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Five Critical Aspects Individuals Must Consider Prior to Open Enrollment

By: PRLog Helps People Become Engaged Health Care Consumers
ST. LOUIS - Oct. 17, 2016 - PRLog -- When open enrollment begins on November 1, 2016, thousands of health care consumers will turn to to help them navigate the system and arm them with the information they need to make informed, smart decisions. A health care technology start-up whose primary focus is patient engagement, contains a wealth of easy-to-understand articles, tips and checklists to guide consumers through the open-enrollment process.

"The Affordable Care Act (ACA) requires individuals and families to have health insurance, unless they qualify for an exemption," Randy Gerber, founder of, said. "There is a lot of confusion about open enrollment and the health insurance exchange. cuts through the clutter with independent, unbiased information that allows consumers to be better educated and make informed decisions regarding their insurance options."

Five essential things people must consider prior to beginning the upcoming open enrollment process:

1.     Determine if you're eligible.

The ACA requires exchanges to be available in every state. Each state has two marketplaces: one for individuals and one for small businesses. Individuals may purchase an individual plan or family plan if they:

·       Meet state residency requirements

·       Are not in jail (unless they are in jail pending charges being dismissed)

·       Are a U.S. citizen, U.S. national or a lawfully present resident

2.     Be familiar with significant terms and key dates.

To help determine whether buying insurance on the exchange is right for them, people need to first understand a few key words and phrases to make sense of some government lingo:

●      Premium Tax Credit – financial assistance that lowers the monthly premium

●      Cost-Sharing Reduction – financial assistance that lowers out-of-pocket costs on things like deductibles, copays and coinsurance

●      Coverage – another way of referring to health insurance

●      Open Enrollment Period – the time when people can sign up for insurance through the marketplace. In 2016, these dates are Nov. 1, 2016 through Jan. 31, 2017. If people do not want to use the online marketplace, they can also enroll over the phone, by mail, or with in-person help.

3.     Understand the financial consequences.

If an individual can afford insurance but chooses not to buy it, they'll pay a penalty. For 2016, this amount is one of the following (whichever is higher): 2.5 percent of the annual household income or $695 per person ($347.50 for each child under 18), with a maximum penalty of $2,085 per family.

4.     Realize the significant changes that have occurred for 2017.

The country's five biggest providers of health insurance claim they are all losing money on their ACA marketplace plans. This is causing some insurers to drop coverage or cancel plans for expansion in 2017. United HealthCare, Humana, Aetna, Anthem, and Blue Cross Blue Shield have all announced significant changes to their plans. Why? A report released earlier this year from the Blue Cross Blue Shield Association found ACA enrollees had higher rates of chronic conditions, used medical services more often, and had higher medical costs. Larger numbers of sicker, older people rather than healthy, younger people are signing up for coverage through the marketplace.

5.     Watch your mailbox to see if you need to take action.

If an insurance provider is dropping out of the marketplace, individuals will receive a letter telling them their coverage will not be renewed next year. If coverage is being canceled, it is back to square one. This means back to the marketplace to price and compare new plans during the upcoming 2016 open enrollment period.

About Pacient

Pacient is a health care technology start-up dedicated to empowering consumers to make informed decisions. Its primary portal,, delivers plain language answers that patients can act on regarding insurance; doctors, hospitals and other providers; kids' care; prescription drugs; privacy and technology; and family care. Founded in 2016 by Randy Gerber, a health care attorney with more than 35 years of experience and an adjunct health care law professor, Pacient's handpicked team of health care writers continually identify and curate its content. Pacient's multi-screen platform allows U.S. consumers to access the information they need to actively manage their health care anytime and anywhere on a personal computer, smart phone or tablet. Visit:; Facebook:; Twitter:; or YouTube: to learn more.

Annemarie Schumacher
Schumacher Creative

Photos: (Click photo to enlarge)


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