Everyone needs health insurance. Medical care is increasingly complex and expensive. When you need medical care, insurance protects you against most of the costs so you can focus on getting well. We know from research that people who have health insurance throughout their lives are healthier. They are less likely to develop chronic conditions like heart disease or diabetes. Insurance also provides valuable preventive services to help keep you well, and most are at no cost to you.
Every year we all need to spend a little effort insuring our health. And now is the time – open enrollment begins Nov. 1 and ends Dec. 15, 2019. During open enrollment you can enroll for the first time, renew current coverage, re-evaluate plan prices and services, and either renew your current plan or choose a different one.
Follow these steps to be sure you choose the best insurance for your personal needs and at a price you can afford.
Private, non-group health insurance – You can shop for a health plan on the Marketplace, also called the state Exchange. It offers details about plans available in Arkansas. All Marketplace plans must be “qualified health plans” that cover the 10 essential health benefits, limits the amount of deductibles and co-pays, and has no restrictions for pre-existing conditions or lifetime limits on coverage. However, Marketplace plans cover different services, offer different co-pays and deductibles and have different monthly premiums. Do not use the Marketplace if you are eligible for a group policy, such as Medicaid or from your job.
Health insurance through your job – You will receive specific instructions to renew your health insurance from your workplace.
Medicaid, Arkansas Works or ARKids – People with Medicaid or ARKids First do not have an enrollment period. They can enroll as soon as they become eligible, based on their income and assets.
Arkansas Works (Arkansas’ Medicaid expansion) – You are covered by a private insurance company and the premiums are paid by Arkansas Medicaid. You can use the Marketplace to compare plans and change coverage to another private plan during the Nov. 1 to Dec. 15 open enrollment period.
Medicare – Medicare beneficiaries’ open enrollment period is Oct. 15 to Dec. 7, 2019. You can shop for (or change) Part D Medicare drug plans, supplemental coverage (“medigap”) or Medicare Advantage plans. You may also leave your Medicare Advantage plan and return to original Medicare, or from original Medicare to a Medicare Advantage plan. Visit medicare.gov for more details and to compare plans and prices.
Even if you are happy with your current coverage, smart shoppers can benefit by comparing plan prices, benefits and services covered. Plans can and do change from year to year, and your health needs can change, too. Comparison shopping helps you get the best health coverage for your current health needs and at the best price.
Arkansans using the Marketplace can choose from more than 60 options including Obamacare plans (Affordable Care Act), health maintenance organizations (HMOs), preferred provider plans (PPOs), Medicare options and even short-term plans that provide next-day coverage. All plans available in Arkansas are listed on the Marketplace website. Plan prices and services for 2020 will be available by late October. After Nov. 1, visit HealthCare.gov. or myarinsurance.com and you will be guided through the process.
To be sure you get the best plan, follow these tips:
Review the plan’s Summary of Benefits and Coverage and use it to compare plans. The Marketplace website can provide a side-by-side comparison of all the plans you want to compare.
Look at the plan’s network of providers. Be sure the doctors, pharmacists, therapists and hospitals you prefer are in the plan’s network. Using network providers will save money; out-of-network providers will cost more.
Check the formulary. Check your plan’s link to the prescription drugs they cover (formulary). If your medications are not listed, the plan does not have to pay for them.
Review plan changes. Your current insurance company should have sent a notice describing any changes to your policy for 2020 and the new premium. When comparing plans, compare deductibles, co-pays, and the doctors and hospitals in your plan’s provider network. Children can stay on their parent’s insurance through age 26.
You can complete an application on-line. You must complete your new or renewal application before 11:59 p.m., Dec. 15, (Dec. 7 for Medicare) for your health insurance coverage to begin Jan. 1, 2020. If you miss this deadline, you will not be able to sign up for a Marketplace health plan until Nov. 1, 2020, a full year from now. Once you sign up with a plan, you must stay with that plan for 12 months.
However, if you had certain changes in your life (new job, marriage or divorce, gaining/losing a dependent, moving, losing COBRA coverage, etc.) during the year, you may qualify for a Special Enrollment Period. If you cannot afford COBRA coverage from a previous job, you can sign up for Marketplace coverage and then drop your COBRA coverage.
Most Arkansans shopping on the Marketplace will qualify for a subsidy. You must update your subsidy every year because it is based on your past year’s income. The website will show the plan’s full cost, any cost-sharing or premium tax credits you’re eligible for and the monthly premium. You can use your subsidy to reduce your monthly premiums or pay the premiums and get a tax credit when you file your income tax return.
Dec. 15, the Marketplace will automatically renew the same plan you have this year. If that plan is no longer offered, they’ll renew you with a similar plan. If you want a different plan, you must select one before December 15. You can complete an application on-line.