Guide to open enrollment for health insurance for individuals and families

Health insurance can be a lifeline in times of need. But its intricacies often leave people confused and anxious. This makes the process of purchasing a health plan feel overwhelming. But whether you’re shopping for health coverage for the first time or reevaluating your current plan, being well-informed is key.

In this article, we'll help you confidently shop for a health insurance plan in ten easy steps.

In this blog post, you'll learn the following:

• How the open enrollment period works.
• How to compare health plan options to find the best one for you.
• If you qualify for a special enrollment period.

1. Know where you can buy individual health insurance

Individuals and families can get coverage through the federal Health Insurance Marketplace at HealthCare.gov or their state-based exchange. Alternatively, you can also find off-exchange plans directly from an insurance carrier.

If your employer uses PeopleKeep to administer your QSEHRA or ICHRA benefit, you can shop for a health policy right from your user dashboard. Our licensed professionals can also help you make the right coverage decisions.

2. Understand the open enrollment period

Open enrollment for health insurance is when individuals can enroll in or make changes to their health insurance plans. It's a crucial time for individuals, especially those who may have experienced changes in their circumstances, such as job changes, family additions, or financial shifts. During this time, people can sign up for new coverage, switch plans, or make adjustments to their existing policies without facing penalties or restrictions.

For most, it takes place in the fall, running from November 1 to January 15. However, some states, like California and Rhode Island, have extended open enrollment periods. Make sure to check the annual window where you live each year. Outside of the open enrollment period, individuals can only enroll in health insurance if they experience a qualifying life event. These events include moving, marriage, or the birth of a child, among others. This makes the open enrollment window essential for accessing healthcare coverage.

3. Gather necessary information

Prepare the information you'll need to have on hand, such as:

• Personal details like your name, ZIP code, and Social Security number to verify identity. You'll also need the Social Security numbers for everyone in your household who you will include on the policy.
• Income details (such as W-2 forms or pay stubs). This helps the Marketplace determine eligibility for subsidies or specific plan options.
• Information about your current health insurance (if you have it).
• Any relevant medical records or documentation for accurate coverage assessment, such as:
  • Current medications
  • Pre-existing health conditions
  • Medical history
• Preferred healthcare providers and specialists to ensure they’re in-network and covered under the selected plan.

4. Evaluate your current health needs

Before enrolling, assess your healthcare needs. Are you generally healthy? Or do you have chronic health issues?

Consider factors such as:

• The number of doctor visits you have annually
• Any ongoing medical conditions
• Necessary prescriptions.

This will help you choose a plan that best fits your requirements.

5. Consider your healthcare providers

When picking a health insurance plan, you want to consider healthcare providers for several reasons. First, your choice of providers directly impacts the accessibility and quality of medical care you receive. Different insurance plans have varying networks of doctors, specialists, and hospitals. Choosing a plan that includes your preferred healthcare providers can ensure continuity of care.

Second, out-of-network providers often incur higher out-of-pocket expenses. This can lead to unexpected costs. By examining the provider network associated with each health plan, you can avoid situations where you face additional fees for seeking care outside the network.

Lastly, some plans offer more resources or benefits based on their provider relationships, such as coordinated care programs, preventive services, and specialized treatment options. By considering these additional details when choosing a plan, you can secure a system that aligns with your health needs and maximizes your insurance benefits.

6. Check for eligibility for health insurance subsidies

Depending on your annual income, you may qualify for premium tax credits¹, also known as health insurance subsidies. Many individuals and families may qualify for subsidies based on their income level and household size. These extra savings can result in lower monthly premium rates and out-of-pocket costs for medical services.

However, you can only qualify for tax credits and subsidies if you use the public exchanges at HealthCare.gov or your state’s marketplace.

By understanding eligibility requirements, you can effectively compare different health insurance plans. This helps you choose one that meets your needs while staying within your budget. If you don’t check if you qualify for tax credits, you're missing out on potential financial assistance for healthcare costs, which affects your overall well-being and financial stability.

7. Learn key health insurance terms

When searching for a plan, you’ll likely come across various terms you haven’t heard before. You’ll want to ensure you understand these terms before selecting a plan.

Some common health insurance terms include:

• Deductibles
• Coinsurance
• Copayments or copays
• Health maintenance organizations (HMOs)
• Preferred provider organizations (PPOs)
• Point of service plans (POSs)
• Exclusive provider organizations (EPOs)

You can use the links above to learn more about each term you’re unfamiliar with.

8. Research a variety of health insurance plans and compare costs

Look into the different insurance plans offered in your area. You can typically do this through state or federal health insurance marketplaces. Before you buy individual health insurance, you should familiarize yourself with the various metallic tiers of plans.

There are four metal levels of health insurance plans, ranked from lowest to highest premium cost:

• Bronze plans
• Silver plans
• Gold plans
• Platinum plans

Although all Marketplace plans provide the ten essential health benefits, they vary in terms of what you pay and what your health insurer covers for healthcare expenses.

Don’t just look at health insurance premiums. If so, you might be swayed by a plan with a cheaper monthly premium that may cost you more in the long run. You also want to consider other costs associated with the plan, such as deductibles, copayments, and the provider network. A lower premium rate might mean higher out-of-pocket costs when you need medical care.

If your employer offers you a health reimbursement arrangement (HRA) like a qualified small employer HRA (QSEHRA) or an individual coverage HRA (ICHRA), you also need to consider which plans you need to participate in the benefit. In both cases, you’ll need a health plan that meets minimum essential coverage (MEC) standards. All health insurance plans on the public exchanges meet this standard, but those available directly from a carrier may not.

9. Enroll online or seek help

You can enroll online through the healthcare marketplace or with an insurance company directly. However, if you prefer assistance or have enrollment questions, consider working with a health insurance broker or health benefits navigator. Both brokers and navigators can help you apply for premium tax credits and compare marketplace plans for free.

10. Take note of special enrollment periods

If you miss the open enrollment period, you may still be able to sign up for or change your coverage if you qualify for a special enrollment period due to life events.

The four basic types of qualifying events are:

• Loss of health coverage
• Offer of new health benefit
• Changes in household
• Changes in residence

For those struggling financially, there's also a low-income SEP. This allows you to find affordable health coverage at any time during the year.

What to do after you purchase a health insurance plan

Once you sign up, make sure to check your health coverage every year. Your health needs or financial situation may change, and it’s wise to reassess your options each open enrollment period to make sure you have the best plan for your circumstances. You should also set a reminder for when the next open enrollment period begins. This helps you stay updated and ready to adjust your health insurance coverage if necessary.

After you enroll, you should also keep copies of your enrollment forms and any communication with your insurance provider. This documentation can be helpful in case of any discrepancies or issues regarding your coverage.

Additionally, your employer may require proof of your insurance coverage if they offer an HRA as a health benefit. With an HRA, your employer can reimburse you for monthly insurance premiums. This way, they can help you with your own individual insurance coverage instead of buying a group plan for the entire workforce. You can also receive reimbursement for more than 200 other HRA-eligible out-of-pocket costs.

Conclusion

You're not alone if you're worried about picking the right health insurance plan. There are many factors to think about, and the whole process can feel somewhat daunting. By following these steps, you can navigate the open enrollment process with confidence, ensuring you choose the right health insurance plan for you and your family.

1. https://www.irs.gov/affordable-care-act/individuals-and-families/questions-and-answers-on-the-premium-tax-credit