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Understand Coverage Options For 2019 Open Enrollment

by Kelley Turek, Executive Director, Employer & Commercial Policy, AHIP

October 31, 2018

For individuals and families who purchase health coverage on their own, open enrollment for 2019 plans begins Thursday, Nov. 1 and ends Saturday, Dec. 15. People who do not get coverage through their job or other government programs like Medicare or Medicaid can shop for and enroll in coverage in the federal health care Marketplace.

Consumers who shop on HealthCare.gov or a state website will have a similar experience as in prior years. Like before, people who are currently enrolled in coverage should update their application, explore plans available in their area, and either choose to remain in their current plan or pick a new plan. By Nov. 1, enrollees will receive a notice from their current plan with information about any changes to their benefits or costs. On HealthCare.gov, they can compare plan options, check to make sure their doctor is in-network and their prescription drugs are covered, and enroll in an affordable coverage option.

This year, alternative coverage options are also available. These plans, called short-term plans, may have a lower premium but cover different benefits. Short-term plans can provide protection from catastrophic events when an individual or family is transitioning between longer-term comprehensive coverage and would otherwise be uncovered. However, these short-term plans may cover fewer benefits and can result in higher out-of-pocket costs if consumers need services that aren’t covered.

Below are a few key differences between Marketplace health plans sold on HealthCare.gov and short-term plans:

While no one expects to get sick or injured, consumers should consider how much coverage they think they might need and pick the plan that will best meet their health needs and work with their financial situation. Consumers should ask themselves the following questions:

  • Do I regularly use health care services, have chronic conditions, or use a prescription drug regularly?
  • Do I expect to use few services, like annual preventive care services?
  • Do I just need to fill a temporary gap in coverage for a short period of time?

Before picking a plan, it is important to review what benefits are covered, out-of-pocket costs (including copays and coinsurance), and whether their doctor is in network and their prescription drugs are covered. Consumers can contact the health insurance provider directly, call the Marketplace, or consult a trusted agent, broker, or navigator for help reviewing these options before choosing coverage.