Key Topics:

  • Get organized and start early
  • Calculate household income
  • Look at the past to help with plan selection
  • Don’t drag your feet and try to beat the deadline.

Each year as Open Enrollment for the Affordable Care Act (ACA) approaches you vow to do a better job in reviewing your health insurance options and not be stressed over the process of selecting your health insurance coverage for the next year.  You have the best intentions to complete the process unscathed; but for various reasons Open Enrollment turns into activity akin in enjoyment to an audit from the IRS.

Stateside Insurance Services provides some insight on how to make the Open Enrollment process not as hectic and improve your plan selection to best meet your health insurance needs. The following are some tips for the upcoming Open Enrollment, which runs from November 1 to December 15 for a January 1, 2021 coverage effective date.

  • Start Early – It seems a bit obvious but if you start early you allow yourself the most time possible to research, review and make a coverage decision. Since 2016, Open Enrollment has been November 1 to December 15 only allotting for a 45-day enrollment period. Additionally, this year’s Open Enrollment starts on a Sunday, November 1. Regardless of the day Open Enrollment falls or ends on there are no extensions-zero. If you start early you take advantage of every day allowed to evaluate your options.
  • Calculate your household income for 2021 – One of the most significant aspects of the ACA is the availability of subsidies from the federal government to reduce the cost of health insurance. Subsidies are based on the household income and are applied to the individuals who are to be insured. Historically 40% of Stateside clients have qualified for subsidies, which made their insurance more affordable. The household income question is one of the first questions Stateside personnel ask so we can identify the most suitable coverage for the lowest premium available.
  • Physicians & Networks – Coverage options fall into either HMO or EPO networks. The important aspect to understand with either type of network is there are no out-of-network benefits. None. Do not even think about going out-of-network unless it is a dire emergency. Since networks are now very restrictive it is important to provide a list of your physicians to Stateside so their network participation can be identified. Coverage may look very attractive from a premium or benefits standpoint but if none of your doctors participate in the network the benefits of the coverage are greatly reduced.
  • Organize a list of prescriptions – Just like the list of physicians, it is important to understand if your prescriptions are listed on the carrier’s formulary. A formulary is the list of drugs a health insurance carrier identifies as most effective for treating a specific condition. Health insurance carriers have the ability to exclude some drugs from their formulary, which means the prescription will not be covered. Also, carriers assign prescriptions into classifications known as “Tiers”, which determines the plan benefit assigned to the drug. Complete prescription information is required in order to determine the overall benefit of a plan and whether a higher premium of a benefit rich plan can be justified. 
  • Do not procrastinate – A common denominator of every Open Enrollment since the first one in 2013 is that the enrollment systems cannot keep up with the application surge that occurs during the few days leading up to the deadline. Stateside has always told our clients to make their decision by December 10 to allow enough time to submit the application and confirm acceptance. Invariably, applications submitted on December 14 or 15 are subject to delays, enrollment errors and technical issues. Since the goal is to have applications submitted by December 10 that emphasizes the importance of starting early.
  • Review recent health history – In order to determine the best plan for the new policy year it is important to look at the recent past. An individual’s health history in the past two years can be a good indicator of their healthcare needs for the upcoming year. Have you experienced any major health conditions such as cancer, diabetes, Crohn’s disease, heart or circulatory system disorders? Is there potential for surgery? Has your physician discussed high blood pressure or cholesterol issues? Is there a possibility of being prescribed a monthly maintenance drug? Have you been diligent in completing a physical each year? Since ACA plans do not restrict benefits based on preexisting conditions it is important to make Stateside aware of your health history, which should be considered when evaluating benefits such as deductible, office visit co-pay benefits, and prescription benefits.

STATESIDE CAN HELP!

Stateside Insurance Services, since 2003, has focused on providing comprehensive health insurance information, responsive customer service and expert industry knowledge for Texas consumers. Stateside has annually been recognized by health insurance carriers and the Health Insurance Marketplace as a Top Producer in Texas.

Whether the health insurance policy is for an individual, family, small business or supplemental Medicare coverage, Stateside dedicates the time, and our deep industry expertise, to ensure our clients have identified the best health insurance plan for their specific needs. 

Stateside is available to answer any general questions regarding your coverage options, can provide a subsidy determination, and even assist in creating and submitting online applications for ACA compliant plans during an Open Enrollment or throughout Special Enrollment periods. 

Stateside can be contacted either by phone (866) 444-3332 (toll free) or by email at info@texasplans.com. Our Telephone Appointment System can be accessed through:

Phone Appointment Reservation.  


By using the Telephone Appointment System, clients can take advantage of scheduling a health insurance discussion when convenient for their schedule. During Open Enrollment phone appointment availability is expanded to include extended hours and weekends.