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Open enrollment for health insurance.

It’s that time of year … not the holidays but open enrollment for health insurance. This began on Nov. 1, 2015 and ends 90 days later on Jan. 31, 2016.

Many people still question whether or not health insurance is necessary. For those of you considering getting on PrEP or those that already are, making sure your insurance plan covers the cost is crucial. Same goes for those diagnosed with HIV. You want to double check that your doctor, clinic, tests, medications are covered by the plan you enroll in. To help you make the correct choice there are people called navigators to assist you. They can be reached by calling 800-318-2596 or visiting healthcare.gov.

Here is a list of 10 reasons why one should consider getting health insurance through the marketplace:

  1. Government assistance has made health insurance more affordable than ever. The government provides subsidies that could help you save hundreds each month on health insurance premiums. But if you miss open enrollment, you may miss out on your subsidy.
  1. Pre-existing conditions are COVERED. Too many Americans were unable to get the health insurance they so badly needed due to pre-existing health conditions. Under healthcare reform, those days are gone. Insurance companies cannot refuse to cover you due to a past or current health condition and they can’t terminate your policy if you get sick.
  1. It’s the law. Federal law requires that all Americans have health insurance that provides coverage for everything from hospitalization to prescription drugs. If you don’t have the right kind of coverage, you may have to pay the “individual mandate” tax to the IRS.
  • In 2016, the penalty for not enrolling will be $695 per person ($347.50 per child under 18) or 2.5% of annual income (based on income above the tax filing threshold), whichever is greater. The penalty will be assessed when federal taxes are filed for 2016. (thebodypro.com)
  1. This is the ONLY time you can buy comprehensive health insurance. If you miss open enrollment, you may not be able to purchase the health insurance coverage you need – and the coverage the government requires you to have – during 2015.
  1. No annual or lifetime limits. Even a minor accident or a short stay in the hospital can result in thousands of dollars in medical bills. Under healthcare reform, insurance companies are prohibited from imposing annual or lifetime limits on comprehensive health insurance.
  1. Benefits, benefits, benefits. Healthcare reform requires insurance companies to cover 10 essential health benefits: hospitalization, doctor’s visits, emergency care, mental health services, prescription drugs, rehabilitative therapy, lab tests, pediatric services, and preventive services including vaccinations and chronic disease management.
  1. Women’s wellness. All new plans must cover preventive services for women without a copay, including breast and cervical cancer screenings, contraception and well-woman visits.
  1. Changing plans may save you BIG money. This year more and more insurance companies are competing for your business. You may like your current plan, but perhaps there is a new plan available that provides better coverage at a lower cost. If you don’t research your new options, you may end up paying more.
  1. Physician networks are improving. Last year, many people were upset over “skinny networks.” That means insurance companies limited which doctors and hospitals they would cover. This year is different – insurance companies listened and broadened their networks to meet the needs of their customers. Is your doctor or local hospital covered under your current plan?
  1. Everyone’s doing it. Last year, millions of Americans finally got the health insurance they needed. The number of uninsured Americans dropped dramatically, as people discovered subsidies have finally made health insurance affordable for everyone.

Please take the time to learn about insurance and take the necessary steps to get enrolled this year. Act by Dec. 15 for coverage effective Jan. 1, 2016.

(healthcare.gov, thebodypro.com)

About the author

Peter Stoker

C. Peter STOKER, MPH, CHES, is a community health education coordinator, HIV outreach educator, epidemiologist for Salt Lake County Health Department. Information in these articles is gathered from multiple sources and are a reflection of the author’s opinion only.

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