Fall Health Insurance Open Enrollment Triggers Questions for All Americans, Whether Employed or Not

New laws and rising costs make it important to revisit coverage options now

KANSAS CITY, Mo., Sept. 21, 2011 /PRNewswire/ -- With the economy weighing heavily on the wallets of consumers, and health care reform still confusing to many, Americans have more to think about than ever as they make health insurance open enrollment decisions this fall. Rising medical costs and new coverage laws make it a good time to review your options whether you receive coverage through your employer, are self-employed or even if you are unemployed.

"While 153 million Americans receive health insurance coverage through their employers, more than nine million people are self-employed, and close to 14 million are unemployed, according to the Bureau of Labor Statistics," says National Association of Insurance Commissioners (NAIC) President and Iowa Insurance Commissioner Susan E. Voss. "Whatever your situation, health insurance choices can seem complicated. Your state insurance department offers free resources to help you make sense of it all."

Consumers should consider the following tips when evaluating their health insurance coverage options.

Employer-Based Group Health Insurance

If you are one of the many Americans who receive health insurance through an employer, you are usually limited to open enrollment periods to make changes to your plan. Be sure to carefully review all your options before selecting or changing your coverage. Many employers are expected to increase premiums, co-pays and deductibles to offset increasing health care costs. If you have several plan options, do not automatically renew what you had without a side-by-side comparison.

  • Make sure current physicians and area hospitals are in the plan's network.
  • Review any pre-existing condition exclusions, prior authorization requirements and annual limits.
  • Check any prescriptions you take against the list of each plan's approved drugs for co-pay variations.
  • Make a list of premiums, out-of-pocket expenses, co-pays, co-insurance, deductibles, specialists and benefits for each health, vision and dental plan.
  • See if the cost for dependent coverage has increased. Some employers are raising costs now that coverage is available for dependents through age 26.
  • Ask if your employer offers a wellness program or incentives for healthy behaviors such as exercising regularly or not smoking. Many employers offer incentives to employees committed to living a healthier life.
  • In addition to health insurance, you may be able to contribute pre-tax dollars to a flexible spending account (FSA) or health savings account (HSA). Check closely to see if the list of covered expenses for reimbursement has changed since last year.

Individual Health Insurance Coverage

If you are self-employed or your employer doesn't offer coverage, you face unique health insurance challenges, but you still have choices. Here are some tips to help when shopping for coverage:

  • First, investigate the cost of being added to your spouse's or domestic partner's employer plan.
  • If that is not an option, consider shopping for private insurance that will allow you to customize care to your lifestyle, health and budget. You may be charged more based on your age, gender or health, and some pre-existing conditions may not be covered. Note that recent tax law changes make it possible to deduct the cost of premiums from your taxable income. The NAIC offers tips to help you better understand and apply for individual coverage.
  • If you are in good health and can afford a minimum of $1,200 in out-of-pocket expenses for yourself or $2,400 for your family, you might consider a high-deductible plan. This means you will pay for basic doctor's visits and prescriptions out of pocket, but have coverage if needed for major medical care such as surgery or disease treatment.
  • If you have a pre-existing condition and have been uninsured for at least the last six months, you may qualify for the new Pre-existing Condition Insurance Plans (PCIP). These plans offer a range of benefits, including primary and specialty care, hospital care and prescription drugs. They do not charge a higher premium because of a medical condition and do not base eligibility on income.
  • Many professional or philanthropic associations offer state regulated health plans. For a fee, you can join these organizations and have the ability to participate in the plan.

Health Insurance When Unemployed

If you lost your job last year, you were likely forced to determine how, or if, to continue your health insurance. Now is a good time to review your decision and determine if your choice is still appropriate. In addition to the options above, the Consolidated Omnibus Budget Reconciliation Act (COBRA) gives unemployed workers the right to temporarily purchase health insurance through a former employer. Although this option requires you to pay the entire premium yourself, it can provide more comprehensive coverage than a more restrictive or costly individual plan.

  • COBRA coverage is typically available for up to 18 months after losing a job, but in some circumstances benefits can be extended for up to 36 months.
  • If you were previously employed by a smaller company, check to see if your state has a "mini-COBRA" law that extends coverage to employees of companies with fewer than 20 workers.

If you have been unemployed awhile and your family income has taken a significant hit, you and/or your children might be eligible for Medicaid or the Children's Health Insurance Program (CHIP).

  • Medicaid is available to low-income children, parents with dependent children, the permanently disabled, and individuals over the age of 65. Eligibility varies from state to state.
  • CHIP provides low-cost health insurance coverage for children in families who earn too much income to qualify for Medicaid but can't afford to purchase private health insurance. The eligibility rules and benefits are different in each state.
  • If you are a veteran, see if you qualify for free or reduced price treatment at a Veterans Affairs (VA) hospital or clinic near you.

For more tips and resources as you review your insurance options this fall, visit health.insureuonline.org, or find your state insurance commissioner at http://www.naic.org/state_web_map.htm.


The National Association of Insurance Commissioners (NAIC) is the U.S. standard-setting and regulatory support organization created and governed by the chief insurance regulators from the 50 states, the District of Columbia and five U.S. territories. Through the NAIC, state insurance regulators establish standards and best practices, conduct peer review, and coordinate their regulatory oversight. NAIC staff supports these efforts and represents the collective views of state regulators domestically and internationally. NAIC members, together with the central resources of the NAIC, form the national system of state-based insurance regulation in the U.S. For more information, visit www.naic.org.

SOURCE National Association of Insurance Commissioners (NAIC)