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How To Maximize Your Obamacare Benefits During Open Enrollment

Aside from providing basic health coverage, the various ACA plans also include some pretty decent perks.
Florida Blue agent Ismaris Crespo, right, explains the different Affordable Care Act enrollment options to Catherine Reviati on Nov. 2 in Hialeah, Florida.Alan Diaz / AP

The Trump administration may have all but eliminated its promotional budget, and narrowed the window to only 45 days (it ends December 15), but open enrollment for Obamacare, aka the Affordable Care Act, is thriving, met with a record-breaking number of sign-ups in the first week.

“I think that the old saying, ‘there’s no such thing as bad news,’ comes into play here,” says says Chris Orestis, EVP of GWG Life, an insurance and financial services company, who has been tracking signups. “You've got so much discussion that has gone on around ‘repeal and replace,’ and so much talk in the media about things that would hold back open enrollment that it's created an urgency that hasn't been there in the past. There is a rush to get in under the wire, with people being driven almost by a sense of panic. We’ve also seen states really take on a grassroots effort and spending millions to do their own promotions, along with the work of activists and Obama himself getting the message out. It’s not paid media, it’s earned media.”

But even amid the fervor, confusion abounds. Consumers are scrambling to assess what plans are available to them and determine their best choices. David Rae, CFP, AIF, and president, founder of DRM Wealth Management LLC People adds that buyers are also concerned about the steepened price of premiums, and possibly even wondering whether they’re safe for the duration of 2018.

Before we get into the various benefits out there, let’s have a quick refresher on where we stand. First, the ACA is still, as Joel Cantor, interim director, Institute for Health, Health Care Policy & Aging Research at Rutgers University puts it “the law of the land,” meaning that even though many providers have pulled out of the exchange (largely because, as Cantor notes, “it’s not a very profitable market”), all states must participate in the ACA. So if you don’t sign up and don’t have another form of healthcare, “you're subject to a stiff fine when you go to pay your taxes,” says Cantor. Secondly, even if Obamacare is repealed, you will be covered for 2018.

“In the event there is a radical change, people will be grandfathered in and safe for all of 2018,” says Orestis.

Lastly, if you are already enrolled in a plan for 2017, you do need to renew for 2018. Now is also the time to change your plan, or update it to reflect any changes in marital status, etc.

Now onto the good stuff: what you actually can get with these plans. Beyond basic health coverage, various ACA plans also include some pretty decent perks including flexible spending accounts, health saving accounts, and possibly even a dependent care flexible spending account — meaning you can pay for your kids’ daycare with pre-tax dollars. You may also qualify for a tax credit.

The Basics Cover More Than You May Know

Regardless of where you live or what carrier you choose, your plan should cover various preventive care services with no out-of-pocket fee. These services include everything from cancer screenings to children’s autism screenings to vaccines.

Dr. Obianuju Helen Okoye, a public health physician and healthcare consultant in St. Louis, MO notes many people don’t know just how much they have access to do with their plans.

“Advice on how to breastfeed is free across the board,” says Dr. Okoye. “Pregnant women can get breast pumps for free which is important to know because they can cost anywhere from $150 to $300. A lot of people may not be getting a lot of these things because they think they have to pay extra for it, but they don’t.”

A recent survey from online insurance marketplace Policygenius found that 78 percent of people couldn’t identify the basic benefits their insurance is required to cover.

“All private health insurance plans (on-exchange, off-exchange and employer-provided plans) must cover preventative services at no cost, even if they haven’t reached their deductible,” says Jennifer Fitzgerald, the CEO and co-founder of Policygenius. “Before looking outside of your insurance for benefits, make sure you’re fully taking advantage of what you already have.”

Once you go beyond the basics, things get more complicated, and it’s essential to do some digging around online and to speak with a healthcare representative to get the most out of your plan. Unfortunately, there’s no simple guide to explain which plan touts what perk, as every state, provider, and policy is different, but here’s what you’ll want to keep in mind while you’re investigating.

Save Medical, Dental, Vision And Possibly Childcare With An FSA

A flexible spending account (FSA) allows you to set aside pre-tax money for medical costs not covered by insurance, making them pretty sweet tax advantages. An FSA has a contribution cap of $2650, but only $500 is eligible to roll over into the next year, so when you’re putting money in, be confident you’re going to use it on eligible expenses. Another catch: an FSA isn’t an option for people who are unemployed or freelance, with Fitzgerald noting “FSAs are only available to you through an employer.”

David Rae, CFP, AIF, and president, founder of DRM Wealth Management LLC adds that if you do qualify for an FSA, you can use the money for anything health-related including dentistry, vision, and virtually anything doctor-ordered (the chiropractor counts!). “But hold on to receipts to back it up,” Rae adds.

Another type of FSA you may be eligible for is a Dependent Care FSA (DCFSA), which allows you to invest up to $2,500 a year in pre-tax dollars towards childcare services (double that if your are married and file a joint return). Rae adds that there’s no rollover option here, but that “most parents have a pretty good idea that they’ll spend that $5,000.” You can also use these funds for the care of a relative who lives with you and cannot be on their own.

Check Out Gyms Even Without an FSA

Orestis of GWG Life adds that you may be able to use your FSA to cover gym costs, though “it does depend on the plan.”

That said, you may not even need an FSA to save on a fitness membership. If the gym has a partnership with your insurance company (as Rae notes an increasing number of gyms do), they’ll likely give you a discount regardless of what type of plan you have.

And if you can’t get to the gym because of a chronic health condition or other valid reason, Dr. Okoye recommends talking with the insurance company, noting that “some will provide at-home personal trainers or fitness equipment.”

Again, it really depends on the insurance company, but it’s worth a shot as this benefit does exist, and Okoye finds that “a lot of people may not be taking advantage of it.”

Same goes for visits to therapists, chiropractors, acupuncturists, and other licensed healthcare professionals who may not accept insurance. Not only should you be able to use your FSA for these expenditures, you may be able to seek some form of reimbursement for the cost of visits from your insurance company.

“Not all plans have the same amount of visits allowed, so be conscious of how many times you can go and be covered,” says Rae.

Health Savings Accounts (HSAs) Tout Rollover Perks

Arguably the wisest choice of a pre-tax spending account (and one with no employer strings attached) is a health savings account (HAS), which is available via high-deductible health insurance plans. The reasoning it’s partial to these types of plans is because “when you're in a higher deductible plan you're probably younger and healthier and not consuming as much healthcare, and paying lower premiums on a monthly basis,” Orestis explains.

An HSA is stricter than an FSA (no 24 Hour Fitness with this one), but you can still use it for dental, vision, and prescriptions. The contribution limit for a single person is $3450, and $6900 for a family. Unlike an FSA, all unused funds rollover, so you can use them the next year or even in 20 years. And like a regular savings account, HSAs earn interest.

Prescription Discount Cards

“All health insurance plans offer prescription drug coverage, but not all plans cover all medications,” notes Fitzgerald of Policygenius. “Prescription discount cards allow you to buy medication at lower costs than you might be able to otherwise. The best part is that you can use them even if you have insurance. If a needed medication isn’t covered by your plan’s drug formulary, or you haven’t met your deductible, a prescription discount card can lower the costs substantially and help keep drugs affordable.”

Another thing to consider, at least when looking at brand name prescriptions, is going straight to the manufacturer site of your prescription; you could land a hefty coupon.

“If you go to there is a coupon you can get to save $300,” says Dr. Jen Wolfe, a senior care pharmacist. These coupons can be used in conjunction with insurance plans and are fantastic. GoodRx is a legit company and so is Blink Health (an app), [but use caution] as most discount cards you will find on the internet are bogus.”

There's Help Navigating the Process

Overwhelmed? Don’t fret. There are trained experts to help you through this.

“There are licensed health care navigators in every state who can help,” says Kim Buckey, VP of client services, DirectPath, noting that you can use navigators even if you aren’t buying through Obamacare. After all, helping you find the right plan is part of the job of an insurance broker. “A broker can help identify good choices for you and answer your questions. If you’re employed, your employer may offer enrollment help —either through online tools or meetings with members of HR or outside benefit educators.”

Though it’s tempting to put this whole headache off until the last minute, you really should get started now because this is an investment that requires research — and you’ll have to really weigh your options and treat this like the biggest, most important purchase of the year, as it just may end up being that.

“The word I use is shop: just be sure to shop,” says Cantor. “If you pick up the phone, there is information. Because of a quirk in the way the current administration is dealing with subsidies — which is very complicated to explain — there are cases where the gold plans are actually less expensive than silver plans.”

Another point that experts underscore is that even if something serious does happen to ACA (as in, it gets repealed or majorly altered), you’re safe for the duration of 2018 if you sign up during this open enrollment period. And finally, when enrolling, make sure to verify that the company is legit, as Orestis notes, “Now is the time when you may see a lot of scammers out there promoting low cost plans that are fake.”

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