The stakes are higher for picking your health care insurance this year, whether choosing employer-sponsored plans or health exchange coverage.
An individual must have some kind of coverage or pay the individual mandate penalty. For 2015, this will be $325 per adult in a family and half that much for each child under 18, up to $975 per household.
"Everyone should get some kind of coverage," said Timothy Jost, a professor at Washington and Lee University School of Law.
Here are things you should know about open enrollment:
Know your employer's open enrollment period.
Open enrollment for all health care exchanges is shorter for 2015: Nov. 15 to Feb. 15. Individuals may qualify for special enrollment periods beyond this time frame if, for example, they get married, have a baby or move.
|Employer-sponsored vs. exchange coverage?|
Some employees can decline employer-sponsored insurance and instead pursue tax credits on public exchanges. Employer-sponsored insurance must be affordable and offer adequate coverage, said Andrea Riggs, director of communications for GetInsured. If the employee's contribution toward a plan is less than 9.5 percent of the employee's household income, then it is deemed affordable.
An employee with low enough wages may also be eligible for Medicaid, Jost said.
|Research a plan’s total cost|
Don't just focus on the premiums, Riggs said. A few employers, for example, do not cover hospitalization, Jost said. What's the out-of-pocket limit? Does your employer offer a Health Savings Account (HSA), which can roll over and is yours to keep?
|Vocabulary and mechanics|
Healthy people who need less care should be more comfortable paying lower premiums (the amount paid for your health plan by you and/or your employer) with less coverage, Riggs said. This means higher co-pays (fixed amount paid for a service) and higher deductibles (the amount paid out of pocket before an insurer will pay up). People who need more care should opt for richer benefits (lower co-pays, lower deductibles) with higher premiums.
|Don't forget about providers and drugs|
Make sure any doctors and specialists key to you are in a plan's network, that there are enough providers near your home or work and that your prescribed drugs are covered.