Written by Susan J. Penner, RN, MN, MPA, DrPH, CNL, and author of Economics and Financial Management for Nurses and Nurse Leaders, Second Edition, 2013. Dr. Penner teaches financial management in the University of San Francisco Online Master of Science in Nursing program.
Nearly half of all Americans have health insurance coverage through their employer. Most senior citizens and some Americans with disabilities have Medicare coverage. American citizens residing in the US and not currently incarcerated, on Medicaid or on Medicare may be eligible to purchase insurance through Obamacare’s Health Insurance Marketplace.
Choosing or changing health plans can be difficult and confusing. There are many plans to choose from, and consumers may find it challenging to select the plan that best fits their needs. This post offers a few tips to manage the challenges of open enrollment.
Open enrollment is a specified time period that allows people to purchase health insurance, switch health plans, or change the dependents on their plan. Open enrollment for 2016 Obamacare coverage is from November 1, 2015 through January 31, 2016. Some Americans are allowed exceptions to this schedule if they qualify for the Special Enrollment Period. Free assistance for Americans enrolling in Obamacare or changing Obamacare plans is available from the Marketplace Call Center or local assistance services.
Employer Sponsored Health Insurance
Employer sponsored health plans have different dates for open enrollment, although health plan selection is usually scheduled in the fall. Americans with employer sponsored coverage should ask their employer for information about the dates for open enrollment. Employer sponsored coverage may be unavailable until the following enrollment period, if an employee misses the deadline.
Some employers provide Human Resources services, where employees can get advice about plan choices. Employees might also want to ask about Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs). HSAs and FSAs enable employees to get tax savings on money that they set aside for selected medical expenses. Additional advice is to compare the costs of available health plans, assess the employee’s and family’s health needs for the coming year, and explore wellness programs that could save money on health care costs.
Obamacare Health Insurance Marketplace
The Affordable Care Act, also known as Obamacare, continues to generate political opposition. Many states have declined to establish state-based marketplaces or to expand Medicaid benefits. Despite this controversy, a September 2015 US Census report finds that the rate of uninsured Americans dropped to a new low of 10.4% in 2014. Americans who are eligible for Obamacare and who can’t get affordable insurance through their employer should explore the Health Insurance Marketplace.
The Healthcare.gov website is a great way to start learning more about health plan enrollment in the Health Insurance Marketplace. Information is available for individuals, families and small businesses. Healthcare.gov reminds viewers of enrollment deadlines, and quickly directs the user to state exchanges. There is information on how to use the Health Insurance Marketplace, how to apply for exceptions to open enrollment, and how to get help if computer access is difficult.
Medicare Open Enrollment
Last year I shared some advice for Medicare enrollees. Medicare open enrollment for 2016 is from October 15, 2015 to December 7, 2015. If Medicare beneficiaries are satisfied with their current Medicare plan, they don’t need to take any action over the open enrollment period. People needing help choosing or changing their Medicare plan can contact their local State Health Insurance Assistance Program (SHIP) for free assistance.
Nurses and Open Enrollment
Nurses are likely to work in settings that provide employer sponsored health plans. Nurses also have the problem solving skills to select the best plan for them and their families. However, people often seek out nurses for health care opinions and advice. The tips shared here might be helpful for nurses faced with insurance questions from patients, relatives or neighbors.
Nurses who help younger and older Americans find resources for health plan decisions can improve their clients’ physical and financial health. Get informed, and get enrolled!