The ACA Health Insurance Marketplace and Open Enrollment for 2019

Benita Lee
Benita Lee, MPH, is on the Research Team at GoodRx.
Posted on

Now’s the time to enroll in individual health insurance for 2019. With this open enrollment period, we’ll have more plans to choose from on healthcare.gov‘s Health Insurance Marketplace (also known as the Exchanges) compared to previous years. We’ll also see broad shifts in insurance availability and pricing as a result of important insurance policy changes in recent years.

Here’s what you need to know about enrolling in a health insurance plan for 2019, including information on how GoodRx can help you save on your prescription drug costs.

 

 

Open enrollment deadlines

In most states, open enrollment begins November 1 and ends December 15, with plans becoming effective January 1, 2019. A total of 11 states and the District of Columbia were given some flexibility in terms of enrollment schedules. DC and six states have the following extended enrollment periods:

The remaining five states (Idaho, Vermont, Connecticut, Washington and Maryland) are slated to follow the November 1 to December 15 schedule, but last-minute extensions could still be added before the end of open enrollment.

Open enrollment periods apply to all individual health insurance plans, regardless of whether they are purchased on or off the Exchanges. To enroll in a plan through the Health Insurance Marketplace start at www.healthcare.gov to search for a plan that’s right for you. Check this page for updates on enrollment deadlines: www.healthcare.gov/marketplace-in-your-state.

 

Special enrollment deadlines

Plan changes and new enrollments outside of open enrollment periods are only possible for people who experience a qualifying event. Enrolling in health insurance outside of open enrollment is called special enrollment, and the deadline for enrollment is 60 days following the qualifying event. If you miss that deadline, you’ll have to wait until the following year’s open enrollment period to apply.

Qualifying events include (but are not limited to) these life events:

For more information about special enrollment and qualifying life events, visit this guide here: www.healthcare.gov/coverage-outside-open-enrollment/changing-plans.

 

 

What’s changing in 2019?

A lot has changed in health insurance policy recently, including the loss of federal subsidies for insurers, an increase in short-term plans that do not meet Affordable Care Act (ACA) standards, and the repeal of the individual insurance mandate. Reading about what these changes mean can be dizzying, but in short, they all impact insurance availability and pricing. Here’s a summary of how they will affect your options for next year’s plans:

 

 

Watch out for auto-enrollment

If you are enrolled in an individual health insurance plan, open enrollment is your time to choose a different one. If not, you will most likely be enrolled again for 2019 in the plan you already have. This might sound nice, but plans change every year—including their premiums, benefits and coverage—so be sure to log in and re-enroll before your open enrollment deadline.

Some insurers may leave the Health Insurance Marketplace after December 31. If you currently have coverage through the Marketplace, but your insurer is planning to leave at the end of the year, you will be automatically enrolled with a different insurer unless you pick a new plan by the end of open enrollment. Depending on which state you live in, you may be eligible for a special enrollment period, which will give you 60 days after your old plan ends to enroll in a new plan.

 

How can GoodRx help?

GoodRx discounts can help you get the best deal on your prescription medications, even after you enroll in health insurance. In many cases, just because a drug is covered doesn’t mean it’s affordable. And having insurance doesn’t guarantee that your drug will be covered at all.

So, don’t forget to shop around. Check GoodRx coupon prices for your medications against their prices with your insurance, and choose whichever option is cheaper. If you don’t already know what your copay will be for a prescription, call your insurer or use their web portal to get an estimate of your cost.

When using GoodRx instead of your insurance to pay for a prescription, your payment won’t count towards your deductible. However, you can always contact your insurance company to see if you can submit a receipt and apply that towards your deductible. Some plans will allow you to submit receipts for potential reimbursements or deductible credits.

Need more than a coupon? GoodRx can also help you find savings tips, suggestions for alternative, less-expensive drugs, and information on assistance programs and manufacturer savings.

 

 

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