5 Secrets You Need To Know During Open Enrollment

5 Secrets For Open Enrollment


You may have missed the deadline to sign up for health insurance coverage that will begin 1/1/2015, but all is not lost.  There still may be an opportunity for you to add coverage in the next few days as there are special circumstances that will permit you to buy coverage if you meet several criteria.  We wanted to highlight a few key "secrets" we've seen this year that you need to know that may help you get coverage or at least avoid trouble in 2015.

5)  You May Still Add Coverage If You Meet Special Requirements

While most people that missed the sign up deadline on 12/15/14 must simply deal with the reality that they can now only obtain coverage that begins on 2/1/15, you may still have the opportunity to buy coverage that begins January 1st.  If you have coverage that is being terminated by an employer on 12/31/14 or your coverage is being terminated by your insurance carrier for some other reason than a lack of premium payment, there may be an opportunity to still sign up.  Contact Us today or simply call us at 713-422-2935 and we'll walk you through the process.

4) Who Are These Companies?

We often call the Government Marketplace with our clients to ensure that they have help applying for financial assistance and enrolling in a plan that we've discussed and we know fits our client's needs.  I am often amazed how often during our calls that a Marketplace Representative will recommend a plan to our clients without knowing anything about them or how they use insurance.  The recommendation is based solely on the net price of the plan and not based on the reputation of the company, its track record of claims payment, its financial health, or the size of its physician network.  The entire thought process is that the plan is cheap.  The representatives are always astounded when I ask them if they have ever heard of "Molina Health" or "Community Health", and of course they never have.  The concern I have is that if our client were to sign up with these insurance companies and the service or the insurance was poor, would anyone be responsible?  The answer of course, is no one would be responsible except the poor people that are steered into these policies.  These are the same policies that the government tells you only increased 2% or 3% this year as well.  These are HMO plans with really small networks that no one would buy if they had a choice.  These firms may be wonderful, but are you going to risk your physical and financial health hoping these companies are great?

3)  HMO Plans Lack More Than Just Doctors

I mentioned in the point above that the Marketplace representatives always suggest cheap insurance companies you've never heard of and probably wouldn't want to risk buying if you could help it.  The Marketplace folks always also recommends HMO plans because they are cheaper.  While I like the affordability of the cheaper HMO plans, I'm scared to death of the things that no one is talking about, that you are missing more than just doctors!  When I visit with callers about the HMO network, I always mention that the physician networks are only about 1/3 the size of the regular PPO network.  Many clients understand that this is unacceptable, but some are convinced that the cheaper route is better.  My concern is that these clients also appreciate that it isn't only doctors they'll miss when they sign up for the HMO plan, it is hospitals! The hospitals that are missing from the HMO network aren't just any hospitals, they are the leading facilities in all of Houston!  You'll see that Memorial Hermann, Texas Children's, M.D. Anderson, and even the county trauma hospital, Ben Taub Hospital, doesn't take the Blue Cross HMO!

Let's use the Blue Cross HMO and PPO as examples and we'll do a search here in the Houston area.  Here is a link to follow along;

Blue Cross Provider Finder

Click on the link above and then find the words "Provider Finder" in the text.

Next to Texas, click the word - Start Search

At the top of the page Select the Blue Advantage HMO network.

Input your zip code and also select from the drop down box "Medical/Surgical Hospital"

Try again by modifying your search, but this time select the Blue Choice Network.

Everyone's results may vary. 

In Houston, in the HMO Network, I can choose only 16 hospitals (for a city with a population of 4 million)!  When I choose the Blue Cross Blue Choice PPO network, I find 56 hospitals available.

2) Beware Of The Tax Man!

The Affordable Care Act (ACA) was paid for in large part by a huge array of new or expanded taxes.  The 2014 tax year will introduce a new set of IRS forms we must use and a new group of people will be forced to file tax returns that never did before.  There are three main issues you need to be aware of when navigating the treacherous waters of the ACA now.

If you obtained a financial subsidy and purchased a health insurance plan "On Exchange" this year for 2014 you will now be required to file an income tax return.  Even if you earned an amount below the filing requirement, you must now file a tax return because you obtained a subsidy.  In addition, you must file IRS Form 8962 which will reconcile if you received too much financial assistance, or not enough.  If you received too much financial assistance, you'll owe more taxes for the 2014 year.  If you did not get enough of a subsidy, you'll get a larger refund in April.  

Notice that I mentioned that you must have purchased a plan "On Exchange" through the government Marketplace?  If you were a taxpayer that should have qualified for a subsidy but did not buy a plan through the Marketplace you will not get a refund.  These issues are complex and the process is maddening.  Make sure to Contact Us so we can help you obtain the maximum help in paying for your health premiums in 2015.

Finally, if you decided to not purchase health insurance in 2014 you will owe taxes in April.  Depending on your financial situation you could owe as much as 1% of your household income for the year.  If you decide to not purchase insurance in 2015, your penalty will increase to as much as 2% of your household income!

1)  You're Dating Your Plan, Not Marrying It

Health insurance is serious business and I get excited when clients want to discuss plans and make sure that they are getting the best coverage at the best price.  Sometimes we find ourselves with situations where two plans or two companies are priced exactly the same or look like there is no difference.  In that case, we need to remember two important things.  First, if we purchase a plan and find we hate it, we have until February 15th to pick a new one.  This will help many shoppers as we know that we have a way out if we recognize that a plan doesn't serve our needs immediately.  Second, if we get past the February 15th deadline to make our last change, we can always choose a plan next year.  In other words, we are just dating!  If you discover that the plan really has too high of a deductible and you wished you had a few office visits with a co-pay, you may have to deal with it till Open Enrollment in November of 2015, but you'll always be able to get a new plan in the next calendar year.

You still have time to make changes in plans or analyze the options that may be best for your family.  Don't hesitate to call us at 713-422-2935 or click Contact Us and we'll be happy to help you get started today.

Jason Bohmann
Texas Health Design