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Buying health insurance during open enrollment?

9 ways to get your application right

Published: November 15, 2014 06:30 AM

If you buy health insurance on your own, the second national open enrollment period begins today, Nov. 15, and runs through Feb. 15. About 8 million Americans ended up buying private health insurance through their state Health Insurance Marketplace the first time around, and this year the government projects that number will increase by a million or two.

The enrollment process itself can be tricky. Here are nine things you need to know to make things as easy as possible.

Both new and returning customers

 

1. Understand the deadlines.

If you are enrolling for the first time or want to switch plans, do so by Dec. 15, so your new coverage will start on Jan. 1, 2015. If you wait until later, your coverage won’t start until February or March.  

2. If you get stuck, call for expert help.

Every state Health Insurance Marketplace has access to free, trained, non-commercial assisters or Navigators who can answer your questions, solve problems, and guide you through the process. If you find yourself stuck, or aren’t sure how to fill out parts of the application, don’t hesitate to call. If you live in a state whose Marketplace is run by HealthCare.gov, the place to look is localhelp.HealthCare.gov. If you live in a state that’s running its own Marketplace, the link for in-person help should be easily visible on the home page. (Here's an interactive map to help you find your Marketplace.)

If you are a returning customer

 

3. Don’t automatically default to auto-renewal.

This fall, you’ll likely be getting notices from both your insurance company and your Marketplace that if you don’t take any action, your plan will automatically be renewed for 2015 at the same subsidy level.

Do not auto-renew, even if you can. According to federal officials, most people with premium subsidies in 2014 will end up paying more than they need to if they auto-renew. The plan you bought last year may no longer be the most affordable one, and if your income has changed your subsidy might not be correct.

So, go back into your Marketplace account and look for the “Enroll To-Do List.” Update your income information for 2015, get a new subsidy determination, and then look at your plan options. One good piece of news: according to the folks who run HealthCare.gov, about 90 percent of your application will be pre-populated with information you gave last year, so you’ll only have to re-enter the parts that have changed.

Once you have done this, you MUST re-select a plan.

Special information for returning customers in Idaho, Massachusetts, Nevada, and Oregon: Your states are changing their Marketplace web platforms for 2015. You must set up a new account and reapply as if you were visiting for the first time.

For returning customers in Rhode Island: Your state Marketplace, HealthSourceRI, isn't allowing auto-renewals. You must log back into your account, update your information, and select a plan for 2015.

How to pick the best insurance plan for you

The three most important questions you need to consider.

How to apply for financial help with your premium

Hint: it's kind of like doing your income taxes, in advance.

If you are buying health insurance for the first time

 

4. Buy on the Marketplace.

You can bypass the Marketplace and buy individual insurance coverage through online or local brokers or directly from health insurance companies, and it will satisfy the requirement to have health insurance. But if, like 85 percent of the people who bought Marketplace coverage last year, your income qualifies you for tax credits to lower the cost of your premium, the only way you can get that help is by purchasing a plan through the Marketplace. (Here's information on the relevant income ranges.)

Even if you expect your 2015 income will be too high for a subsidy, it’s still prudent to buy through the Marketplace. If your income were to come in lower than you expected during the year, you can claim the subsidy when you file your taxes—but only if you bought through the Marketplace in the first place. (For more on how these tax credits work, use our free interactive tool.)

5. Keep a record of your user name, password, and answers to security questions.

When creating a new account, you’ll be answering three security questions that you’ll need to reset your password in case you lose it. Write your answers down and put it somewhere you’ll be able to find it later, because you won’t necessarily remember whether you chose Fluffy or Fido for “your favorite pet” a year later.

6. Don’t freak out that the Marketplace knows what kind of car you took out a loan on.

To create your account the Marketplace needs to verify that you are who you say you are. To do this, it electronically accesses records from Experian, one of the big credit reporting agencies. You’ll be presented with a series of questions drawn from your Experian records that only the real you can answer. For instance, you might be asked to pick out an old street address, or the model of car you took out a loan to buy.

If you don’t have an Experian record  (it can happen if you’re just out of school, or simply someone who has never taken out a loan or credit card), you may be asked to upload or mail in identity documents instead.

7. When asked if the Marketplace can electronically access your tax and income records, say yes.

Since subsidies are based on income, the Marketplace needs to verify the income information you supply. One way it does this is by querying the IRS and other databases that have information about your income.

If you don’t provide this information, you’ll be asked to submit it manually either by uploading it or mailing it in. This could slow down your enrollment process considerably.

8. When asked if you plan to file an income tax return, say yes.

Say yes even if you have never filed a tax return before, and even if you aren’t sure you’ll be making enough money to file. “If you don’t, you take yourself out of eligibility for tax credits,” explains JoAnn Volk, a health insurance expert at Georgetown University’s Center for Health Insurance Reform. “You have to file even if you fall below the filing threshold if you want a credit.”

9. When asked about your family size, put down the total number even if not everyone is applying for insurance.

This is one of the trickiest parts of the application. The tax credit premium subsidies are calculated based on your whole family’s income, even if not everyone is going to buy insurance on the Marketplace. This can happen, for instance, if your family includes a young adult child who has turned 26 and aged off his or her parent’s employer plan, or a married couple that includes one person on Medicare and one not.

The easiest way of figuring your family size is to think about your tax return for 2015. The number of people listed on that return is your family size. (Here's a sample Form 1040 that we labeled that shows where to look).

Note that couples who are living together but not married are considered separate families for tax and subsidy purposes. Same-sex married couples are considered part of the same family even if they now live in a state that doesn’t recognize their marriage.

—Nancy Metcalf

Submit a question to Consumer Reports' health insurance expert. Be sure to include the state you live in so we can provide a more-detailed answer.

More health insurance information

To find out how to apply for, select, and use health insurance, including Medicare, visit our main health insurance page.


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