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Choosing a Health Plan for 2015…What to know (and do) now

The national open-enrollment period for health insurance coverage for 2015 is Nov. 15, 2014 through Feb. 15, 2015. During this period, insurance carriers offering coverage must guarantee acceptance into Affordable Care Act (ACA)-compliant health insurance plans without limitations on pre-existing conditions.

If you haven’t already prepared for the 2015 open-enrollment period, here are some important steps to take.

Know your current benefits

Find out if your current health plan complies with the ACA. In all materials describing plan benefits, health plans must disclose whether or not they are ACA compliant. Check your materials or contact your carrier to confirm the status of your plan.

• ACA-compliant health plans. If you’re enrolled in a 2014 ACA-compliant health plan, your benefit year ends Dec. 31, 2014. Your coverage ends Dec. 31 even if you enrolled in the plan after Jan. 1, and any changes to your benefits or rates will be made at the beginning of each calendar year. To continue your coverage in 2015, you can renew you current plan or choose a new plan through the American Psychological Association Insurance Marketplace.

• Non-compliant health plans. If you like your current health plan, you may be able to keep it. But if your carrier discontinues your plan or it loses “grandfathered” status, you may have to upgrade to a plan that meets ACA requirements. In most cases, your insurance provider will tell you if you’re required to make a change for 2015. You may be at risk for a penalty if your plan isn’t ACA compliant, so check your materials or contact your carrier to confirm. The government accessed penalty for non-compliance with ACA has increased for 2015 – 2 percent of your income or $325 per adult /$162.50 per child, whichever is more.

Once you’ve determined the status of your current plan, learn about your benefits and plan features so you can accurately compare plans in the American Psychological Association Insurance Marketplace. Review the Summary of Benefits & Coverage (SBC) in your plan materials or contact your carrier.

Shop for coverage

Prepared with information about your existing coverage, you’re ready to start shopping. You can compare plans from the leading health-plan providers on the marketplace. We recommend that you start shopping 45 days before your desired effective date. During open enrollment, if you enroll:

• Between the first and 15th day of the month, your coverage will start the first day of the next month.

• Between the 16th and the last day of the month, your coverage will start the first day of the second following month. For example, if you enroll on Dec. 16, your coverage will start on Feb. 1.

Consider a government subsidy

Determine if you or any of your staff members qualify for a government subsidy. The American Psychological Association Insurance Marketplace has tools to help. If your household income is at or below 400 percent of the federal poverty level, you may be eligible. Household income is based on your modified adjusted gross income (MAGI).

Household SizePercent of Federal Poverty Line
For each additional person, add $4,020/year for families at 10% of poverty
A member benefits counselor can help you apply and select a subsidized plan.

Choose the plan you need

All ACA-compliant plans are categorized by the average share of total health spending on essential benefits paid for by the plan. The ACA identifies actuarial-value categories as “metal levels” specified as bronze, silver, gold and platinum. Bronze plans have the least generous cost coverage and platinum plans have the most generous cost coverage.

The American Psychological Association Insurance Marketplace offers decision-support tools and easy access to information you need when deciding which option is best for you. Metal levels, provider searches, prescription formulary lists and benefit summaries all are included. Our goal is to help you make the most informed decision. And we’ve made applying simple with a paperless application process that typically takes less than 10 minutes to complete.

Compare traditional plans and HDHPs

There are two main types of insurance plans: traditional plans that offer copays for office visits and prescription drugs, and High Deductible Health Plans (HDHPs). HDHPs feature higher deductibles than traditional plans and can be combined with a health savings account (HSA) to pay for qualified out-of-pocket medical expenses on a pre-tax basis.

Each private exchange plan is noted either with an HSA symbol, so you may easily spot the plans that are HSA compatible, or as a co-pay option.

Choose a network, check prescription drug coverage

Choosing a provider network type is key. In the private exchange, each plan has a link where you may enter your doctor’s name and confirm if he/she is in the network. HMO options typically cost less, but they don’t cover out-of-network services and require that you choose a primary physician for referrals. PPO and POS options have the broadest networks and cover out-of-network services. With these plans, you don’t need to choose a primary physician and don’t need referrals.

EPO networks are hybrids between PPOs and HMOs and have very limited networks. We often recommend HMOs and EPOs for those who want the lowest cost and are willing to seek referrals and stay within the provider network.

Next, find out where your regular medication(s) fall under the drug formulary. Each plan covers drugs differently and may have multiple tiers (generic, brand, specialty). Check the “prescription” link for each plan to search for your medications.

Once you’ve decided on a plan, you’re a click away from creating your account and applying online.

Start early

Finding the best coverage can be daunting. That’s why Member Benefits has licensed benefits counselors to help with the process. Although you can’t apply for 2015 coverage until Nov. 15, you can start evaluating your needs now.

Call a Member Benefits counselor at (800) 282-8626, or start shopping now.