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How Skipping the ACA Open Enrollment Could Cost You

How Skipping the ACA Open Enrollment Could Cost You - TaxACT Blog

The Thanksgiving holiday is always a time to reflect and remind ourselves what we’re grateful for: family, friends, a good job . . . okay and those door-busting Black Friday deals.

In the spirit of the season, you’re probably thanking your lucky stars you’ve already got health insurance and you don’t have to worry about this next ACA open enrollment, which begins on November 15.

More time to think about the turkey and trimmings feast just a few weeks away. Right?

Not so fast.

Even if you’ve got health coverage and your plan is set to automatically renew for next year, consumer advocates and policy experts — including Ivan Williams, GetInsured’s senior policy analyst — say you should carefully review your current ACA policy.

If you don’t, you could wind up paying for it in the long run, with higher out-of-pocket costs, smaller tax credits — or even no health insurance at all.

How Skipping the ACA Open Enrollment Could Cost You - TaxACT Blog

“You don’t want to put your insurance on autopilot,” says Williams. “If you’re not charting your course, you could end up somewhere you don’t want to be.

Or worse, you could end up crashing — meaning your healthcare could run out. It’s always a good idea to be proactive, review your coverage options.”

Unfortunately, a recent survey found that only 43 percent of people who used the federal insurance marketplace or a state-run exchange during the last open enrollment plan on returning to look around for a 2015 healthcare plan.

Whether they had a bad shopping experience or they’re just “shrugging their shoulders,” opting to let their policy auto-renew, it could be a costly mistake.

Here are four reasons why reviewing your health plan annually is a smart move:

So You’re Not Caught Uninsured.

If you’re currently covered by a plan through the federally facilitated marketplace (FFM), you’ll receive two important forms: a notice from your current insurer and one from the marketplace.

The insurance company notice will let you know whether you’ll automatically be enrolled in a 2015 plan or if you’ll need to take action to continue coverage.

“Those with state plans should check with their insurance companies and with their marketplace, as some states won’t automatically sign you up for 2015 coverage,” says Williams.

Californians, for example, will have to log in to and complete an online renewal, while New Yorkers will only be auto-renewed if they selected that option when they signed up for their 2014 coverage.

To add to the potential confusion, some states are in the process of switching from a state-based health insurance exchange to the federal marketplace; others, like Idaho, which were served by, will now be running their own.

Use this map to see where your state stands.

The bottom line: Find out from your insurance carrier or your Affordable Care Act (ACA) marketplace what you need to do to ensure coverage for 2015.

Keep in mind that the deadline to enroll in a plan that’s effective beginning January 1 is December 15, regardless of where you shop.

Though you may recall the many deadline extensions from the last open enrollment, don’t count on that happening again this year.

 So you don’t end up with a plan that’s changed.

“Review your policy to make sure there are no changes that might surprise you in 2015,” says Williams.

For example, a lab previously used by your doctor may no longer be a covered provider, leaving you to foot the (potentially costly) bill for any tests or blood work.

Or perhaps your trusted primary care physician (PCP) has opted out of your plan’s network.

“Doctors and other providers can drop out, be dropped, or be added to a network at any time, so even if you’re not changing insurance companies it’s worth checking their current provider list,” Williams says.

Another thorny situation that can come up:

Your current plan, slated for auto-renewal, is discontinued, and your insurance carrier enrolls you in another plan closest to your old one.

If they don’t offer a policy in the same tier level (bronze, silver, gold, or platinum) as your old plan, you could wind up with a different level of coverage, including changes to your premiums, copays, benefits, and out-of-pocket costs.

Even if your insurer enrolls you in another plan in the same tier, check to make sure your preferred doctors are still in-network and to see if there are any differences in covered services.

Your insurance company will notify you about any plan changes, and send you the new plan information, so make sure you fully understand any differences in premiums, copays, coinsurance, and deductibles — and think about whether it’s worth considering another marketplace option, including a different insurance carrier.

So You’re Receiving the Right Tax Subsidies and Cost-Sharing Reductions.

If you get a notice saying your health plan is set to auto-renew with the same tax credits you got in 2014, there are important reasons you should revisit your state or federal marketplace to update your information.

Tax subsidies, which can lower the cost of your monthly premium, are based on your household size and income.

If, for example, you recently welcomed a new baby or were unfortunately laid off from a job, you’ll want to let the marketplace know since you might be eligible for higher subsidies.

On the other hand, if you got a well-deserved raise, your subsidies would most likely decrease, and if you don’t update your subsidy eligibility information, you may end up owing Uncle Sam a chunk of change when you file your 2015 taxes (in April 2016).

Eligibility for cost-sharing reductions is also based on your income, and if that has changed significantly within the last year, you’ll definitely want to review your health insurance options.

If your income dropped and you’re enrolled in a silver tier plan, you may now be eligible for cost-sharing reductions if you weren’t before.

If your income is less than it was and you’re enrolled in a different metal tier plan, you might want to switch to a silver plan to take advantage of cost-sharing reductions, assuming you’re eligible.

A cost-sharing reduction lowers the amount you pay out-of-pocket for deductibles, coinsurance, and copayments.

Even if your household size and your income haven’t changed, the standard plan your area can raise or lower the tax subsidies you receive.

How Skipping the ACA Open Enrollment Could Cost You - TaxACT Blog

So your 2015 plan is the best fit for you.

All other things being equal — same plan, same household size, and same income — perhaps your health situation has changed since you bought your last plan.

Maybe you considered yourself in the peak of health so you opted for a bronze plan, with low monthly premiums but higher out-of-pocket expenses like deductibles, copays, and coinsurance.

Then you had your annual physical and received a surprising new diagnosis of diabetes, a chronic condition that you’ll need to manage with regular medication and checkups.

A bronze plan may no longer be the best choice, and you’ll want to look at a different tier with higher premiums but lower out-of-pocket cost.

The good news is that more ACA plans will be offered in many marketplaces this year, so it pays to carve out some time to shop again (before or after the turkey).

Taking a hard look at your health insurance options (and your health) this time each year is a really good idea.

Even if you think your plan is fine.

Even if you’d rather get a jump-start on your holiday gift shopping (and brave the Black Friday frenzy) than sit down to review your policy.

It’s sort of like brushing and flossing, or exercising: You do it because you know it’s good for you in the long run. Tweet this

And in this case, it’s not just good for your physical health — and your family’s — it’s good for your financial health as well.

Monthly Tip from Ivan Williams…

“With so many purchasing choices available and so much information to digest, shopping for health insurance can be overwhelming. Use an online tool like the GetInsured Plan Score, or let a licensed health insurance broker help guide you through the process. They’ll work with you to find the best plan — and it won’t cost you a thing.”