Health Insurance

Open Enrollment 2019: Everything You Need to Know

With healthcare plans changing almost yearly, open enrollment is often open season for confusion. See how to make an informed decision for 2019 coverage.

Like the changing foliage, apple picking and Halloween, open enrollment season is a fall rite of passage for millions of adults. It’s the time of year your company HR team will send you multiple emails and set up just as many meetings to walk you through your healthcare benefits. On paper, open enrollment is a period during which you’re required to enroll in or opt out of health, dental and vision insurance coverage for the coming year. In practice, it can be a head-scratching time for many who have to sift through changing healthcare packages, weigh the rising cost of healthcare coverage hitting your paycheck and determine just how much coverage is right for you and your family.

If that wasn’t enough to induce mild anxiety, once open enrollment closes, you won’t be able to make any changes to your coverage for the coming year, unless you qualify for a life event change, such as getting married or expanding your family. While you’ll be the one who ultimately decides which plan makes the most sense for you during open enrollment, we’ve outlined the major healthcare changes that have been made over the past year and the steps you should take to guarantee you have the right healthcare coverage you need.

When is open enrollment 2019

If you receive private health insurance as an employee benefit through your company, you’ll likely receive open enrollment information from your HR team. While your company decides when to initiate the open enrollment period, it usually takes place over the course of several weeks between October and December. If you miss that open enrollment window, you won’t be able to make any changes to your insurance coverage unless you qualify for a life event.

What are qualifying life events?

There are four basic types of qualifying life events, and because they can happen any time during the year, it allows you to sign up for or change your health insurance coverage outside of your open enrollment period.

Qualifying life events

  • Loss of health coverage: The loss of a job, losing qualification for Medicare or Medicaid services, or aging out of your parents' plan.
  • Changes in household: A birth, adoption, death, marriage or divorce in the family.
  • Changes in residence: Moving to a new region outside of your current insurer's coverage.
  • Other qualifying events: Becoming a U.S. citizen, leaving incarceration, joining or leaving the AmeriCorps.

ACA open enrollment

Although President Trump failed to repeal and replace the Affordable Care Act, often referred to Obamacare, if you purchase your own healthcare coverage, you’ll still face several changes when you visit health insurance exchanges this year.

Your health benefits might change

Under the Affordable Care Act, insurers in all states were required to meet 10 essential health benefits. In 2019, states can choose from 50 health benefits to provide more flexible plans. This means that you might have more options to choose from in 2019, but the coverage provided by each health insurance plan may vary, including the plan you chose last year. You need to carefully examine the types of coverage your family requires and choose accordingly.

You're (probably) not required to obtain coverage

While ObamaCare hasn’t been repealed, individuals who opt not to have healthcare coverage will no longer be hit with a federal tax penalty, which was the case in 2018. Still, it’s worthwhile having insurance as a potential cost-saving measure. As many uninsured Americans who’ve gotten sick know, the bill for one trip to the emergency room can exceed an entire year's worth of premiums.

But despite the federal repeal of the individual mandate, if you live in Massachusetts, New Jersey and Washington, D.C., you’re still subject to a state-level mandate. And other states are considering mandates of their own. Vermont is the most recent state to pass such a law, which will go into effect in 2020.

When is ACA open enrollment?

The ACA open enrollment window has been reduced from 90 days to 45 days. If you purchase your health insurance on the healthcare.gov health insurance marketplace, open enrollment opens on Nov. 1, 2018, and ends on Dec. 15, 2018. Your coverage then goes into effect on Jan. 1, 2019.

The following states have extended their open enrollment dates.

  • California: October 15, 2018 to January 15, 2019
  • Colorado: November 1, 2018 to January 15, 2019
  • Massachusetts: November 1, 2018 to January 23, 2019
  • Minnesota: November 1, 2018 to January 13, 2019
  • Rhode Island: November 1 to December 31, 2018
  • Washington D.C.: November 1, 2018 to January 31, 2019

If you miss your state's open enrollment window, you won’t be able to make changes to your coverage unless you qualify for a life event change. Visit HealthCare.gov to sign up for coverage under the federal program.

Medicaid and Medicare open enrollment 2019

If you or a family member did not previously qualify for Medicare, Medicaid or the Children's Health Insurance Program (CHIP), and you do qualify now, you can apply at any time. Here’s how to figure out if you qualify for either federally funded health insurance program:

Medicaid & CHIP coverage

The Medicaid and CHIP programs were put in place to help low-income individuals, families with children, pregnant women, the elderly and people with disabilities. Even if you don't think you'll qualify for Medicaid based on your income, it's still worth applying. Each state offers different state-level programs, and you could qualify for aid there. Visit HealthCare.gov to apply.

Medicare coverage

The nation's Medicare program was built to ensure individuals age 65 or older had access to healthcare. But those with disabilities may actually qualify at younger ages. You can see the list of plans and check your eligibility at Medicare.gov.

When is Medicare open enrollment?

Unlike Medicaid, Medicare does have an annual open enrollment window. The Medicare open enrollment period begins on Oct. 15, 2018, and ends on Dec. 7, 2018. Coverage kicks in on Jan. 1, 2019.

During the Medicare open enrollment period, individuals who are eligible for Medicare parts A and B can make changes to their coverage, change between Original Medicare and Medicare Advantage plans and apply for Medicare Parts C or D.

What insurance benefits should I review this year?

With rising healthcare costs and regulatory changes, it won’t come as a surprise that many companies now change insurance plans or providers for employees from one year to the next. So as much as you would like to snooze through your company's open enrollment meeting, you should review the benefits package—even if you expect to enroll in the same plan. Not only could the terms of your plan change each year, such as a higher deductible or a change in in-network providers, but your own medical needs may be different now.

Find the right health insurance plan

Was a family member recently diagnosed with a new medical condition that requires regular doctor visits or medication? Or were you blessed with good fortune and required to make almost no visits to the doctor in the past year? These considerations will help you determine which type of health insurance policy is right for your family.

If you anticipate no major or recurring medical expenses in 2019, you should consider choosing a high-deductible plan and pairing it with a Health Savings Account (HSA), if your company offers this. Sure, with a high-deductible plan you pay more out-of-pocket for each doctor’s visit before your insurance kicks in, but you may not actually need to see doctors all that often outside of your annual checkups and preventive visits. Meanwhile, your monthly premiums will be lower than with a low-deductible plan.

But if you expect to spend more on medical care on a regular basis, you might want to choose a low-deductible plan. A low-deductible plan comes with higher monthly premiums taken out of each paycheck, but your coverage kicks in sooner, costing families with high medical expenses less in the long-run.

Should you open a Health Savings Account

Health Savings Accounts (HSAs) are only available to those in qualifying high-deductible plans—plans with a deductible of at least $1,350 for individuals and $2,700 for family coverage—so you might not see this as an option during your open enrollment period. But if you do, it’s worth taking advantage of it. HSAs let you put away pre-tax money indefinitely for medical needs. This lowers your tax bill at the end of the year, and in the off-chance that you don't ever need to use those funds for medical expenses, they're treated much like a traditional IRA.

HSA contribution limits for 2019

Contribution limitAge 55+
Individual$3,500$4,500
Family$7,000$8,000

Those who turn 55 or older during 2019 can contribute an extra $1,000 to their HSA. If both spouses are over 55 years old, they can both make the $1,000 catch-up contribution, but since HSAs are filed under one person's name, each spouse needs to open an individual account, rather than one family account, to contribute the maximum of $9,000. Since medical costs continue to rise and consume a large portion of retirees' savings, anybody who is able to should consider maxing out their HSA.

Should you open a Flexible Spending Account

Flexible Spending Accounts (FSAs) are similar to HSAs, but with one key difference: FSAs follow a "use it or lose it" annual policy. In this way FSAs aren’t as attractive as HSAs, but they still let you save money on taxes, medical expenses and prescriptions. Just remember: You'll lose any amount you don't spend by the end of the following year. That said, the list of qualifying expenses is surprisingly extensive and includes items such as glasses, contacts and even sunscreen, so spending through the account shouldn't be too difficult.

(At the time of writing, the IRS hasn’t released FSA limits for 2019, but based on the rate of inflation, you’ll likely be allowed to contribute up to $2,700 for the coming year.)

OTC items you can buy with your FSA card
Source: FSAstore.com

Some companies also offer dependent care FSAs, which give parents valuable childcare tax breaks. If you have children under 13, you can contribute up to $5,000 to a dependent care FSA to pay for things like daycare, after-school programs, nanny expenses and summer camp. (Dependent care FSAs can also be used to cover the cost of care for a spouse or relative in your home who is physically or mentally incapable of caring for themself.) Since these costs are pretty easy to predict, fully funding a dependent care FSA is a no-brainer for most parents.

Do you need dental and vision insurance?

If dental and vision insurance are part of your benefits package, you’ll want to think through whether you or your family members need either type of coverage. If, for example, you have excellent vision and your eyesight hasn’t changed in recent years, it might be safe to skip vision insurance for the next year. While you won’t see that much of a difference in money back by cutting vision insurance, it could still save you $60 to $120 dollars a year.

Dental procedures, on the other hand, can be expensive, and even more so if you skip preventive care, like regular dental cleanings. So if it's an option, purchasing dental insurance may save you a few painful (and costly) visits from the Tooth Fairy. If you have multiple plans to choose from, follow the same basic logic as choosing a health insurance policy: If your family tends to have high dental expenses, choose a low-deductible plan. If you were blessed with great teeth, choose the high-deductible option.

Other open enrollment benefits

Employers commonly offer other lesser but valuable perks, such as commuter benefits, transit passes or parking permits. These benefits may reimburse you for the cost of your commute, or allow you to buy your monthly commuter pass with pre-tax dollars.

Should you get life insurance coverage?

Some employers offer a limited amount of life insurance completely free of charge so why not take it? The amount they offer, though, typically isn’t enough to cover the full amount of life insurance you need, in the event something happens to you.

Generally, experts say you should carry five to 10 times your annual salary in term life insurance. But we recommend adding up your total debts and your family's future financial needs to calculate how much life insurance you need.

See if your employer offers an option to upgrade, and compare that cost with the price of private life insurance. If you have a pre-existing medical condition, you may find a better price from your employer since the group policy is guaranteed to provide you coverage. But if you’re relatively healthy, you might find lower prices elsewhere.

Now that you’ve gone through the trouble of signing up for this financial safety net, you don’t want to leave your beneficiary information blank or as an afterthought. Now’s a good time to make sure this information is still accurate—especially if you’ve gotten married or divorced, welcomed a baby or had a loss in the family—while you have the electronic paperwork in front of you.

Daniel Caughill

Daniel is a Staff Writer at ValuePenguin, covering insurance, retirement and other personal finance topics. He previously wrote about compliance and best practices for K-12 school districts at Frontline Education.