After Halloween, don't forget about your health; make sure this is on your to-do list

Nov. 1. The day after Halloween. The unofficial beginning of the holiday season. It’s also the start of the open enrollment period for individuals not covered under an employer group policy to purchase health insurance coverage for next year.

While not as exciting as trick-or-treating, prepping for the Thanksgiving feast or Christmas shopping, open enrollment is an important time because the Affordable Care Act (ACA) requires most Americans to obtain health insurance coverage for their families and themselves.

Starting Nov. 1, you can buy health insurance online on healthcare.gov or directly from an insurance company until Jan. 31, 2016. To have coverage by the first of the year, however, you have to purchase a plan by Dec. 15.

The government may help you pay for this coverage

Under the ACA, you may qualify for a tax credit if your income is below a certain level. For example, a family of four with a household income of up to $97,000 could qualify for a tax credit. The credit is applied toward your insurance premium. In addition, you may also qualify to pay lower out-of-pocket costs (deductible, coinsurance and copayments).

It doesn’t cost you anything to see if you qualify for a tax credit.

Don’t forget! If you received a tax credit in 2015, you don’t automatically get one again in 2016. You need to reapply every year for the tax credit through healthcare.gov. Even if you’re planning to keep your same health insurance plan, you’ll need to reapply for the tax credit. Things like income changes, marital status and family size affect the amount of tax credit you may receive, so make sure your information on healthcare.gov is up-to-date.

What happens if you don’t buy health insurance?

There are about 176,000 Nebraskans who don’t have health insurance coverage, according to the Nebraska Department of Insurance. Under the ACA, if you aren’t covered by a health insurance plan, you may have to pay a penalty on next year’s federal income tax filing. In 2016, the penalty for not having health insurance coverage is $695 for every adult in your family and $347.50 for every child under 18, or 2.5 percent of your household income, whichever is greater.

Mark your calendar! Open enrollment starts Nov. 1!

After you put away the Halloween candy and before you start your Christmas shopping, mark open enrollment on your calendar. Make sure you’ve got the health insurance coverage you need before it’s time to ring in the New Year.

Need help picking a plan? Contact your broker or agent or go to nebraskablue.com.

By Cameron Arch, BCBSNE assistant general counsel

HEALTH INSURANCE TERMS


COINSURANCE

The percentage of the bill you pay after your deductible has been met.

COPAY

A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 

DEDUCTIBLE

The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.

SUBSTANCE ABUSE DISORDER SERVICES

Includes behavioral health treatment, counseling, and psychotherapy


in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)

out-of-pocket

Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.

penalty

If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.

premium

The amount you pay to your health insurance company each month. 


Preventive services

Health care services that focus on the prevention of disease and health maintenance.

rehab SERVICES

Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).

specialist

A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.