Open enrollment is a critical opportunity for consumers to secure health coverage, ensuring access to essential medical services and protecting against unexpected healthcare costs. It's when you can select health care coverage for you and your family for the next year.
For most non-traditional workers, a good choice to find coverage is the Affordable Care Act (ACA) marketplace. Income subsidies and tax credits can make it even more affordable.
TIP #1: In ACA plans, you are guaranteed acceptance. A pre-existing condition like diabetes won’t lock you out.
TIP #2: It’s easy to find the perfect plan through Mercer Indigo (more in a moment).
Knowing these terms helps ensure a happy dance of “Yes, it’s covered!” when you need health care.
Open Enrollment. Generally, Open Enrollment is the timeframe that spans November 1 to January 15 when you can enroll or change coverage; however, a few states have different date ranges. For all states, if you want your coverage to start January 1, be sure to enroll by December 15.
VERY IMPORTANT: You cannot enroll or change health plans outside of these dates unless you have a Qualifying Life Event, like losing coverage, getting married or divorced, or moving.
Health Insurance Marketplace®. A place where you can buy health insurance coverage. For ACA plans, some states run their own marketplaces. (For example, in California it’s Covered California®)
Essential Health Benefits. All newer ACA plans must cover 10 essential health benefits. These include emergencies, hospitalization, prescription drugs, maternity and newborn care, laboratory services and more.
Preventative health services. Free services—like vaccinations and screenings—in a health plan. Plans differ and services are only free within your plan’s network of providers.
Network vs. Out-of-Network. An in-network doctor, hospital or health care provider is one who contracts with a health plan to provide care at discounted rates. An out-of-network provider’s services will be billed at full price and may not be covered at all by your health plan.
Cost Sharing. How you split costs with your health plan. (Note, each year starts new.) Key terms of cost sharing include:
Premium tax credit. Helps lower your premium when your income qualifies. You’ll estimate your taxable income for the coming year. If at the end of the year, you take more credit than you’re due, you pay it back with your taxes. If you’ve taken less, you get the difference back.
Extra savings or cost sharing reductions. A second way to save when your income qualifies. When you enroll in a Silver plan, extra savings can reduce your deductible, copays and coinsurance.
Metal levels. ACA plans come in 4 metal tiers: Bronze, Silver, Gold and Platinum. Your cost shares and premium vary between tiers, with Silver featuring extra possible savings.
Say you have a health insurance plan with the following:
This means you pay $4,000 in health care costs before your insurance starts. After you pay $4,000, you pay 30% for covered services and your insurance company pays 70%. You pay $25 for each office visit regardless. After you’ve paid $5,000, your health plan pays 100% until the plan “renews” again the next year.
Mercer Indigo offers more that just comparing plans and carriers, we have licensed agents standing by to answer your questions and help you find the right coverage fit (all for free!) Plus, you can add off-Marketplace supplements to better protect your family. For example, shop Indigo for:
These supplements and others pay cash benefits for you to use any way you want. You can see plan options and reviews, just as you do for ACA-compliant plans.
Here are a few things to have at hand when you're ready to shop.
Shop for health insurance from leading insurers with confidence at Mercer Indigo. There’s no need to stumble around confusing government websites. Find the right coverage today!