It’s pumpkin season! While that means fall fun and activities, it also means it’s time to prepare for Open Enrollment: The annual opportunity for most Americans to update existing health benefit options or establish brand-new health insurance plans. 

The 2022 Open Enrollment period for the federal Exchange and most states runs from November 1, 2021, through January 15, 2022. To receive coverage beginning January 1, 2022, applicants should enroll by December 15, 2021. For information regarding health insurance options in your state, make sure to visit your state’s health insurance website. 

For employees looking to initiate or update health, dental, and life insurance plans and ancillary or voluntary benefits, you may want to consider acting now if you’re interested in discounted rates. Outside of the Open Enrollment period, accessing insurance, changing plans, and using tax credits to obtain discounted rates may become much more difficult.

Eligibility and Coverage

To be eligible to enroll in health coverage through the Health Insurance Marketplace®, employees must:

  • Live in the United States (U.S.).
  • Be U.S. citizens or nationals

Individuals with Medicare coverage are not eligible to use the Marketplace to buy a health or dental plan.

In terms of the Affordable Care Act (ACA), insurers must provide health benefits in the following essential categories:

  • Ambulatory (outpatient) services 
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Laboratory services
  • Mental health and substance use disorder services, including behavioral health treatment
  • Pediatric services including oral and vision care 
  • Preventive and wellness services and chronic disease management
  • Prescription drugs
  • Rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices

Automatic Re-enrollment

For those looking to refresh existing health plans, the time to take action is between November 1, 2021, and December 15, 2021. 

Failure to log in and update details before December 15 may result in automatic re-enrollment in an existing plan. This might be reassuring in some ways but ideally, to make certain they receive all the savings they qualify for, insured individuals should review all the available options in their 2022 plan and assess whether changes should be made and additional options or direct policies added.

Optional extras worth considering may include adult dental care, life insurance, and vision—which are not available from the Marketplace but can be purchased directly from insurance companies.

Employer programs

Open Enrollment also presents the opportunity to sign up for workplace benefits programs. These may incorporate commuter discounts, childcare benefits, and other advantages ranging from legal services to pet insurance, and will vary from employer to employer. For calendar year plans, the open enrollment window is opening soon. Alternatively, for plans with renewal dates other than January 1, the open enrollment season will occur prior to the start of your new plan year.

Employer programs almost always have payroll implications. Some may be entirely employee-paid through salary withholdings, while for others, the cost might be shared between employee and employer. As such, it’s essential for employers to communicate in such a way that employees can understand the ramifications of all the available options and make an informed choice. Equally, employees should be proactive in evaluating the options and making the appropriate decisions. 

Health Insurance Discounts and Tax Credits

Under the American Rescue Plan Act of 2021, individuals and families may now be able to get more savings and lower costs on Marketplace health insurance coverage than previously.

An increase in the number of health insurance tax credits, for example, means that more low and modest income earners will now pay a discounted rate for health insurance purchased through the Marketplace. Some may even qualify for free health insurance. 

Eligibility for tax credits will be determined on the basis of the estimated household income for 2022 recorded on the application for Marketplace coverage. 

Depending on the health insurance plan they choose, individuals may also be eligible to open tax-advantaged health savings accounts (HSAs) and health flexible spending accounts (FSAs). How much to contribute to such accounts is one of the decisions to be made during Open Enrollment.

Note: Given the complexity of the health insurance landscape, it’s vital that employees talk to their employers to understand the different options and make careful choices that meet their specific needs. 

Changes to Health Insurance Outside of Open Enrollment

Under specified circumstances, individuals may enroll in or change to a different plan outside of the Open Enrollment period. Such circumstances include life events such as changing jobs, moving, getting married, or having a baby. In these cases, the application must be made within 60 days of the qualifying life event.

The Bottom Line

Open Enrollment season is now. Are you ready? When a carefully prepared health benefits portfolio could make the difference between successfully navigating an unexpected health challenge and financial catastrophe, it’s worth taking the opportunity to ensure you are prepared.

Click here to learn more about PrimePay’s comprehensive portfolio of benefits administration services for pre-tax benefits, no matter the size or choice of plan.

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