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Confused about insurance coverage? Get the facts

Confused about insurance coverage? Get the facts

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The election may be over, but the nationwide healthcare discussion is far from finished. Speculation about what’s going to happen abounds. Between news articles, tweets, family debates and Facebook posts, it’s likely that you feel overwhelmed at this point.

The nitty gritty

Let’s focus on what we know: Regardless of what may happen to the Affordable Care Act—commonly referred to as Obamacare—in the coming year, the law is still in place. What’s more, the period of time in which you must enroll in a health insurance plan—known as open enrollment—began November 1 and ends January 31. If you want coverage by January 1, 2017, you’ll need to purchase an individual or family health insurance plan long before you wrap that last present (you have until December 15th to enroll).

To avoid a tax penalty, you’ll need to purchase qualified coverage by January 15, 2017. (If you already have health insurance through your employer, you’re good to go.)

Could things change? Of course. But it’s not likely that they’ll change quickly, and local insurers recommend sticking with the current rules for now. Make sure you’re protected in case of accident or illness and that you can get the preventive care you need to stay healthy. If you’re still fuzzy about how or when to enroll, perhaps it’s time for a quick review.

How to prepare for open enrollment

1. Plan ahead. Ideally, you’ll be able to renew your existing health insurance plan or choose a new one during open enrollment. You should receive a reminder and instructions from your current insurer on how to renew your plan—read these materials carefully.

Review any premium or benefit changes, and consider whether switching to a different plan might make sense. The lowest-premium plan is enticing, but you might get a little more bang for your buck (better coverage) with a slightly more expensive plan.

2. Ask. This isn’t a time to be shy about asking questions. Many people don’t know what type of coverage they have until it’s too late to change, and insurers are generally happy to answer your questions. “We spend countless hours helping people on the phone and in person to make sure they find a plan that meets their needs. We genuinely want our members to be happy with the plan they choose,” says Heidi Castaneda, Individual Plans Program Director at SelectHealth, a local not-for-profit health insurer.

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Shutterstock

“Many people are surprised to learn about the differences between plans and are happy to know they qualify for help paying for their family’s health insurance coverage,” she continues. Castaneda advises people to be proactive in asking questions when they don’t understand what a plan covers or how an out-of-pocket maximum works.

3. Know your numbers. You’ll want to see if you qualify for help paying for a plan, such as a premium tax credit or cost-sharing reduction. Both of these are fancy terms for ways you can lower your out-of-pocket costs. With a premium tax credit, the government will help pay for your premium (the amount you pay each month to your health insurer for your plan). Cost-sharing reductions can improve your benefits so you spend less overall.

When you are signing up for a new plan, be prepared with your previous year’s tax and income information. Use a tool like this one to learn more about how you could save money.

Penalties can be steep

Before you decide to forego a health plan altogether, remember that if you go more than 60 days in the year without health insurance coverage, you may have to pay a penalty at tax time (for everyone in your household). Penalties are at their highest rate since the Affordable Care Act was implemented, so you’ll fork out more money than you may have in the past.

Next time you find yourself in need of health insurance coverage, be sure to enroll in a plan that fits your needs from a trusted provider.

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