What You Need to Know About Health Insurance Open Enrollment 2022

Your health is your most precious asset. You can protect it with health insurance coverage that meets your unique needs.

During open enrollment, you have the opportunity to obtain or change your Marketplace Health Insurance plan, without penalties. These plans were created under the provision of the Affordable Care Act (ACA), also known as “Obamacare.”

This year, open enrollment is from November 1, 2021, through January 15, 2022. If you want your new health insurance coverage to start on January 1, 2022, you need to enroll by December 15, 2021.

This guide explains what you need to know about the open enrollment period.

What Is Open Enrollment?

Open enrollment is an annual time frame in which the United States federal government allows people to enroll in a health insurance plan for the next calendar year, either as individuals or as part of a family plan. During the open enrollment period, you can also opt to keep or change your existing plan.

Note: For small business owners who want to apply for health insurance for their employees, you can do this any time of year. If your employer offers health insurance, the open enrollment period listed above also doesn’t necessarily apply to you. Your employer may have a different open enrollment period in which you can apply – within 60 days of being hired, for example.

Actions you can take for your individual or family insurance during open enrollment include:

• Enroll in Marketplace Health Insurance benefits for the first time
• Change your current plans
• Change your coverage amounts
• Drop coverage completely

When you take one of the actions above, you are typically bound to that option for the next year, until the next open enrollment period.

What Happens If You Miss the Open Enrollment Time Period?

If you miss the open enrollment time frame, you may still qualify to enroll in a government health insurance plan if you’re eligible for a Special Enrollment Period. To qualify, you have to experience a certain Qualifying Life Event, like:

• You get married or divorced.
• You have a baby or adopt a child.
• There’s a death in the family.
• You lose other health insurance coverage.
• You move to a different ZIP code or county.
• You have changes in your income that affect the coverage you qualify for.
• You become a U.S. citizen.
• You leave incarceration.

There are also special exceptions that can be made if you miss the open enrollment period. You can research what you qualify for and get information on filing an appeal for a Special Enrollment Period.

Also, know that you can apply and enroll in the Children’s Health Insurance Program (CHIP) or Medicaid at any time of year, including outside of the open enrollment period.

Who’s Eligible for Marketplace Health Insurance?

To qualify for the open enrollment period, you must:

• Live in the U.S.
• Be a U.S. citizen or national
• Not be incarcerated

If you already have Medicare coverage, you cannot use the Marketplace to buy a health or dental plan. Rather, you’d need to get that coverage through a Medicare plan.

Read what to expect during the Medicare Annual Enrollment Period, which lasts through December 7, 2021.

What’s Covered in a Marketplace Health Insurance Plan?

All Marketplace Health Insurance plans cover at least 10 essential health coverage benefits. These include:

• Ambulatory patient services
• Emergency care and services
• Hospitalization
• Laboratory services
• Substance use disorder and mental health services
• Pediatric services, including oral and vision care
• Pregnancy, maternity and newborn care
• Prescription drugs
• Preventive and wellness services
• Rehabilitative and habilitative services and devices

While all these services are covered, who you can receive treatment from will depend on the plan. Each plan has limits on the primary care and specialty doctors who are in-network. If you have a doctor you want to continue to see, you may want to keep your existing plan or find one that provides coverage for that doctor.

What Do You Need to Apply for Open Enrollment Health Insurance Coverage?

HealthCare.gov shares the information you’ll need to successfully enroll in healthcare coverage. This includes:

Name and date of birth

Information about your household

Mailing addresses

Information about individuals applying for coverage

Social Security numbers

Employer and income information

Plan for around 20 minutes to an hour to apply for health insurance coverage online, especially if you want to research plans and see which doctors are covered in each one.

Can You Get Reduced or Free Healthcare Coverage Through Marketplace Health Insurance?

Yes, you may be able to get Marketplace Health Insurance at a reduced cost or even for free. This coverage may include Medicaid and CHIP.

Typically, subsidized coverage for health insurance with premium tax credits is also available to individuals whose incomes are below certain levels. To qualify for a premium tax credit:

• Your household income must be between 100% and 400% of the federal poverty level (FPL) .
  
• Your household income must be below 138% of the FPL in states that have expanded Medicaid coverage.

If your income is above 400% FPL, you may still qualify for Marketplace Health Insurance plan savings. You can apply for a quote to see what you qualify for.

What If I Don’t Want Government Health Insurance?

If you don’t want a Marketplace Health Insurance plan, you have other options. You can contact an Arizona health insurance broker to get a private insurance plan that’s perfectly tailored to meet your needs.

Note: If you choose to go with a private insurance plan, you will not be eligible for government subsidies like those listed above.

One of the benefits of going the route of private health insurance is that you can talk with your Arizona health insurance agent and explain your exact health situation and what type of coverage you want for you and/or your family members. In some cases, you may want different health insurance plans for different members of your family. An agent can walk you through all your options.

Also, since network coverage is more limited with government health insurance plans, a private plan can enable you to see the exact doctors you want, with coverage.

You can get a private insurance plan for your family or yourself any time of year. If you miss the open enrollment period for a federal plan and aren’t eligible for a Special Enrollment Period, contact a private health insurance plan provider to get coverage.

How to Determine What’s Best for You: Marketplace Health Insurance or a Private Plan?

During this open enrollment period, you may be considering your options: a federal Marketplace Health Insurance plan, or private insurance. Answering these questions can help you decide.

• Which doctors do I want to see? You’ll want a plan that enables you to visit the doctors you trust and are comfortable with.
• Am I eligible for government subsidies? If you are, the only way you can get these is to apply for a Marketplace Health Insurance plan.
• What kind of relationship do I want with my health insurance provider? When you work with a private agent, you typically have them as a single point of contact you can get in touch with whenever you have questions. With a federal plan, you may have to call in to national help hotlines and talk with different customer service representatives each time. Some people find this to be a hassle and want the level of comfort and ease that comes with working with a private broker.
• How comfortable am I navigating my health insurance coverage options? Depending on the complexity of your family’s healthcare needs, you may be able to save time and money, and get better coverage, by working with a private broker. When you work with an expert, they’ll be able to provide you with the most cost-effective healthcare recommendations for everyone in your family. Attempting to get coverage on your own in the Marketplace can be more difficult and complicated.

There are also cost considerations. You may be able to save money going with one type of provider over the other.

An advantage of working with a private insurance broker is that your needs are their priority. It’s a broker’s job to provide you with the top health insurance coverage options and walk you through what’s available, so you’re comfortable with your choice and get all your healthcare needs met.

At AZ Health Insurance Brokers, we always offer free consultations so you can research your options. Call us at 602.617.4107 to talk with a representative. Or contact us online and we’ll be in touch.