Open Enrollment Under Way for Health Care Law

The open enrollment period to sign up for individual health insurance under the health care law known as the Affordable Care Act begins November 15, 2014 and runs through February 15, 2015. That’s when people who do not have health insurance through their jobs and are not currently receiving health coverage through Medicare can shop for a health plan on their state’s marketplace. If you have already purchased a plan through the marketplace, you can renew your current plan (although it’s a good idea to find out if your plan’s coverage has changed) or switch to a new one.

To compare health insurance plans and choose the best one for you and your family, visit the official website, HealthCare.gov (for Spanish, CuidadoDeSalud.gov), or call 1-800-318-2596. To find people in your community who can help answer your questions and help you with the enrollment process, visit localhelp.healthcare.gov.

Who doesn’t have to wait for open enrollment?

People who qualify for coverage through Medicaid or Children’s Health Insurance Program (CHIP) can apply for and enroll in those programs at any time of year.

Special enrollment periods are available for people who have had a life change, such as marriage, legal separation, loss of insurance, or birth of a child – they have up to 60 days after the event to enroll.

Affording a plan

The marketplace groups health plans into 4 coverage levels – platinum, gold, silver, and bronze. The highest category is platinum; these plans charge higher monthly premiums but they cover a larger portion of expenses, so that deductibles, co-payments, co-insurance, and other costs average lower. The lowest premium cost is the bronze category; you pay less up front but these plans require the patient to pay more out-of-pocket costs later on.

Low- and middle-income people shopping for coverage in the marketplaces may qualify for help paying for their plan. Most individuals earning up to $46,680 per year and families of 4 with a combined income of up to $95,400 per year could be able to get financial help to pay a health plan’s monthly premiums and/or out-of-pocket costs for medical services.

Visit HealthCare.gov (for Spanish, CuidadoDeSalud.gov) to see if you may qualify for financial help to pay for a health plan.

Choosing a plan

To figure out the kind of health insurance coverage you need, think about how often you use your insurance coverage, whether you expect to see any specialists, what prescription drugs you take, whether you use specific therapy services, and what hospitals or clinics you use most often. When you begin comparing specific plans consider the following:

  1. What are the total costs associated with the plan? Add up the costs of co-payments, co-insurance, deductibles, and premiums. If you or someone who will be covered under the plan is living with cancer, a plan with more comprehensive coverage (such as a gold or platinum plan) may be a better choice. These plans may have a higher premium, but the overall amount of money you spend to see your doctors, fill your prescription drugs, and visit a hospital or clinic are lower than in other plans (such as a bronze or silver plan).
  2. Does the plan cover the prescription drugs you take? Check the plan to find out whether it covers your medicines, and if so, how much will you have to pay each time you fill a prescription. For some expensive medications, your plan may impose some limits (either in the number of drugs you can take in a given month) or may require additional approval (like prior authorization) before it will cover your drugs.
  3. Does the plan cover your doctors, hospitals, and clinics? Find out if the doctors (primary care, oncologist, other specialists) you visit are included in the plan. Plans can change the doctors, hospitals, and clinics they cover, so you should double-check the information you receive from the plan with your preferred doctor, hospital, and/or clinic to make sure they will be in the plan. If your doctors, hospitals, or clinics are not covered under the plan next year, you will likely have to pay more to see them. Some plans will not cover any of the costs of doctors not in the plan network.

Coverage that helps people with cancer

Scientific studies by the American Cancer Society have shown that people with health insurance are less likely than the uninsured to be diagnosed with late-stage cancer and are more likely to survive the disease.

The health care law ensures that:

  • All health plans sold in new health insurance marketplaces cover essential benefits that include cancer screening, treatment, and follow-up care
  • Proven cancer screenings and other preventive care be made available at no or very low cost to people in new plans, in Medicare, or who are newly eligible for Medicaid
  • Medicare covers a yearly check-up to discuss disease prevention and ways to stay healthy
  • Health care professionals are trained to treat pain and other symptoms to help improve patients’ quality of life
  • The “donut hole” in Medicare Part D that forced seniors to pay high costs for prescription drugs after they reached a certain limit is shrinking from year to year until it’s finally closed in 2020
  • Coverage is made available for patients who participate in clinical trials

Call the American Cancer Society at 1-800-227-2345

Having health insurance is an important matter, and deciding on a particular health plan can be complicated. The American Cancer Society Health Insurance Assistance Service (HIAS) is able to educate cancer patients, cancer survivors, individuals with cancer symptoms and those calling on their behalf about health insurance options available during the Affordable Care Act open enrollment.

Call 1-800-227-2345 and ask to speak to someone from HIAS about:

  • The difference between health insurance plans sold through the health insurance marketplace and plans sold outside of the marketplace
  • Help locating marketplace plan details including premiums, deductibles, coinsurance and more
  • Who qualifies for marketplace premium and/or cost sharing assistance
  • Choosing a plan that is right for you and your family
  • Referrals to in-person enrollment assistance through marketplace navigators or assistors

HIAS also provides guidance on all health insurance options year-round to people affected by cancer.

Visit the American Cancer Society online at cancer.org

The American Cancer Society has information and resources about private health insurance plans, government programs such as Medicare and Medicaid, and other possible sources of coverage and financial help:

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.


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