All Americans should explore plan options during the 2016 OEP

Health Insurance

January 1, 2016

Under the Affordable Care Act (ACA), all Americans must purchase an approved health insurance plan every year. This requirement applies to residents in states with their own exchanges and those relying on the federally facilitated Marketplace. Generally, the sign-up process is conducted during the annual Open Enrollment Period (OEP), which runs from Nov. 1, 2015 through Jan. 31, 2016.

The OEP applies to beneficiaries purchasing their own plans. Those with employer-provided coverage and Medicare and Medicaid customers have their own enrollment periods. Coverage can begin on Jan. 1, 2015, if you enroll in an ACA-approved plan by Dec. 15, 2015. If you fail to enroll, you may have to pay a tax penalty. For 2016, this will be the greater of: $695 per adult and $347.50 per child, or 2.5 percent of your income.


The OEP benefits providers and pricing

While the enrollment process can be time-consuming, you should think of it as a good thing. During this three-month window, you and your family can compare a wide range of policies. In fact, the U.S. Dept. of Health and Human Services (HHS), which oversees the ACA, found that there are usually 40 Qualified Health Plans (QHPs) available in one location; urban areas may offer up to 100.

If you like your current coverage, the Marketplace will automatically re-enroll you in your existing plan. There is the possibility that your current plan may be discontinued in 2016. However, the ACA will again take care of it, automatically shifting you to a similar plan.

But even if you’re satisfied, you should still review other options. Your policy may experience changes for 2016, or even disappear. A new plan may even result in your coverage improving overall. You can click on the federal website,, to find a wide range of private and for-profit policies; it provides links to state-run exchanges, as well.

The Marketplace will enable you to narrow down the options you prefer for your 2016 health plan. Regardless of the options you’re considering, all plans are basically determined by three factors: benefits provided; doctors and facilities covered; and pricing.

If you have doctors and facilities you want to stay with, you should check to make sure that they are covered within a selected plan. Every year, providers, including specialists, are added or removed providers. For people with particular health concerns, this could be a very important factor. Prescription drug coverage could change from plan to plan, as well.

Pricing also play s a very big role in your coverage search. If you receive on tax credits or federal subsidies to help pay your premiums, you should take this into effect when considering plans. According to the nonprofit Kaiser Family Foundation (KFF), tax credits are calculated using the second-lowest, silver-tiered plan as a benchmark; these are the most common, as well. If you prefer a cheaper policy, but it’s not available, your premiums may dramatically increase. As such, you need to set aside enough time to carefully research plans within your desired price range.