Policy Periods and ObamaCare

With ObamaCare deadlines for open enrollment approaching, it’s important to think about health insurance policy periods. Here are some key facts to help you understand why getting covered during open enrollment isn’t just about avoiding the fee, it’s about value.

  • Your health insurance deductible (the amount you have to pay for covered in-network services before coinsurance kicks in) and out-of-pocket maximums (the amount you have to pay for covered in-network services before your insurer pays 100%) are based on policy periods.
  • Policy periods are typically annual.
  • Most marketplace plans go from January 1st to December 31st. This is true even if you enroll in a plan later in the year.
  • If your plan starts late, then you may not get a full value out of your deductible and out-of-pocket maximums. As the amount you paid in is only applicable to that policy period!

Bottom line: Under the ACA you have every incentive to fall into the rhythm of making sure your plan is chosen and cost assistance information is in order by December 15th (the 23rd in some states).  Failing to update your info can cost you money on your taxes, failing to pick the right plan means you may under-buy or over-buy accidentally, and waiting until the last minute means not getting the full value out of your plan.

Do yourself a favor and go to HealthCare.Gov now and get your health insurance in order for the New Year.

Author: Thomas DeMichele

Thomas DeMichele is the head writer and founder of ObamaCareFacts.com, FactsOnMedicare.com, and other websites. He has been in the health insurance and healthcare information field since 2012. ObamaCareFacts.com is a...

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Life events affect everyone with uncontrolled timing. For instance, I checked out the preview of the 2015 plans prior to 11/15/14, a few times during the first 10 days or so of November. I have coverage (FOR 2 ONLY) through marketplace, and my neighbor was interested induing the same, since he did not last year as didn’t understand but realized now he pays far more with the privately carried BC plan he has had for 20 years (he owns a very small bs, maybe 2 employees, and due to a heart attack and bypass done about 15 years ago, was always told if he cancelled, he’d never be able to find health insurance, though he has had no heart problem since, and quite a few years never even reached his annual deductible–However, independent of the Marketplace, he pays at least twice what he would for very similar or practically same coverage with same company, therefore strongly considering trying the Marketplace. ) NOW THIS IS THE MORE IMPORTANT POINT, BUT AT LEAST YOU WILL UNDERSTAND THE REASON FOR THE COMMENT. FIRST: WILL THE AVAILABILITY OF SUCH INSURANCE REMAIN, EVEN WITH THE NEW SENATE, AS OFTEN ‘HEAR’ ‘THEY’ WOULD LIKE TO OVERTURN AND GET RID OF ACHC- OBAMACARE ? I’D NATURALLY FEEL AWFUL CONTINUING TO ENCOURAGE HIM TO GO WITH OBAMACARE IF FOR SOME REASON GOVERNMENT HAD THE RIGHT TO CANCEL IT– THEN WHAT WOULD PEOPLE DO WHO TRUSTED THE GOOD WORD OF GOVERNMENT (AGAIN) IF THEY COULD NOT EVEN GET THEIR OTHER INSURANCE BACK, OR AT EVEN A MORE EXORBITANT PRICE ? SECOND: LIKE I SAID, HAD PRINTED OUT EVERYTHING AND LOOKED INTO CURRENT PLAN HAVE, HOW ITS COST HAS BEEN INCREASED BY ABOUT $100/MONTH NOT DUE TO ANY INCREASE IN INCOME, AS WELL AS NEWER ONE TO THIS MARKET AREA. THEN, EVERYONE IN THE HOME BECAME SICK WITH FLU-FLUE LIKE ILLNESS AND SINUS -COLDS LEADING FROM MERELY VIRAL TO BACTERIAL OVER SPAN OF ABOUT 3-4 WEEKS-BACK AND FORTH,LINGERING, ETC, FIRST THANKSGIVING I DID NOT EVEN COOK A THING!! THEN MY IN-LAW WHO LIVES WITH ME BECAME ILL, AND NOT TO DETAIL, AND AFTER IN THE HOSPITAL ACTUALLY MUCH IMPROVED AFTER 2 DAYS OF FUID AND ANTIBIOTIC, ENDED UP AFTER ANOTHER NEARLY 3 WEEKS, DIED!! In addition, my spouse had another surgery as being treated daily for osteoradionecrosis, stemming as latent effect of high dose head radiation 11 years ago… thus as you can see, I had no time to resume,nor ability because hot spots in hospitals are not relaible, and my laptop for such is not top noct– the home desktop Mac is reliable. I was please dan grateful to know that at least my same coverage continuing, andwil check into the price that is at where supposed to be. However, TO SAY THAT I WOULD HAVE A PROBLEM IF CHANGED AS HAVE TO 2/15/15 TO DO SO,IS JUST NOT RIGHT, AND IF FOR SOME REASON WE ARE ALLOWED A LOWER PREMIUM AFTER OFFICially doing the resignup- vs the auto sign up that was done (we have the documentation form the insurance company and the Marketplace), THEN WE SHOULD STILL HAVE THE LOWER COST, AS TO MY UNDERSTANDING. ALSO, IDK, BUT IF SOMEONE WOULD CHANGE, SEEMS THAT WHATEVER DEDUCTABLE THEY PUT OUT IN THGE JAN OR FEB MONTHS, SHOUD AUTO GO TO THE NEW COMPANY AS A COURTESY, OR AT LEAST 2/3 SHOULD!! ONE MONTH (11/15-12/15) FOR RESIGNING DURING HOLIDAYS AND AT PEAK FLU SEASON IS NOT THE OPTIMUM PERIOD OF TIME TO ENSURE JAN 1 ETC.. Besides the realistic life events that occur. ALSO THIRDLY, WAS NOTIFIED ONLY ON12/23 (SPOUSE SURGERY DATE), THAT OUR DENTAL WE PICKED, THOUGH NOT SUPPLEMENTED, WAS BEING CANCELLED.NOW I HAVEN’T BEEN TOLD THAT FROM THE DENTAL COMPANY, BUT WILL LOOK INTO TI. I CANNOT IMAGINE IT GOING OUT OF BUSINESS, SO MAYBE THAT APPLIES ONLY TO BEING A CHOICE IF SUPPLEMENTED FOR DENTAL THROUGH THE MARKETPLACE. EITHER WAY, I DO NOT THINK EVEN A DENTAL PLAN SHOULD BE ABLE TO BE ‘DROPPED’ FROM CHOICES UNTIL MARCH 1, THEREBY GIVING THE FAIR AMOUNT OF TIME ALLOWED FOR ENROLLMENT PERIOD,(TECHNICALLY NOT ENDING TILL 2/15) WHAT DO YOU THINK,AND ANY FEED BACK AVAILABLE????

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