you will want to change your Obamacare health-care plan in the coming months, or to sign up for Obamacare. Read up on the topic, and your decision-making will be easier.

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The article 7 Things to Know as Obamacare's Open Enrollment Period Approaches originally appeared on Fool.com.

Longtime Fool specialist Selena Maranjian , whom you can follow on Twitter , has no position in any stocks mentioned. Nor does The Motley Fool. Try any of our Foolish newsletter services free for 30 days. We Fools don't all hold the same opinions, but we all believe that considering a diverse range of insights makes us better investors. The Motley Fool has a disclosure policy.

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