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Health Care & Insurance

It's Time for Open Enrollment for Health Care Exchanges

You have a three-month window to shop around for a better deal on individual health insurance.


The federal and state health care exchanges are gearing up for a second year, but there is little reason to grab for the aspirin bottle. Here's good news: You're likely to find more insurance policy options this year -- and far fewer technical glitches.

See Also: 50 Ways to Cut Your Health Care Costs

Open enrollment for individual health insurance for 2015 runs from November 15, 2014, to February 15, 2015. This period applies to those who shop on the government exchanges or buy a policy from an agent or directly from an insurer. Go to for the link to your state's exchange. (The federal government runs the marketplaces for many states.)

If you enrolled during last year's disastrous rollout, your policy will be renewed automatically unless you make a change. Even if you already have insurance, you should review other options. Your current policy may no longer be the best match.

This is your opportunity to make a change if you were unpleasantly surprised by some of the features in your policy. Perhaps you discovered that your doctors or drugs weren't covered, or your health condition has changed. "Some plans that were competitive in 2014 are not as competitive in 2015, and a lot of consumers would be better off comparing plans again," says Elizabeth Carpenter, director of the health care reform practice at consulting firm Avalere Health.


Whether you're enrolling for the second time or the first, you'll probably find more choices for 2015. According to the U.S. Department of Health and Human Services, 77 more insurers will be selling policies on the exchanges for 2015, a 25% increase from last year. United Healthcare, for example, sold policies on four exchanges last year, but hopes to sell on 24 exchanges in 2015. Cigna is entering three additional states.

Average premiums are generally rising, but the size of the increase can vary significantly by state, based on competition and insurers' claims costs. A study of nine state exchanges by Avalere found average premiums for silver plans will increase by as much as 16% in Indiana but by just 2.5% in Rhode Island. Average silver plan premiums will fall by 1.4% in Oregon. "Most people last year picked the policy with the lowest or second-to-lowest premiums, but that plan may no longer be the lowest-cost plan," says Cynthia Cox, a senior policy analyst for Kaiser Family Foundation.

But premiums are only part of your overall costs. Depending on the plan you choose, the plans with the lowest premiums could end up charging large co-payments for drugs and medical care.

Individual plans sold on and off the exchanges are categorized as bronze, silver, gold or platinum, based on the percentage of health care costs that they cover. A bronze plan should cover an average 60% of costs, while a platinum plan covers about 90%. Bronze plans charge the lowest premiums, but you'll pay more out of pocket if you need a lot of care. With platinum plans, your premiums will be higher, but your deductibles and co-payments will be lower.


Look at your medical expenses for last year and calculate what you would have paid out of pocket for your drugs, medical care and premiums. If you have more medical expenses, a platinum or gold policy with the higher premium -- but low co-payments -- may cost you less in the end. If you have few medical expenses, it may make sense to buy a bronze or silver plan, which has a lower premium but less robust coverage. Some insurers, such as United Healthcare and Aetna, offer online tools that itemize your expenses for the year.

Robyn McHale, 63, a self-employed information technology consultant in Naples, Fla., will likely keep the platinum plan that she chose last year. Rather than use the exchange, she bought the policy with the help of local insurance agent Wayne Sakamoto. In 2013, before the new health law took effect, her policy charged $1,000 per month in premiums and a $10,000 deductible. She has osteoporosis and a bladder condition. "I'd think twice before having any test because I knew the cost was coming out of my pocket," she says.

Under the new law, insurance companies cannot charge more if you have a preexisting condition. McHale's premiums cost $959 per month, but her deductible dropped significantly, to $950 for the year. She hit the deductible after filling just one 90-day prescription for her bladder condition, and she now has very few out-of-pocket expenses.

McHale made sure the policy covered her doctors and hospitals in Florida and provided coverage when visiting family in St. Louis. She'll reassess her options during open enrollment this fall but will probably stick with the same policy. "I've been happy with the plan, and it's so easy," she says.


Check Plan for Your Providers

Make sure your doctors and hospitals are covered in the network for the policy you are considering. Some insurers are expected to shrink networks for 2015. Find out how the insurer covers doctors and other providers out of the network, which can be important if you develop a medical condition midyear and want to get specialized care. "Some plans may not offer you any coverage out of network other than for emergencies, and some may have partial coverage out of network," says Kirsten Sloan, senior policy director for the American Cancer Society.

You may have more options if you don't buy on a government exchange and instead shop from an agent, directly from an insurer or through a Web site such as These policies must meet most of the same standards as those sold on the exchanges. Several insurers sell more policies off the exchanges than they do on the exchanges in many states.

If your income is less than 400% of the federal poverty level ($46,680 if you are single or $62,920 for a couple in 2014), you may be eligible for a federal tax credit to offset premium costs. But the subsidy is generally available only if you buy a policy on an exchange.

Say a married couple are both age 62 with annual income of $50,000 -- 322% of the federal poverty line for two people. Based on the $11,564 annual premium of a silver plan in Maryland, the couple could get a $6,814 tax credit. To estimate a subsidy, check the subsidy calculator on your state's exchange.


Those with incomes of up to 250% of the federal poverty level ($29,175 if you are single or $39,325 for a couple in 2014) may qualify for a subsidy to help pay for out-of-pocket costs, such as deductibles and co-payments. But this subsidy only applies to silver plans.

You need to act quickly if you want a new policy to take effect as soon as possible. Even though open enrollment runs from November 15 to February 15, you must apply for coverage by December 15 for coverage to take effect by January 1.

If you're eligible for Medicare at some point next year and you want to enroll, you can cancel your marketplace plan without penalty when your Medicare coverage starts. Be sure your Medicare has started before you drop the marketplace plan. You cannot use the marketplace to buy a Medigap supplemental insurance plan.

If you need help with your application, you can find a "navigator" on your state marketplace Web site. Or call the 24-hour marketplace helpline at 800-318-2596.