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Open Enrollment: Here’s What You Need to Know

By Jesse Ellis O'Brien
Policy Director

The countdown is on for enrolling in health insurance for 2015. With all of the changes coming to health care in Oregon, it’s more important than ever to get the facts about what’s happening and how you and your family can get coverage that works for you. Here’s our guide to Oregon’s open enrollment period, which starts November 15.

Does this affect me and my family?

  • If you are currently uninsured, or if you purchase your own coverage, this is your chance to get covered, stay covered or shop around for better coverage.
  • If you purchased insurance through Cover Oregon in 2014, you must take action to stay covered. See below for more info.
  • If you currently have coverage through your job, through Medicare or another state or federal program, this open enrollment period does not affect you.

Where to go to get covered

  • Starting November 15, Oregonians who need to buy health coverage on their own should go to healthcare.gov, the new online marketplace for health insurance. All plans on the marketplace have comprehensive coverage, and you can’t be turned away or charged more for a pre-existing condition. Many Oregonians will also qualify for tax credits to help pay for coverage. Use this easy online tool to see if you may qualify.
  • Due to the widely-reported problems with Cover Oregon’s online enrollment system, CoverOregon.com is no longer the go-to website for enrollment. However, CoverOregon.com will still have useful tools for consumers, including info about finding in-person enrollment help.

Key Dates and Deadlines

  • November 15: Open enrollment begins
  • December 15: Deadline to enroll in coverage beginning January 1, 2015. This is also the deadline for everyone who enrolled through Cover Oregon to take action to avoid a gap in coverage in January—there is no automatic renewal this year.
  • January 15: Deadline to enroll in coverage beginning February 1, 2015
  • February 15: Open enrollment ends
  • You cannot enroll in health coverage through healthcare.gov  after February 15 unless you experience a special life-changing event such as having a baby—see here for info about your options if you miss open enrollment.

Using the Marketplace

  • To start the enrollment process and see if you qualify for tax credits to help pay for coverage, go to healthcare.gov and create an account. To do this, you need some basic information about yourself and everyone else you want to cover—for example, a spouse or children. See here for a checklist of info you may need, and here for a quick rundown of the process of creating an account.
  • Once you have created an account, healthcare.gov can let you know whether you or anyone in your family qualifies for tax credits or programs like the Oregon Health Plan or Oregon Healthy Kids.
  • At healthcare.gov, you can compare health insurance plans apples-to-apples in plain language. You can “window shop” for plans without creating a user profile.
  • If you need help applying or picking the plan that’s right for you and your family, free in-person help is available. CoverOregon.com will have a searchable list of insurance agents and community groups in your area that can provide help free of charge. You can also call the health insurance marketplace 24/7 at 1-800-318-2596.

Renewing coverage

  • If you enrolled through Cover Oregon in 2014, you must re-enroll through healthcare.gov to have coverage in 2015. There is no automatic re-enrollment option this year.
  • While this may be a hassle, it is also a good idea to take the opportunity to shop around. Health insurance premiums change from year to year. For 2015, some premiums are going up while others are decreasing. If your insurer is hiking premiums, you may be able to find a better deal elsewhere.
  • If you are receiving tax credits to help pay for coverage this year, those credits may change next year, so make sure you look into all your options to make sure you’re getting the best deal and making the most of your tax credit eligibility.
  • If you do not enroll through healthcare.gov by December 15, you may miss out on coverage for the month of January, so don’t wait too long to take advantage of the opportunity to shop around.

Tips for getting the best deal

  • Don’t just look at the premium. Out-of-pocket charges for health care services and prescription drugs can quickly break the bank if you aren’t careful, especially if you have health conditions that need regular medical attention. Plans with low premiums often have high out-of-pocket costs, so be sure to check co-pays, deductibles and co-insurance rates as well as premiums. See here for a simple tool to help you figure out what kind of plan is best for you.
  • To look into the details of costs and coverage for different services, check a plan’s Summary of Benefits and Coverage document, which is available via healthcare.gov.
  • Check out the plan’s network. Health insurance plans usually have a network of participating doctors and hospitals, and may not allow you to go outside that network, or may charge you more if you do. Some insurance companies may also have different networks for different health plans they offer.
  • Some health insurance plans try to keep down costs by having very small networks that limit consumer choice. This is not necessarily a bad thing, but it’s important make sure you know what you’re buying—especially if you have a relationship with a doctor that you want to keep.
  • You can find info on networks through provider directories, which are posted on insurance company websites. If it’s important for you to keep your current doctor, you should also ask him or her directly, since provider directories are not always accurate and up-to-date.
  • Check out the plan’s prescription drug coverage. This is especially important if you have a prescription that you know you need. You can find general info the cost of drugs via the Summary of Benefits and Coverage, but if you want detailed list of specific covered drugs, you need to check the insurer’s formulary, which is available via the insurance company website.

With all of the new options and consumer protections out there, it’s easier than ever to find a health plan that works for you and your family, but it can still be challenging, and we all know that health care still costs too much. At OSPIRG, we’re trying to do something about that, but we’ve still got our work cut out for us.

Please stay in touch as you shop for coverage and let us know about your experience. We are here to be your advocate.

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