Open enrollment is on! It's time to select your plan - or face a penalty next year. Selecting an individual health care plan is not an easy task in itself, but doing so, while on a tight budget, amounts to a real challenge. The government website www.Healthcare.gov offers a variety of plans from which to choose but comparing plans is not simple, particularly for individuals who have never been exposed to key concepts such as deductibles, formularies, out-of-pocket expenses, EOBs, etc.

The Centers for Medicare and Medicaid Services, CMS, recently published a very useful article to help individuals find a plan that works best for their family, see http://blog.cms.gov/2015/11/17/five-facts-about-deductibles/ 

There are five critical facts you need to know about deductibles:

  • All plans offered on Healthcare.org cover recommended preventive serviceswithout a deductible.
  • Each plan is specific but many plans also offer non-preventive health services such as generic prescription drugs without a deductible. 
  • As you review each plan, visit the section called “costs for medical care” to determine what services are covered without a deductible.
  • Factor-in services covered without a deductible along with your monthly premiums, deductible, and other out of pocket costs when choosing the plan that is right for you. Do not focus solely on the monthly premium!
  • Financial assistance is only available if you select a Silver Plan. Therefore, a Silver Plan might be a cheaper option for your family even though the monthly premium may appear more expensive on its face. You may save more with a Silver Plan because of potential financial assistance for the monthly premium, lower copays, lower deductibles, and more services covered with no deductible at all. It is like buying a car that is more expensive up front, but gets you better gas mileage, lower insurance premiums, and enhanced safety features.

You can check your eligibility for financial assistance at https://www.healthcare.gov/lower-costs/. The quick and easy-to-use tool will also determine if you may qualify for Medicaid based on your income and the size of your household. Do not assume that you don't qualify. The thresholds are higher than you think. For example, a couple living in Ohio would need to make over $63,720 not to qualify for any financial assistance with the premiums.

CMS representatives are available 24 hours a day, every day, except for Thanksgiving and Christmas Day: (800) 318-2596. Help is free and confidential.

If you fail to secure health care coverage this year, you may be liable to pay a penalty. For 2016, the penalty is the greater of: (1) $695 per adult, $347.50 per child under 18, with a maximum of $2,085 per household; or (2) 2.5% of your household income, not to exceed the total yearly premium for the national average price of a Bronze plan sold through Healthcare.gov.

It is high time to pick your plan. Share on!