Are you one of the nearly 20 million Americans who will buy their own health insurance coverage this year? If so, we’ve put together this checklist to help you prepare for annual Open Enrollment. (If you need personal help with anything, please feel free to email us at firstname.lastname@example.org. We’ll do everything we can to help you make a confident health insurance decision this year.)
Here’s the checklist. I’ve gone into details on each item below.
- Understand what Open Enrollment is
- Confirm your state’s Open Enrollment dates and deadline
- Decide whether to use a health insurance agent
- Gather your current coverage information
- Check to see if you qualify for a premium tax credit
- Create a list of your preferred providers
- Create a list of your current prescriptions
- Understand your new coverage options
☐ Understand what Open Enrollment is
Open Enrollment is the only time of the year you can buy an individual health insurance policy in the U.S. without having a life event. During this time, you can buy any individual or family health insurance plan available in your state for the upcoming year. These plans usually take effect January 1st.
☐ Confirm your state’s Open Enrollment dates and deadline
Open Enrollment starts November 1st and runs through January 15th in most states. To secure coverage effective January 1st, you must enroll in a plan by December 15th. If you enroll after December 15th, your coverage will take effect on February 1st. Here’s a state guide we put together for Utah. (If you’d like us to add a similar guide for your state, please contact us.)
☐ Decide whether to use a health insurance agent
A health insurance agent is a licensed insurance professional who helps consumers find, use, and manage coverage. When you pay your premium, the insurance company sets aside a small amount of money each month to pay a third party agent to help you. When you make someone the agent on your policy, they receive that money. Most people don't realize this, but you're paying for an agent whether you have one or not. Unfortunately, many agents don't provide great service and support to their clients who buy their own health insurance. Here are some of the ways a health insurance agent can help you as a consumer:
- Save you time searching for, enrolling in, and renewing your coverage.
- Advocate for you with the insurance company.
- Help you understand your coverage details.
- Assist you with life events.
(LegUp Health is a free health insurance agency that helps you confidently find, use, and manage your own coverage. If you’re not already a client, read more about our services here or create a free account. You can use our online tools even if you do not want to make us your agent right now.)
☐ Gather your current coverage information
Your current coverage information includes details like your premium, out-of-pocket maximum, deductible, and copays. When you have these details available, it will be easier for you (and a new health insurance agent) to find and compare similar plans for the upcoming year. (Note: If you have an insurance agent, they should already have this information available for you. For example, LegUp Health clients can log into their portal and access this information.)
☐ Check to see if you qualify for a premium tax credit
Most Americans qualify for new premium tax credits. This is a big deal. These tax credits reduce the cost of your health insurance dollar-for-dollar. (For example, if you qualify for a premium tax credit of $200 per month and you pick a plan with a $300 monthly premium, you would only need to pay $100. That’s some serious savings.) Eligibility for a premium tax credit is based on your household size and modified adjusted gross income (MAGI). To check if you qualify for a premium tax credit, estimate your household’s income and use the chart below. If you qualify, you can then use this calculator to estimate how much your monthly premium tax credit will be. (Note: If you qualify for a premium tax credit, you only get it if you buy coverage through your state’s health insurance marketplace.)
☐ Create a list of your preferred providers
Consider your existing providers when shopping for a plan during Open Enrollment. Providers include doctors, specialists, urgent care facilities, and hospitals. Different health insurance companies cover different provider networks. And some health insurance companies offer multiple provider network options for each plan. Having your providers handy will make it easier for you to narrow your options based on which plans cover them.
☐ Create a list of your current prescriptions
Consider your existing prescriptions when shopping for a plan during Open Enrollment. Prescription drug coverage varies from plan-to-plan. Having your prescriptions handy will make it easier for you to narrow your options based on which plans cover them.
☐ Understand your new coverage options
Your individual health insurance coverage options vary by state and zip code. One complication is that some plans are only available for purchase on your state’s marketplace. At LegUp Health, we refer to these as “on-marketplace” plans. Other plans are only available for purchase outside of your state’s marketplace. At LegUp Health, we call these “off-marketplace” plans. You can use our shopping and quoting tool to compare all on-marketplace plans in every state, but it does not show off-marketplace plans. If you don’t qualify for a premium tax credit, you will want to understand both your on-marketplace and off-marketplace options. (Note: Utahns can use our Utah state guide to review all on-marketplace and off-marketplace plans available in the state. If you’d like us to add a similar guide for your state, please contact us.)
By completing this checklist, you’ll be prepared to shop for health insurance during Open Enrollment. (And when you’re ready to shop, consider using LegUp Health to make a confident decision.)