Tech + Health

11.16.14 12:35 AM ET

Think You’re Invincible? Here’s Why Open Enrollment Matters

Did you know that the second Obamacare open enrollment period starts November 15? We’re guessing you didn’t. Only 1 in 10 uninsured people have open enrollment on their radar, according to a recent Kaiser Family Foundation poll. The same survey found that two-thirds of the uninsured know “only a little” or “nothing at all” about the marketplaces where people can shop for insurance.

It’s time to change that. Whether you’re insured through your employer, you enrolled through the marketplace last year, or you’ve been slacking on the insurance front, it’s important to understand what the Affordable Care Act (ACA) means for your health—and how enrollment works. Here are four reasons to check out the healthcare marketplaces this year.

1. Prevention Is Your Best Friend (Even If You’re Healthy)

Fitness and wellness-minded folks know that the key to good health is prevention. Luckily, the ACA requires insurance plans to cover certain recommended preventive services, like vaccinations, well-woman visits, and certain screenings at no cost, whether you buy insurance through Healthcare.gov or you have employer-sponsored insurance. 

“As long as your doctor is in-network, the plan can’t charge you anything—even as part of the deductible—for these recommended preventive services,” says Benjamin Sommers, MD, PhD, assistant professor of health policy and economics at Harvard School of Public Health

Got a nagging running injury that’s slowing you down? Physical therapy, in addition to mental health services and prenatal and postnatal care, is among the ACA’s list of “Essential Health Benefits” that plans are required to cover—but may require copays. The most generous private insurance companies might cover other optional wellness services, like acupuncture, nutrition counseling and chiropractic care, but it’s up to the insurer as to what to include. Consumers should read through their plan or call the insurer to find out exactly what’s covered, Sommers says.

2. You’re Not Actually Invincible

If you exercise most days, eat a healthful diet, don’t often wind up in the doctor’s office, and are basically a superhero, you might not see the point in buying insurance. But picture this: You’re running, playing basketball, or hitting the slopes when you land wrong or take a spill. If you tear your ACL and need surgery it could cost you a whopping $20,000 to $50,000 out-of-pocket if you’re uninsured. Cringe.

In addition to preventing you from blowing your life savings on unexpected medical costs, access to health insurance has also been linked to lower rates of depression and improved health and well-being. Worth it? We think so.

And we guarantee the cost of insurance isn’t going to leave you broke (or take away from the funds allocated to your gym membership—more on that later). The marketplace insurance plans are divided into five categories based on how generous they are when it comes to helping you pay your medical bills, explains Sommers. A platinum plan pays 90 percent of costs; gold plans pay 80 percent; silver plans pay 70 percent; bronze pay 60 percent. There is also the option of catastrophic coverage plans, which pay less than 60 percent—and are only available to those under age 30 or with a hardship exemption.

For platinum, gold, or other more generous plans, the premiums (or amount you pay up front) will be more expensive. While the less generous plans cost less up front, they’ll leave you footing up to 40 percent of the bill if you wind up sick or injured.

“Some people who are in very good health may prefer to spend a bit less and have less generous coverage, but this depends on personal preferences,” says Sommers. “It also depends on whether you’re receiving a tax credit, which for many young adults will cover the majority of the premium.”

3. You’ll Get Sweet Discounts

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If you’re a fitness lover like we are, it’s probably important to you that your company offers at least a few solid health perks. As of January 1, 2014, the ACA now allows companies to offer rewards to employees who participate in a wellness program that meets insurer guidelines (like joining a program to quit smoking, or even signing up for a gym). 

Last year, the rewards doled out could only add up to 20 percent of your total cost of insurance — but this year, that number has climbed to 30 percent (and it’s 50 percent if you’re ditching cigarettes!). So let’s say that your total cost of health insurance coverage is $3,000, of which you pay half and your employer pays half. If you participate in your company’s wellness program, you could receive a $450 reduction in the cost of your insurance premium. If you were a smoker and participated in a smoking cessation program, too, you’d save $750 on your yearly insurance cost.

4. You’ll Stay Out of the Penalty Box

“It’s still worth going back to the website and entering your updated information to see if the prices or plan options have changed.”

Skipping out on insurance in 2015 will cost you more than it did in 2014. Under the ACA, adults without minimal essential coverage will be charged a penalty when they file their tax return. If you didn’t have health coverage in 2014, be prepared to pay either one percent of your income (above the expected tax-filing threshold of $10,300 for a single filer and $20,600 for a couple) or $95 per adult, whichever is higher, when you file your 2014 federal tax return. 

While that might just seem like a slap on the wrist compared to the cost of insurance, the penalty increases every year. That means if you don’t have employer-sponsored insurance and ignore the 2015 open enrollment, you’ll be required to pay a penalty of two percent of your income or $325. In 2016, the fine is two-and-a-half percent of your income or $695. The penalties are set in stone through 2016, but after that they will remain at $695 per year, plus inflation. Sign up and you can spend that extra money on spin classes, instead.

Ready to Take the Plunge? Here’s What You Need to Know About Open Enrollment

While the 2014 open enrollment was famously plagued, eight million people managed to wade through the website glitches and sign up for insurance through the Health Insurance Marketplace. This year, enrolling will (hopefully) be as easy as visiting Healthcare.gov between November 15 and February 15, entering some personal information and selecting a plan that meets your needs. 

When you sit down to sign up, you’ll need your social security number, income information from the past year (from pay stubs or W-2 forms) and an estimate of your 2015 income. You’ll also want to have the policy number for your current health insurance plan (if you have one), your plan ID, and a completed “Employer Coverage Tool” for every job-based plan you or someone in your household is eligible for.

“If you already have a plan from last year, it’s still worth going back to the website and entering your updated information to see if the prices or plan options have changed,” says Sommers. “You may qualify for more or less of a tax credit than last year, and you may find another plan you like better this time around, as more insurers are joining the marketplace for year two.”