We are at the onset of Open Enrollment, with the deadline cut down to December 15th, the last chance to enroll in a healthcare plan for 2019 is approaching.


What Does Open Enrollment Mean To You


During Open Enrollment, you can enroll in any new plan available for you. Preexisting conditions do not apply by law by the ACA. Premium rates are equal for all based on age and the state you live in. It is important to know that the plan you enroll in during this period will be in effect through December 31st, 2019. You will not be able to upgrade or switch plan during the remainder of the year.
Having said that, a business/group qualify to make a plan change at any time of the year with some conditions that apply. Individuals qualify for a change in coverage only due to qualifying events during the year such as death, birth, loss of employment, loss of Medicaid. The only way one can switch plans in 2019, after Open Enrollment concludes, is if they qualify for a group plan or they lose existing health coverage due to a qualifying circumstance, such as a death in the family, divorce, loss of employment or termination of Medicaid coverage.


It is important to note that even though group plans can commence all year round, the current open season can be very helpful for people who are employed or part of another insurance group too. During open season, you can obtain group coverage without many of the year-round requirements, such as excluding a particular percentage of the group from participating in the plan. You will be able to meet participation requirements with just 1 out of 40 employees during Open Enrollment. Yes, you read that right, 1 out of 40 employees.


In any case, don’t just sit back and swallow a premium increase. There may be better plans for you out there today, with benefits that better suit your needs, a better provider network and/or more competitive premiums.


Choose the Best Plan For you


We at Cosmo Insurance will give you some good news you’ll want to hear about your health care options. While some premiums in the individual market have become more expensive than ever, the market is also more saturated than ever with different options – some of them more cost efficient than other.


Cosmo knows these options inside out, and will guide you towards the best one for you. Horizon and AmeriHealth will be continuing their health options from last year and offering competitive premiums. Horizon will be adding on mobile chats and video consultations with Doctors, while AmeriHealth’s new partnership with Robert Wood Johnson University Hospital has allowed the carrier to expand its options. One popular insurer, Oscar will be coming back to New Jersey this year. Oscar offers quality insurance and will be bringing health options to New Jersey for small businesses and individuals. It is a savvy technology-based carrier that provides ease of access to their thousands of members through telemedicine. Oscar has a network of world-class doctors and hospitals within the reliable QualCare and an app that will allow you to have a free Virtual Visit, book an appointment with a doctor, and receive prescriptions quickly. They can help you find a doctor, understand your plan, and save money on care all throughout your phone.


Another major attractive option for small businesses in New Jersey is husband-and-wife group plans. Cosmo found a quality insurer that offers group rate coverage with significant savings for a two person, husband-and-wife group. If a husband and wife are partners or work for the same corporation (25+ hrs per week) they can qualify for the affordable coverage- even if there is no one else in the group. Previously, insurers did not offer group coverage for husband and wife alone.


And if you thought things couldn’t get any better than that, than you’re going to be surprised. You have the option of choosing between Tier One/Tier Two plans from the same insurer. The Tier One plan offers you lower premiums and out of pocket expenses than the Tier Two plan simply by virtue of the different physician/medical facility network you can use. The Tier One plans find physicians and medical facilities that will be willing to negotiate lower reimbursement rates than the conventional Tier Two networks.


The Bottom Line


When deciding between plans, make sure that you understand what each plan means for you. The current array of plans can be confusing, with various “tiers” and different in-network and out-of-network coverage. Let a knowledgeable agent explain to you – honestly – what each plan will mean for you in the real world, for your expected expenses. Look carefully into the provider network of each plan being offered to you. Are your doctors and preferred medical facilities covered?


Whatever plan you end up choosing, the earlier you begin the process, the better. You will have more time to understand your options and make a wise decision. When you enroll earlier, you will have your ID cards in time and greater peace of mind in every aspect of your coverage.


You are busy, and possibly confused and/or not thrilled about delving into the intricacies of healthcare. We agents are the rare breed that enjoys this stuff. Waiting for the last minute to enroll can give you great headaches as well, such as having to delay your appointment with your physician even if you very much need the visit.
We understand that you’re flustered and overwhelmed. However, a little time and effort now can pay enormous dividends throughout the next year, both financially and in the quality of your healthcare.


Just give Cosmo Insurance Agency a call. We will simplify the process for you!

Cosmo Insurance Agency is an independent insurance agency serving surrounding communities in New Jersey. Cosmo keeps its promise to assure an efficient and creative approach to the services we offer. Each of our clients experience a personalized and long-term relationship with us. Our New Jersey based team of health brokers guides our clients in helping them choose the most cost-effective options. By incorporating the latest in technology-based tools and laws on healthcare, employee benefits, life insurance and finance, we keep our clients up-to-date with the plans that encompass all of their needs, whether it is individual or group insurance.

 

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