7 things to know ahead of open enrollment



Myles Ma

Myles Ma

Senior Managing Editor

Myles Ma is a health care expert & personal finance writer for Policygenius. He edits the Easy Money newsletter.

Published October 14, 2019|3 min read

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A federal appeals court could nullify the Affordable Care Act in a few weeks, but open enrollment on the state and federal health insurance marketplaces is expected to go on as usual starting Nov. 1.

Shopping for individual health insurance this fall? Here's what you need to know about open enrollment.

(If you're choosing among employer-provided health plans, this guide to workplace open enrollment is for you.)

1. Who can take part?

Enrollment in the state and federal health insurance marketplaces is for people who don't have other health coverage. If you're covered by your job or another government program like Medicare or Medicaid, there's no need to buy a plan on the marketplace, and you won't receive any tax credits or other financial assistance if you do.

2. How to apply

A good place to start your application is via Healthcare.gov. You can find local agencies to help you apply through the website. You can also contact the marketplace over the phone by calling 800-318-2596.

Need more help? Policygenius can also help you compare and buy health insurance plans.

3. When are federal marketplace plans effective?

If you buy a plan before the Dec. 15 deadline, coverage will start Jan. 1, 2020 and last throughout the year.

4. What if you miss the deadline?

Some state exchanges allow people to enroll after Dec. 15.

For example, the deadline to sign up for a plan on the California health insurance marketplace is Jan. 15. Read our guide to open enrollment in every state.

If you miss the deadline, you can still buy health insurance if you qualify for special enrollment due to a life event like getting married, having a baby, moving or losing coverage. Depending on your income and other factors, you can apply for Medicaid at any time. Read our state-by-state guide to Medicaid eligibility.

5. What plans are available?

The plans offered on the marketplace vary by state. But insurance companies offer plans in four tiers: bronze, silver, gold and platinum.

In general, bronze and silver plans have lower premiums but higher out-of-pocket costs, while gold and platinum plans have higher premiums but cover more medical expenses. If you choose a plan with a lower premium, make sure you have enough savings to pay any out-of-pocket costs in the event of a medical emergency.

6. Can you get help paying for your plan?

Depending on your income, you may qualify for a premium tax credit, which lowers the amount you pay each month for insurance.

You may also qualify for a cost-sharing reduction, a subsidy reducing the amount you pay out of pocket for medical services. This can include your deductible, copay, coinsurance and out-of-pocket maximum.

Cost-sharing reductions are only available for plans in the silver category.

7. What information do I need?

The application will ask you for basic information, including your name, date of birth, household composition, address, Social Security number, employer and income level for anyone who will get covered. To qualify for financial aid, you'll have to estimate your household income for the coming year, based mostly on the adjusted gross income from your most recent tax return.

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Image: Michele Constantini