Open enrollment 2018: Answers to five key questions

Open enrollment for Affordable Care Act (ACA) plans run from Nov. 1-Dec. 15, 2017, for 2018 health plans.

The ACA individual health insurance open enrollment period was once three months, but the Trump Administration cut the period in half for 2018 plans, so you don't want to wait this year and lose out on getting health insurance.

The federal government’s rule gives people shopping for 2018 individual health coverage on the federal exchange, or directly with insurers, 45 days to sign up. However, some states that operate their own exchanges, and California, are extending the time that people have to buy health insurance for themselves. Currently, those states are:

• California – Nov. 1 to Jan. 31
• Colorado – Nov. 1 to Jan. 12
• D.C. – Nov. 1 to Jan. 31
• Massachusetts – Nov. 1 to Jan. 31
• Minnesota – Nov. 1 to Jan. 14
• Washington – Nov. 1 to Jan. 15

As part of the ACA, also called Obamacare, you need to have health insurance to avoid getting penalized at tax time.

If you're not covered through your employer, your employer's spouse or another way like Medicare or Medicaid, you can get an individual health plan through the ACA exchanges or buying directly with health insurance providers to cover you and your family.

Here's what you need to know about open enrollment:

What do health plans cover?
There was a time not too long ago when low-cost health insurance plans offered limited coverage. However, ACA required health insurance plans must cover essential health benefits, including:

• Outpatient care
• Chronic disease management
• Emergency care
• Hospitalization
• Pregnancy and newborn care
• Mental health and substance abuse services
• Prescription drugs
• Rehabilitation services
• Lab tests
• Preventive and wellness services
• Dental and vision care for children

The plans offer more protection for you and your family, but with that additional coverage usually comes a higher price tag than what you would have paid for health insurance just a few years ago when insurers could offer plans with limited benefits.

All health plans must now offer the essential health benefits. Beyond that, health insurers' plans vary greatly based on premiums, out-of-pocket costs, deductibles and provider networks. You can find out the specifics about each plan offered by reviewing the Summary of Benefits and Coverage on each plan's website or your ACA marketplace may provide side-by-side comparisons.

What can you do during open enrollment?
You can keep your current health insurance plan or choose a new plan through the ACA exchanges or with a health insurance provider directly.

If you're enrolled in a marketplace plan, it will automatically renew, but you still want to research plan to see if the insurance company made any changes to the provider network and out-of-pocket costs like copays and deductibles. It's a good idea to review that information to make sure your plan still makes sense for you and that your providers are still part of the plan.

ACA plans are divided into four types: Bronze, Silver, Gold, and Platinum. Bronze plans have the highest out-of-pocket costs and the lowest premiums, so you can think of them kind of like high-deductible health plans that have become so common for employer-based health insurance. Platinum has the lowest out-of-pocket costs, but also higher premiums. A good way to look at it is the higher premiums you pay, the lower you'll have to spend on out-of-pocket costs during the year.

Health insurance is one of the most important purchases you make, so spend the time to review your options and pick the right plan for you and your situation.

Think about the past few years of your healthcare services, as well as the healthcare provided to your spouse and family. Then, think about the year ahead.

• Some things to think about?
• Do you regularly visit your provider for a chronic illness?
• Have you been dealing with occasional health issues that may require more healthcare services?
• Do you take costly prescription drugs?
• Do you plan on starting a family in the next year?
• Do you have enough money set aside to pay for potentially high deductibles?

That all goes into what's the best plan to choose for your situation. Generally, higher premium/lower out-of-pocket costs like Platinum plans could make more sense if you expect to need healthcare services. However, if you're young and healthy and would rather pay more for using healthcare services than paying a higher monthly premium, then a Bronze plan could be right for you.

It's critical that you give this much thought because you won't be able to change the plan again for a year.

Is open enrollment the same for other types of health insurance plans?
Open enrollment for ACA plans and individual health plans is Nov. 1-Dec. 15, but it's different for other type of health plans.

For instance, if you are covered by your employer, you will likely have a different open enrollment period. There is no standard open enrollment period for businesses. They choose their own. Many are in the fall or winter, but yours may be in the spring. Check with your employer's benefits department to find out your open enrollment.

If you're in Medicare, your open enrollment is Oct. 15 to Dec. 7, 2017. During open enrollment for Medicare, you can keep the same coverage, change Medicare Advantage or Part D prescription drug plans, switch Medicare Advantage plans, or even swap from Medicare to a Medicare Advantage plan.

For those who qualify for Medicaid or the Children's Health Insurance Program, there is no open enrollment period. Instead, you can enroll at any time of the year.

What if you miss the open enrollment period?
If you don't sign up or don't make changes during open enrollment, you won't be eligible to switch plans for a year unless you qualify for a special enrollment. Some events that trigger a special enrollment is if you get divorced, married, have a child, adopt a child, your spouse dies, your spouse loses a job or even if you are in an HMO and you move outside its coverage area.

How much are the penalties for not having insurance?
The government has been penalizing Americans without insurance during tax time since the ACA took effect. In 2017, the penalty was 2.5% of your income or $695 per adult, whichever is more, and a $347.50 penalty for each child in a family without health insurance coverage. The maximum is $2,085.

However, things may change for 2018. The Republican-led Congress has proposed ending the individual mandate that includes the penalties for not having insurance. So, we'll have to see what happens for 2018. If the penalty remains, you can expect it to stay at 2.5% of your income, but the other dollar amount might increase slightly.

Open enrollment for ACA and individual insurance health plans isn't as long as previous years, so it's important to sign up or make changes during the six-week period. If you are eligible for subsidies, a good place to start is HealthCare.gov, which will take you through the process of getting or changing your ACA health insurance plan. Otherwise, find out about the best health insurance companies and comparison shop for your health insurance plan.