How to navigate Open Enrollment? We asked the experts

Individual and Family

How to navigate Open Enrollment? We asked the experts

Updated on November 14, 2019

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Open Enrollment is an important time for both individual health insurance shoppers and families. It’s the one time each year that you can enroll in health insurance without a qualifying life event – like losing your coverage through your job or having a baby.

There are still lots of questions about buying health insurance during the open enrollment window – and for a good reason! Deciding on a health plan for you and your family is an important decision and one you’ll want to be well prepared for.

To find the answers to your most frequently asked questions, we turned to two of eHealth’s top health insurance experts: Brad Bahan and Erica Mobley. Brad and Erica are both registered health insurance agents with years of experience helping people find coverage during Open Enrollment.

To start, what is Open Enrollment, and why should you enroll during this time?

Brad: Open Enrollment is the period of time that people in the United States who need health insurance can sign up for an individual or family plan. Unless someone experiences a “qualifying event” outside of the annual enrollment period, annual Enrollment is the only time to sign up for individual health insurance under the Affordable Care Act.

Erica: Not enrolling in a health plan during Open Enrollment will leave you uninsured during 2020, which is a considerable risk. Even if you are a healthy individual who never sees a doctor, I always recommend enrolling into the most basic bronze plan. These plans typically will have a higher deductible but are more affordable and secure your coverage in the event of any unexpected health issues.

What do health plan options look like for 2020?

Brad: The plans are comparable to past years as far as benefits go. The 2020 premiums are lower, but out-of-pocket costs are going up across the board. (You can read more about this in eHealth’s 2020 ACA report). 

How do I find the best plan for my lifestyle?

Erica: It really depends on your overall health and how regularly you see a doctor. For example, I’d recommend a high-deductible catastrophic plan for a young, under-30 individual who never needs to see a doctor. However, I’d lead towards a gold or platinum plan for someone who has a chronic illness and goes to the doctor once a month. 

Why isn’t Open Enrollment offered year-round?

Brad: Because of Open Enrollment, every person now qualifies for health insurance regardless of pre-existing conditions. If anyone could enroll anytime, most people would not get insurance until there was a health condition. This would mean fewer available options and higher premiums, which the Open Enrollment period helps to prevent.  

How do I know if I qualify for a subsidy?

Erica: In most states, your household income must be between 100% and 400% of the federal poverty level to qualify for a premium tax credit that can lower your insurance costs. You can verify your qualification during the quoting process by entering your annual income. Typically, if you earn anything under 24k annually you will be eligible for Medicaid. 

Can I make changes to my plan after Open Enrollment?

Brad: You can only make changes outside of Open Enrollment if you have a qualifying life event. You may qualify to enroll outside of the open enrollment period for something such as moving outside of existing coverage area, getting married, giving birth or adopting a child, experiencing divorce or a loss of coverage due to no fault of your own.

How do I keep my doctors and prescriptions when changing plans?

Erica: As an agent, we can verify the doctor in-network from our website tools or even check the carrier’s direct website for their network. However, we always recommend reaching out to your doctor directly to verify, since your doctor may not be listed if they just recently accepted new coverage.

If I’m changing plans, do I need to cancel my old one?

Brad: If you are changing plans, we recommend that you don’t cancel your old plan until you are approved for the new one to ensure that you do not go uninsured.

Can my insurance drop me at any time? Are my pre-existing conditions covered?

Erica: No, your insurance cannot drop you unless you don’t make a payment; otherwise, insurance cannot drop you for any reason. And yes, major medical plans offered during Open Enrollment cover pre-existing conditions. The only type of coverage that does not cover pre-existing are short term policies.

If I apply during Open Enrollment, when will my coverage start?

Brad: In general once approved, your Open Enrollment plan will begin coverage on January 1st, 2020.  However, if you are applying in a state with extended open enrollment your effective date may vary depending on when you purchase and are approved.

(For more information, check out this breakout of open enrollment dates by state)

What’s your biggest piece of advice for Open Enrollment?

Erica: Being proactive and not waiting until the last minute to enroll. The entire country is trying to obtain coverage for the New Year, so carriers will be busy and moving slower. Ensuring your application is submitted promptly will give you an answer as to whether or not you’re approved much sooner than if you were to apply on the last day.

What inspires you to help people find coverage?

Brad: Informing and educating a person on making a life-changing decision. I like knowing that I put somebody’s mind at ease and helped them make the right decision for their needs.

Erica: Giving people peace of mind. Knowing that in the event of any major unexpected health issue they are going to have coverage to help cover their medical expenses.

We’ll let you know when we publish anything new.