Open enrollment 2017

*This post applies to under age 65 only.

Open enrollment! It's the only time of year that you're allowed to start or change your health insurance plan. Once this period is over, you're typically locked in the plan for one full year until the next open enrollment (unless you experience a special qualifying event).

Dates to keep in mind

Please note these dates change year to year.

PLAN TYPE DATES

Individual and Family Health Insurance
On Exchange and Off Exchange

November 1, 2016 - January 31, 2017

Benefits
(Employer Sponsored)

Check with your employer.
Dates depend on your employer's group 'anniversary'

Medi-Cal No specific dates, can apply at any time

Open enrollment

This open enrollment period is for individual and family plans, whether through Covered California (on exchange) or direct to the carrier (off exchange).

During open enrollment, you can:

  • Change to a new health insurance company

  • Change your coverage by upgrading or downgrading (i.e. If you have a new health condition, or you've started taking more prescriptions, this would be the time to review and make a decision)

  • Look at your estimated income and make changes as necessary

Open enrollment for health benefits through an employer

The open enrollment period for employer-sponsored health plans will vary with each employer, because an employer can start a new group health policy at any time during the year. You need to check with your employer or HR department to find out.

Some people choose to opt out of their employer-sponsored health insurance, either because it's too expensive or they want other options. If you opt out, please note these rules:

  • You must decline coverage during your employer's open enrollment period

  • When you opt out, you most likely cannot qualify for premium tax credits through Covered California (the exchange). As long as the employer-sponsored plan is considered 'affordable' and meets 'minimum standards', you will not get premium assistance. An employer's plan is considered 'affordable' if your portion of the premiums are less than 9.66% of your household income.

If you miss open enrollment and do not experience a special qualifying event, you would be able to apply for a short-term health insurance plan. However, these do not count as minimum essential coverage, so you may still pay the penalty for not having health insurance.

Health insurance metal tiers

*This post applies to under age 65 only.

Health insurance is now organized into four different metal tiers: Bronze, Silver, Gold, and Platinum. While each tier differs in terms of premium and cost-sharing, each Affordable Care Act (ACA) plan has the same essential health benefits and has nothing to do with the quality or amount of care you receive.

Bronze: the health plan pays 60% of benefits, and you pay the remaining 40%

  • Lowest tier in the exchange

  • Lowest premium

  • No separate deductible for drugs

Silver: the health plan pays 70% of benefits, and you pay the remaining 30%

  • Second lowest tier in the exchange

  • Second lowest premium

  • Separate deductible for drugs

Gold: the health plan pays 80% of benefits, and you pay the remaining 20%

  • Second highest tier in the exchange

  • Second highest premium

  • $0 deductible (varies; some plans off the exchange may have a small deductible)

Platinum: the health plan pays 90% of benefits, and you pay the remaining 10%

  • Highest tier in the exchange

  • Highest premium

  • $0 deductible

We know it's nearly impossible to predict what your healthcare needs will be in the upcoming year, so we suggest picking a plan that works with your budget and your expected needs (i.e. if you have a surgery planned in the upcoming year, a higher tier may work best for you). You're able to change plans each year during open enrollment or if you qualify for special enrollment.

Open enrollment and special enrollment

*This post applies to under age 65 only.

A benefit of the Affordable Care Act (ACA) is that no person can be turned down for health insurance based on his or her medical history. However, the new rule is that you must sign up for health insurance during a set time frame called open enrollment. If you experience a qualifying life event, you can enroll during special enrollment.

Open enrollment for under age 65

  • A time frame each year in which you can enroll, switch plans, and get subsidies.

  • Typically runs from the beginning of November to the end of January the following year

Special enrollment for under age 65

  • Only time outside of open enrollment where you your family can sign up for health coverage.

  • You must qualify in order to be eligible. Qualifying events may include one of the following life-changing events:

    • Loss of health coverage (i.e. turning age 26, losing job-based health insurance, etc.)

    • Getting married

    • Having a baby

    • Moving your residence outside of your insurance plan's area

  • You typically have up to 60 days from the date of the qualifying event to enroll in a new plan, but make sure to apply as soon as possible to get the earliest effective date. Your plan will not always be effective the date it ended unless you plan ahead.

Things to note

  • For health benefits plans for employers, there is no set enrollment period. You can apply at any time.

What if I don't enroll?

  • You may have to pay a penalty, which increases each year

    • In 2015, the penalty is the higher of these two amounts:

      • 2% of your yearly household income

      • $325 per person for the year

    • In 2016, the penalty is the higher of these two amounts:

      • 2.5% of your yearly household income

      • $695 per person for the year

  • You pay the penalty on the federal income tax return

On exchange vs. off exchange health insurance plans

*This post applies to under age 65 only.

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Health insurance isn't limited to Covered California. If you're ineligible for premium assistance, frustrated by the CoveredCA.com website, or just want to opt out of the Obamacare plans, you can shop off the exchange.

When does it make sense to buy off the exchange?

If you don't qualify for premium assistance (and know for sure that you won't in the upcoming year), then off exchange might be a better option for you.

If you’re earning less than 400% of the poverty line after factoring in family size and income, then you'll probably want to buy on the exchange through Covered CA. This is the only way to get financial assistance with your health insurance. 

What are the advantages of going off exchange?

  • More plan options–all health insurance plans are required to carry the essential health benefits required under the Affordable Care Act. While on the exchange you're limited to the four metal tiers Bronze, Silver, Gold, and Platinum, off exchange can give you extra options in between.

  • Premium–premiums for the same health plan are the same on and off the exchange. If there's an issue with payment, you won't need to contact Covered California. You can get it sorted out directly with the health insurance carrier.

  • Less paperwork–if you don't need premium assistance, you don't need to pull pay stubs and confirm your identity with passports and driver's licenses. The application process is quicker and simpler.

Healthcare reform changes

*This post applies to under age 65 only.

Here are the main changes that will take place January 2014

  • Everyone will be required to have health care coverage (with some exceptions). Most people will be required by federal law to have health insurance or pay a penalty to the federal government if they do not.

  • Each state will have a Health Insurance Marketplace, often referred to as an exchange. These Marketplaces, set to hold an open enrollment beginning in October 2013, will offer another place to find health coverage. Consumers are still able to off the exchange.

  • Guaranteed issue. Medical underwriting will no longer be required in the health insurance application process. By law, health insurance companies cannot deny coverage because of pre-existing or ongoing conditions like cancer or diabetes.

  • Individuals and families may be eligible for financial assistance from the federal government. Help with premiums and will be available through the Health Insurance Marketplace (Covered California). Assistance will be based on a sliding income scale for individuals and families.

  • There are four levels of coverage–Bronze, Silver, Gold, and Platinum. Each level will offer different combinations of co-payments, coinsurance, and deductibles. Bronze plans will have lower premiums with higher out-of-pocket costs, while plans in the higher tiers will have higher premiums and lower out-of-pocket costs.

Our health advisors are available to help with questions and the enrollment process.