Health Insurance 2015: Time’s Running Out!

If you have an individual health insurance plan—or if you lack health insurance altogether — you have limited time to change your plan or enroll in a new one for 2015. Here’s what you need to know.

• Coverage under all non-grandfathered 2014 health plans will end on December 31. All plans bought through the federal health insurance Marketplace or health insurance exchanges are non-grandfathered, and will end on December 31.
• If you have a grandfathered plan, your expiration date might differ. A grandfathered plan must have been in existence and substantially unchanged since the Patient Protection and Affordable Care Act (ACA) was signed on March 23, 2010.
• Plans in the federally run health insurance Marketplace will auto-renew. If you like your current plan and want to keep it, you don’t need to do anything. Subsidies will renew as well. However, if your family size or income has changed, you need to re-enroll to get the coverage you need to avoid penalties, and to get the proper subsidies, if you qualify.
• States have the option of auto-renewing, so if you bought health coverage through a state-run exchange, your plan might or might not auto-renew. Read on for more state-specific information.
• This year’s open enrollment period is shorter than last year’s—from November 15, 2014 to February 15, 2015.
• If you want coverage to start on January 1, 2015, you must enroll by December 15. You can enroll as late as February 15, 2015, but if you have a gap in coverage, you could face penalties.
• You can only buy coverage during the open enrollment period. If you lack coverage or your plan expires, you need to enroll before February 15 or wait until the 2016 open enrollment period, which will begin in the fall of 2015. Individuals going through certain life changes, such as moving, divorce or marriage, might qualify for a “special enrollment period” outside the normal enrollment period.

An early November survey by McKinsey & Co. found that too many people didn’t know about the new open enrollment period for health insurance. Among the uninsured, 54 percent didn’t know about the open enrollment period. Among those who currently have individual insurance, 25 percent didn’t know about the open enrollment period.

If you have health insurance through an employer group or a government plan (such as Medicare, Medicaid or TriCare), you have the coverage you need to avoid penalties under the Patient Protection and Affordable Care Act. The law allows exemptions for those who cannot afford coverage, for those who have a legitimate religious objection to health insurance, and for members of recognized Indian tribes. Nearly everyone else must buy an individual health plan.

If you bought your health insurance coverage through a state-run insurance exchange, your 2014 plan might not auto-renew. In the following states, check the state health exchange website listed below for your coverage options:

• California – Covered California
• Colorado – Connect for Health Colorado
• Connecticut – Access Health CT
• District of Columbia – DC Health Link
• Hawaii – Hawai’i Health Connector
• Idaho – Your Health Idaho
• Kentucky – KYnect
• Maryland – Maryland Health Connection
• Massachusetts – Massachusetts Health Connector
• Minnesota – MNsure
• New York – New York State of Health
• Rhode Island – HealthSource RI
• Vermont – Vermont Health Connect
• Washington – Washington Healthplanfinder

Research Pays Off

Even if your health plan auto-renews, you should research your options anyway. Your premiums and plan benefits can change year to year. A plan that met your needs last year might not be your best choice now. Your insurance company should have sent you information about updated premiums and benefits. Review your plan’s 2015 changes to see if it still meets your needs. Call or visit the plan’s website to make sure your doctor and other health care providers will be in the plan network next year. Also make sure any prescriptions you take will be covered.

If your income or household size has changed, you’ll need to report that information to the Marketplace so you get the right premium tax credit. If you don’t update this information, you’ll get the same premium tax credit you got in 2014. If your income has gone up or your household size changes and you don’t report these changes to the Marketplace, you may owe money at the end of 2015 when you file your tax return.

What to Expect for Costs

According to PricewaterhouseCoopers, as of November 4 price increases for 2015 individual coverage in 43 states and the District of Columbia averaged 5.6 percent. Premiums for single-only coverage will average $381 per month. Actual premium rates will vary significantly depending on your geographical location and coverage level (bronze, silver or gold plans). To see an interactive map showing pricing trends for the states, see http://www.pwc.com/us/en/health-industries/health-research-institute/aca-state-exchanges.jhtml.

Remember that the plans with the lowest premium costs usually have higher out-of-pocket costs when you have a claim. Keep in mind that a health insurance agent can for no charge help you buy coverage on the state exchanges or federal Marketplace.