Whether from the news, the web, your coworkers, your friends, or even your family – you’ve probably heard something about open enrollment. As we’ve explained before, open enrollment can mean a lot of different things. If you’re working and your employer offers health insurance, open enrollment is a time for you to change your plan. If you are enrolled in Medicare, open enrollment is the time when you can make changes to your insurance coverage. When many people think of open enrollment, though, they think of the new health insurance marketplaces that have been set up as part of the Patient Protection and Affordable Care Act (ACA).
What is Covered California?
Covered California is the marketplace (or “exchange”) set up in the state of California to help people shop for insurance. It allows people to conveniently compare plans and pricing so they can make the best decision about health insurance coverage. These marketplaces also allow people to see if they qualify for financial assistance or special programs like Medicaid.
Whether you are you are thinking of buying new insurance or you’re not satisfied with the insurance your employer offers, you may have some questions before you start shopping around, so Meritage Medical Network has put together this list of frequently asked questions about open enrollment to help you make better decisions about your health insurance.
How can I find out if I qualify for financial assistance?
There are a lot of specific rules and requirements for receiving financial assistance. The easiest way to find out if you may qualify for special programs like Medi-Cal, premium assistance, or cost-sharing subsidies is to use Covered California’s “Get Covered Calculator.” Keep in mind that this tool can only make basic estimates based on your household income and the number of people who will need to be covered. To get a more accurate picture of the costs and benefits that apply to you, you will have to complete an application.
Where can I browse through plans during open enrollment?
You can browse through plans without completing an application by using Covered California’s “Preview Plans” tool. You will have to answer a few quick questions to see if you qualify for any special programs or financial assistance, but you can then specify what health care options are most important to you and browse through the different plans that are available. Again, remember that the costs of plans are just estimates unless you file a complete application.
What type of coverage is available?
All Covered California plans will cover “essential health benefits” and probably more. The essential health benefits include 10 categories of care, such as ambulatory patient services, prescription drugs, pediatric services, etc. Marketplace plans will also cover pre-existing conditions and offer free preventative services.
Covered California plans come in 5 basic types: catastrophic, bronze, silver, gold, and platinum. All of them (except catastrophic plans) offer the essential health benefits. These designations simply help consumers meaningfully compare different plans since plans are assigned into a “metal” (gold, silver, etc.) tier based on their actuarial value – the amount of health care expenses that the plan will cover. What this basically means is that bronze plans cover less of the costs of care, on average, than platinum plans. Specifically, all bronze plans must cover a minimum of 60% of costs while all platinum plans must cover a minimum of 90% of costs.
If my employer offers health insurance, can I refuse it?
The short answer to this question is, “yes.” Unless it is part of your contract, you can choose not to accept your employer’s health insurance plan or you can end coverage with your employer’s plan. Some people have discovered that the plans available through Covered California are actually more affordable and have better benefits than what their employers are offering, so it’s a good idea to at least shop around a little. One important thing to note, however, is that if your employer offers health insurance but you decline it, you cannot qualify for any financial assistance when buying a plan through Covered California, even if your income would make you eligible.
Obviously, there are a lot more questions that people may want to ask about open enrollment and Covered California, but we hope that these answer some of the most basic questions you may have as you explore your health insurance options. Feel free to browse around the website for Covered California to get a better understanding of your new options.
Joining our Network During Open Enrollment
Whether you’re shopping for new insurance or you already have it – take the opportunity during open enrollment to make sure your plan covers care with Meritage Medical Network. We are your health care network: with over 700 private practice physicians located throughout Marin, Napa, and Sonoma Counties, we are dedicated to ensuring that you receive the highest quality health care available. Join the network today!