Maybe you have always had health insurance through your employer or your spouse’s employer, and now that option isn’t available. Or maybe you have always been on a parent’s health plan, and now you’ve aged out of that option. Whatever the issue is, now you’re here, and you need to figure out what you are going to do for health insurance in 2019.

We know that you have plenty of questions, so we sat down with our subject matter experts here at Keenan to address some of the most commonly asked questions that we hear from people shopping for coverage. We want to ensure you have the information you need to make the best decision for your health care needs. Health insurance made easy means being educated on the issues.

1. How long is the Open Enrollment period?

In California the Open Enrollment period begins on October 15, 2018 and runs through January 15, 2019. If you live outside of California, your Open Enrollment period may be significantly shorter. The federal government’s open enrollment period is about 45 days, and runs from November 1, 2018 through December 15, 2018.

If you purchase coverage before December 15, 2018 in California, your coverage will be effective on January 1, 2019. However, coverage purchased after December 15, 2018 and before the end of open enrollment may not go into effect until February 1, 2019.

Roughly 262,000 fewer people are expected to purchase coverage in California’s individual market in 2019, due to the elimination of the individual mandate penalty. As a result, rates are increasing by an average of 8.5% (that’s 3.5% higher than if the mandate would have remained in place).

2. What can I do during Open Enrollment?

The Open Enrollment period lets you:

• renew your current individual or family health care plan;
• choose a new plan through the health exchange; or,
• purchase a qualified individual/family plan through a private insurer.

3. What if I miss the Open Enrollment period?

For employer-sponsored coverage, open enrollment is generally the only time that employees can drop their coverage, whereas, in the individual market, people can drop coverage at any time during the year. But in both cases, open enrollment is generally the only time that people can sign up for a plan, or switch to a different plan, unless a special enrollment period is triggered by a qualifying event.

A qualifying event is an event that triggers a special enrollment period for an individual or family to purchase health insurance outside of the regular annual open enrollment period. Our guide to special enrollment periods goes into detail about each of the qualifying events.

In the individual market (on or off-exchange), qualifying events include:

• the birth or adoption of a child
• marriage (and divorce, if the exchange or insurer counts it as a qualifying event)
• loss of other coverage (as long as the coverage you’re losing is considered minimum essential coverage)
• a permanent move to an area where different health plans are available (as long as you already had coverage prior to the move)
• a change in income that changes your subsidy eligibility (only applies if you already have coverage through the exchange)
• an increase in income that moves you out of the Medicaid coverage gap
• a grandfathered or grandmothered plan’s non-calendar-year renewal
• becoming a US citizen or lawfully present resident

If you experience a qualifying event, you have 60 days to select a plan or switch to a different plan (in some cases, the ability to switch from one plan to another is limited during special enrollment periods). In most cases, the coverage will be effective the first of the following month if you enroll by the 15th of the month. But there are different effective date rules for marriage, birth or adoption of a child, and loss of other coverage. 3.5

4. What is included in a qualified health care plan?

All qualified health care plans must include at least ten essential benefits, which are:

• Outpatient care including chronic disease management
• Emergency care
• Hospitalization
• Pregnancy and newborn care
• Mental health and substance abuse services
• Prescription drugs
• Rehabilitation services and devices
• Lab tests
• Preventive and wellness services
• Dental and vision care for children

5. Are there subsidies to offset the cost of health insurance?

The ACA’s premium subsidies are designed to increase to keep pace with the cost of the benchmark plan in each area. As premiums grow, so do premium subsidies. But starting in 2018, premium subsidies became disproportionately large in many areas, due to the way states and insurers handled the loss of federal funding for cost-sharing reductions.

That will continue to be the case in 2019, and the disproportionately large subsidies will be available in more places. As the poverty level rises each year, the income cap on subsidy eligibility also rises; it will be above $100,000 for a family of four in 2019.

The amount of the subsidy you qualify for depends on the number of members in your household, where you live, your household income, and the age of each household member. You can use the KeenanDirect subsidy calculator to estimate what you qualify for.

We know that this might only answer some of your questions, so let us know how we can help you out. We’re here for you to make health insurance easy! Request a no-cost comparison of ACA plans in California here.