Confused about Open Enrollment? Here’s a Glossary to Help!
November 1, 2018
Open enrollment starts today, so it’s important to know what plan fits your needs and provides you with the necessary coverage. Here are some key terms that can help you navigate the health insurance marketplace.
Premiums: A premium is the amount you pay for your health insurance each month. When looking for what plan will fit your needs, it’s important to keep in mind that the plan with the lowest monthly premium may not be the plan with the best coverage for you. If you are in need of a lot of health care, a plan with a higher premium, but lower deductible may actually save you a lot more money. Source: https://www.healthcare.gov/glossary/premium/
Deductibles: A deductible is the amount you pay for health care services before your insurance starts paying for health services. Typically, lower monthly premiums means there is a higher deductible, and the higher monthly premiums have a lower deductible. Under the Affordable Care Act, or ACA, which is also known as Obamacare, some services including preventative care are fully covered before you’ve met your deductible. Source: https://www.healthcare.gov/glossary/deductible/
Preventative Care: Preventative care is the care you receive to prevent illnesses or diseases. It includes: screenings, immunizations, counseling, regular check-ups, flu shots, cholesterol tests, blood pressure tests, and well-visits. These services can help you and your family stay healthy and at no additional cost, preventative care is covered under the ACA. Source: https://www.hhs.gov/healthcare/about-the-aca/preventive-care/index.html
Pre-existing Conditions: A pre-existing condition is a health issue that you had before your health insurance coverage start date. In some cases, insurance companies can refuse to cover treatment for someone with pre-existing conditions. However, the ACA prevents insurance companies from refusing to cover treatment or charge you more because of a pre-existing condition if you purchase from healthcare.gov or a state exchange. It’s important for people with chronic diseases and disabilities to purchase health insurance that will cover the treatment and services they need. New options for health insurance such as short-term health plans created this year by the Trump administration aren’t required to protect people with pre-existing conditions. Source: https://www.healthcare.gov/coverage/pre-existing-conditions/
Tax Credits: A tax credit is an amount of money that taxpayers can subtract from taxes owed to the government. In terms of health insurance, plan holders can receive tax credits that lower their premiums and out-of-pocket costs (like deductibles). Many low- or middle-income households are eligible for tax credits under the Affordable Care Act (ACA), or Obamacare; 85 percent enrollees receive discounts. Source: https://www.healthcare.gov/glossary/premium-tax-credit/
Copayment vs Coinsurance: Copayments are the fixed amount ($20, for example) you pay for a health care service that is covered (paid for by your insurance company) after you’ve paid your deductible. Coinsurance is the percentage of costs of a covered health care service you pay (20%, for example) after you’ve paid your deductible. Source: https://www.healthcare.gov/glossary/co-payment/ and https://www.healthcare.gov/glossary/co-insurance/
Open Enrollment: Open enrollment is a period during which individuals, employees, and employers can add or drop their health insurance, and make changes to their coverage. The ACA marketplace offers an open enrollment period for 2019 insurance coverage from November 1 (today) to December 15, 2018. Some states have extended open enrollment periods, but it is a good idea to enroll by December 15 for coverage that starts January 1, 2019. During this period, you can visit healthcare.gov to compare plans and sign up. Source: https://www.healthinsurance.org/glossary/open-enrollment/
Special Enrollment Period: A time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child. If you qualify for a SEP, you usually have up to 60 days following the event to enroll in a plan. If you miss that window, you have to wait until the next Open Enrollment Period to apply. You can enroll in Medicaid and the Children’s Health Insurance Plan (CHIP) any time of year, whether you qualify for a Special Enrollment Period or not. Source: https://www.healthcare.gov/glossary/special-enrollment-period/