Health

Obamacare FAQ: 8 things you should know about employer open enrollment this year

File: Booklets outlining health insurance options for Californians is seen at a Senior Information & Resource Fair in South Gate, California September 10, 2013 .
File: Booklets outlining health insurance options for Californians is seen at a Senior Information & Resource Fair in South Gate, California September 10, 2013 .
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“Open enrollment” season in the workplace is here – that time of year when people with job-based health insurance are allowed to make changes to their coverage for the following year.

To make the right choice for you and your family, take the time to sort through the health plan options provided by your employer. While that’s certainly a task few look forward to tackling, doing so may save you money and provide you with coverage that works better for you, experts say.

“This is an opportunity to review,” said Karen Pollitz, a health policy analyst with the Kaiser Family Foundation, “to see if other plans offered by your employer might provide additional coverage that you need, or be more economical for you.”

If you’re worried about wading into the hullabaloo still swirling around the first-ever open enrollment period offered under the Affordable Care Act (ACA), also known as “Obamacare,” you can relax, Pollitz says. That highly-publicized open enrollment period that’s still grabbing headlines has virtually nothing to do with the one workers are now entering. (And the same is true for the Medicare open enrollment that’s also happening now).

Overall, Pollitz says, the federal health care law will have little, if any, impact on the insurance choices you and 150 million other American workers face this fall.

“For large employer plans, there aren’t really any new changes,” Pollitz said, adding that most of the significant consumer protections required under the law have already taken effect.

“This year has been pretty routine,” agreed Mike Brewer, president of Lockton Benefit Group,  the world’s largest, privately-owned insurance agency.

Among the major consumer protections now included in all group plans: insurance companies may no longer deny coverage because of a preexisting condition; adult children can now be covered by their parents' health insurance policy until their 26th birthday, as long as that policy provides dependent coverage; and insurers are prohibited from applying lifetime caps on what they’ll pay.  

But the Obama administration has delayed, until 2015,  a provision that requires large employers to cap all of your out-of-pocket medical and prescription drug costs into one consolidated limit of $6,350 for individuals and $12,700 for families.

Until that provision takes effect,  you could pay double that amount and even more, depending upon whether your company drug plan is administered separately from its medical plan and depending upon whether the drug plan now offered to you has any out-of-pocket limits.  

Brewer says the amount you’ll pay for company-provided health insurance next year is likely to bring some good news in the form of smaller-than-usual rate increases.

“On average, what we’re seeing passed on to the employees is about an 8 percent increase,” he said, adding that’s “pretty good” compared with larger increases experienced during the past decade.

So where to begin?  To help you get started, here are answers to eight questions about open enrollment, along with some links to resources.

1. What is open enrollment?

It's the annual period that most companies offer when their employees can make changes to employer-sponsored health plans without being subject to underwriting or evidence of insurability.

2. When does it take place?

Usually at the end of the calendar year. Open enrollment typically lasts from one week to more than a month, depending on the company. Check with your employer's human resources department to find out when your company offers open enrollment.

3. What are my options?

That will depend on your employer’s offerings. But basically, you’ll need to know that health plans come in a variety of flavors and letters (think HMO, PPO, PSO).  Those typically offered by employers include: 

4. What other basic insurance terms should I know before I start comparing plans?

Kaiser Health News provides a comprehensive glossary of health terms. 

5. My existing coverage works well for me. Can't I just ignore all that gnarly paperwork?

Not a good idea. Plans change. So even if you’re happy with your existing plan, you’ll want to at least consider:

6. What’s the most efficient way to compare the plans my employer offers?

The ACA makes the effort easier by requiring your company to provide you with two consumer-friendly forms:

The Centers for Medicare & Medicaid Services (CMS) offers more detail about the forms.  

7. What is a “grandfathered” plan and what does it mean for me?

These are plans set up before the Affordable Care Act was enacted on March 23, 2010.  If your company plan is grandfathered, it doesn't have to comply with some of the consumer protections required under the ACA — such as covering your adult children up to age 26.  But those plans are fast disappearing, as they lose "grandfathered" status once they are materially changed. 

8. Am I eligible for subsidized health care provided on Covered California, the state-run health care marketplace? 

Probably not. While there’s nothing to stop you from buying a plan through Covered California and paying full price for it,  those with qualified job-based health coverage aren’t eligible for the subsidies and cost sharing reserved for those who earn less than four times the federal poverty level.