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In the United States, annual enrollment (also known as open enrollment or open season) is a period of time, usually but not always occurring once per year, when employees of companies and organizations, including the government, [1] may make changes to their elected employee benefit options, such as health insurance. The term also applies to the annual period [2] during which individuals may buy individual health insurance plans through the online, state-based health insurance exchanges established by the Patient Protection and Affordable Care Act. Prior to January 1, 2014 insurers offering individual medical coverage typically allowed new members passing underwriting to enroll at any time throughout the year.
Annual enrollment is also prominent in Medicare, where almost 50 million enrollees can choose to stay in original Medicare, or join or change plans within the Medicare Advantage and Medicare Part D Prescription Drug programs for the coming calendar year, with enrollment usually occurring between October 15 and December 7 the previous year. Individuals usually can make changes to, or sign up for, their health insurance or fringe benefits only once per year [2] during the annual enrollment period or when they have experienced a specific qualifying event. [3] Open enrollment periods are used in insurance markets to limit adverse selection risks resulting when enrollees can switch plans at will. [4]
During this time period, an employer will typically communicate to all eligible employees what options they have for their benefit program. Often the vendors or insurance providers will be present to explain the details of their products. This can be done either with group presentations, "benefit fairs" or meetings one on one with each employee. As travel expenses continue to rise many vendors and insurance providers have turned to using independent "contract enrollers" to do the communication on their behalf. Some companies and organizations distinguish between an active enrollment benefits election period, where employees must re-review or confirm their benefits selections for the coming year, and a passive enrollment benefits election period, where employees are automatically renewed with their existing benefits selections from the current year if no action is taken. [5] For Medicare Part D enrollments, health care providers, along with Medicare itself, coordinate advertising campaigns during the open enrollment period, including paid programming presentations, to make consumers aware of their options. Some campaigns have proven controversial, making broad claims of benefits without clarifying properly who is eligible, and depending on paid endorsers such as celebrities and retired politicians to sell low-quality plans. [6]
Open season is a prominent feature of the Federal Employees Health Benefits Program during which some three million federal civilian employees and retirees may choose among several dozen health insurance plans [1] for the coming year. Open season is scheduled in the fall each year, and plan enrollment decisions take effect in the following calendar year.
Under the Patient Protection and Affordable Care Act, annual enrollment, or open enrollment, is the period that people in the United States who need health insurance can sign up for an individual insurance plan. Unless someone experiences a "qualifying event" (a change in personal circumstances such as getting married or having a baby [7] ) outside of the annual enrollment period, annual enrollment is the only time to sign up for individual health insurance under the Affordable Care Act. Annual enrollment used to last for three months; the 2016 cycle lasted from November 1, 2015 to January 31, 2016. The 2018 annual enrollment cycle was reduced to 45 days (in most states) from November 1, 2017 to December 15, 2017. [8]
Acting during the annual enrollment period is vital for any individual who wishes to buy individual health insurance. During annual enrollment anyone who wants to purchase insurance through the public exchange has the opportunity to do so despite circumstances, such as health or age. Outside annual enrollment, it can be difficult to obtain insurance, either public or private unless circumstances dictate. [9]
In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a significant portion of their funding. States are not required to participate in the program, although all have since 1982.
Medicare is a federal health insurance program in the United States for people age 65 or older and younger people with disabilities, including those with end stage renal disease and amyotrophic lateral sclerosis. It was begun in 1965 under the Social Security Administration and is now administered by the Centers for Medicare and Medicaid Services (CMS).
The Medicare Prescription Drug, Improvement, and Modernization Act, also called the Medicare Modernization Act or MMA, is a federal law of the United States, enacted in 2003. It produced the largest overhaul of Medicare in the public health program's 38-year history.
A health savings account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP). The funds contributed to an account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), HSA funds roll over and accumulate year to year if they are not spent. HSAs are owned by the individual, which differentiates them from company-owned Health Reimbursement Arrangements (HRA) that are an alternate tax-deductible source of funds paired with either high-deductible health plans or standard health plans.
The Federal Employees Health Benefits (FEHB) Program is a system of "managed competition" through which employee health benefits are provided to civilian government employees and annuitants of the United States government. The government contributes 72% of the weighted average premium of all plans, not to exceed 75% of the premium for any one plan.
Medicare Part D, also called the Medicare prescription drug benefit, is an optional United States federal-government program to help Medicare beneficiaries pay for self-administered prescription drugs. Part D was enacted as part of the Medicare Modernization Act of 2003 and went into effect on January 1, 2006. Under the program, drug benefits are provided by private insurance plans that receive premiums from both enrollees and the government. Part D plans typically pay most of the cost for prescriptions filled by their enrollees. However, plans are later reimbursed for much of this cost through rebates paid by manufacturers and pharmacies.
Tricare is a health care program of the United States Department of Defense Military Health System. Tricare provides civilian health benefits for U.S Armed Forces military personnel, military retirees, and their dependents, including some members of the Reserve Component. Tricare is the civilian care component of the Military Health System, although historically it also included health care delivered in military medical treatment facilities.
The prices of health care in the United States are higher than in other countries. Compared to other OECD countries, U.S. healthcare costs are one-third higher or more relative to the size of the economy (GDP). According to the CDC, during 2015, health expenditures per-person were nearly $10,000 on average, with total expenditures of $3.2 trillion or 17.8% of GDP. Proximate reasons for the differences with other countries include higher prices for the same services and greater use of healthcare. Higher administrative costs, higher per-capita income, and less government intervention to drive down prices are deeper causes. While the annual inflation rate in healthcare costs has declined in recent decades, it still remains above the rate of economic growth, resulting in a steady increase in healthcare expenditures relative to GDP from 6% in 1970 to nearly 18% in 2015.
The Medicare Part D coverage gap was a period of consumer payments for prescription medication costs that lay between the initial coverage limit and the catastrophic coverage threshold when the consumer was a member of a Medicare Part D prescription-drug program administered by the United States federal government. The gap was reached after a shared insurer payment - consumer payment for all covered prescription drugs reached a government-set amount, and was left only after the consumer had paid full, unshared costs of an additional amount for the same prescriptions. Upon entering the gap, the prescription payments to date were re-set to $0 and continued until the maximum amount of the gap was reached or the then current annual period lapses. In calculating whether the maximum amount of gap had been reached, the "True-out-of-pocket" costs (TrOOP) were added together.
In the United States, a high-deductible health plan (HDHP) is a health insurance plan with lower premiums and higher deductibles than a traditional health plan. It is intended to incentivize consumer-driven healthcare. Being covered by an HDHP is also a requirement for having a health savings account. Some HDHP plans also offer additional "wellness" benefits, provided before a deductible is paid. High-deductible health plans are a form of catastrophic coverage, intended to cover for catastrophic illnesses. Adoption rates of HDHPs have been growing since their inception in 2004, not only with increasing employer options, but also increasing government options. As of 2016, HDHPs represented 29% of the total covered workers in the United States; however, the impact of such benefit design is not widely understood.
In the United States, health insurance helps pay for medical expenses through privately purchased insurance, social insurance, or a social welfare program funded by the government. Synonyms for this usage include "health coverage", "health care coverage", and "health benefits". In a more technical sense, the term "health insurance" is used to describe any form of insurance providing protection against the costs of medical services. This usage includes both private insurance programs and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children's Health Insurance Program, which both provide assistance to people who cannot afford health coverage.
Medicare Advantage is a type of health plan offered by Medicare-approved private companies that must follow rules set by Medicare. Offered since passage of the BBA in 1997, Medicare Advantage/Part C creates a private insurance option that wraps around traditional Medicare, filling in many or most of the coverage gaps and including new options, resulting in a more conventional health insurance experience for Medicare recipients.
In the United States, health insurance marketplaces, also called health exchanges, are organizations in each state through which people can purchase health insurance. People can purchase health insurance that complies with the Patient Protection and Affordable Care Act at ACA health exchanges, where they can choose from a range of government-regulated and standardized health care plans offered by the insurers participating in the exchange.
The proposed America's Affordable Health Choices Act of 2009 was an unsuccessful bill introduced in the U.S. House of Representatives on July 14, 2009. The bill was introduced during the first session of the 111th Congress as part of an effort of the Democratic Party leadership to enact health care reform. The bill was not approved by the House, but was superseded by a similar bill, the proposed Affordable Health Care for America Act, which was passed by the House in November 2009, by a margin of 220-215 votes but later abandoned.
The Empowering Patients First Act is legislation sponsored by Rep. Tom Price, first introduced as H.R. 3400 in the 111th Congress. The bill was initially intended to be a Republican alternative to the America's Affordable Health Choices Act of 2009, but has since been positioned as a potential replacement to the Patient Protection and Affordable Care Act (PPACA). The bill was introduced in the 112th Congress as H.R. 3000, and in the 113th Congress as H.R. 2300. As of October 2014, the bill has 58 cosponsors. An identical version of the bill has been introduced in the Senate by Senator John McCain as S. 1851.
Members of the United States population between the ages of 18 and 29 who decide that it is in their financial best interest to forgo health insurance are sometimes referred to as young invincibles by the insurance industry, a term coined to express the idea that the young demographic perceives themselves as immune to sickness and injury. The argument is that these individuals are young and in good health, so they have a low risk of experiencing substantial health issues that would lead to large amounts of spending on health care. Further, this group tends to have a mentality of “it won’t happen to me” with regards to most causes of injury. Together, these beliefs lead to the young invincibles not purchasing insurance.
Covered California is the health insurance marketplace in the U.S. state of California established under the federal Patient Protection and Affordable Care Act (ACA). The exchange enables eligible individuals and small businesses to purchase private health insurance coverage at federally subsidized rates. It is administered by an independent agency of the government of California.
Health care finance in the United States discusses how Americans obtain and pay for their healthcare, and why U.S. healthcare costs are the highest in the world based on various measures.
The federal Small Business Health Options Program is an insurance exchange, created by Patient Protection and Affordable Care Act (Obamacare). The Small Business Health Options Program (SHOP) Marketplace helps small businesses to provide health coverage to their employees. Therefore, it is open to employers with 50 or fewer full-time equivalent employees (FTEs), in which it also includes non-profit organizations.
A private exchange, also known as a private benefits exchange or private health care exchange, is an online store or health insurance marketplace where employees or retirees purchase health insurance and other benefits, typically using funds contributed by their employer.