It’s that time of year again! We’re approaching deadlines for enrollment, so here are some important dates to keep in mind:
- Medicare’s 2019 Annual Enrollment Period ends on December 7, 2018.
- Healthcare.gov’s Open Enrollment Period ends on December 15, 2018.
- Covered California’s Open Enrollment Period ends on January 15, 2018.
That’s right! California residents get the longest enrollment period in the country: October 15 – January 15.
And as you look over your insurance options, keep all this in mind:
- The federal individual mandate penalty has been eliminated
Some states, like Massachusetts, New Jersey and District of Columbia, have their own mandates, but the federally imposed penalty for not carrying health insurance was eliminated by the Tax Cuts & Jobs Act of 2017.
- Health insurance is way too complicated, so take nothing for granted
No matter where you buy your health insurance – from your job, from Covered California, from an insurance agent or insurance company – it’s complicated! And it’s binding. Insurance policies are legal contracts with companies who are in the business of making money. In consideration of the premiums that you pay, you contract with an insurer to pay your medical bills, subject to the policy terms and conditions.
It’s a “take it or leave it” deal, also known as an “adhesion contract.” That means you have no power to negotiate it.
The health insurers write the policies with their self-interest in mind. These are highly complex contracts that are inherently confusing.
Supposedly it’s easier today than it was before the ACA, because the insurers use “metal” tiers that distinguish the policies based on how much of your costs the policy will pay: Bronze – 60%; Silver – 70%; Gold – 80%; and Platinum – 90%. But policies in the same tier differ widely in terms of out of pocket expenses and physician choice, so it’s really not a lot easier than it was. And keeping the focus on premiums alone means that consumers overlook other key considerations when choosing their plans!
- Choose carefully because you’re on your own
You’d think our legislators and state regulators would get all “consumer protection” on health insurance but, surprisingly, in California we have way more protections with auto insurance than with health insurance.
For example, with auto insurance you get to pick whichever repair shop you want. Your insurer can’t make you go to their mechanic! Plus auto insurance rates are highly regulated, saving Californians billions of dollars in premiums. Click here to learn why auto insurance works so much better than health insurance!
Bottom line, you’re at a disadvantage right from the start – so don’t just pick the policy with the lowest premiums! There is so much more to consider than cost!
- Consider “choice”
Instead of just considering how high your premiums are, ask yourself:
Does the policy give you the choice of seeing your own doctor?
Double-check and ask your doctor’s office.
Is the plan an HMO, EPO, POS or PPO?
Generally HMO plans limit your choices the most, and PPO plans the least.
HMO means “Health Maintenance Organization”
EPO means “Exclusive Provider Organization”
POS means “Point of Service” Plan
PPO means “Preferred Provider Organization”
Does the policy give you any choice when it comes to your hospital?
Will the policy pay anything at all if you consult an out of network doctor?
- Consider Coverage
Does the policy provide Essential Health Benefits?
It better! Because in September 2018, Governor Brown signed SB 910 (Hernandez) banning the sale of short-term policies, many of which leave off essential benefits to keep the premiums low. While low premiums may sound appealing, the truth is, having inadequate health insurance comes at a very high cost!
How will the policy will respond to your particular healthcare needs?
According to the Rand Corporation, in 2017 nearly half of all Americans have a chronic condition like cancer, diabetes, asthma or heart disease. If you’re one of them, how will the policy respond if you need surgery, chemotherapy or special medications?
Did you receive and review the Summary of Benefits and Coverage for the plans you are comparing?
Here’s a sample Summary from Healthcare.gov. And to make sure you understand what the terms mean, here’s a glossary of helpful terms.
- Finally, consider cost
How much are the monthly premiums?
Will Covered California, or your employer, pay part of the premiums?
Are you prepared to cover the non-premium costs, such as:
- the annual deductible?
- the co-pays for doctor visits, labs, emergency care and hospitalization?
- your share of the cost of your medication?
- the plan’s maximum out-of-pocket costs?
- And can you afford to go outside your provider network if necessary?
Expect to pay a lot more – up to 100% – to go out of network. And out of network charges don’t count toward your maximum out of pocket expenses.
Finally, use this handy Health Plan Comparison Calculator to compare the cost of different plans.
You can get an idea of what your policy might cost if you don’t get sick, and then if you do get sick.
We guarantee it’ll be a real eye-opener!
Doesn’t open enrollment remind you that we need to fix healthcare for real. California Medicare for All is the answer. The perfect place to start is “California” and the perfect time is “Now!”
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HEAL California is an independent news and information hub focused on the California Medicare for All movement. We feature non-partisan news, views, podcasts and videos that highlight the continuing failures of our broken healthcare system and elevate the voices of advocates and organizations fighting for change.
Check out our Media page for experts and additional resources including links to legislation, studies, and more.
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