Health insurance: What you need to know about open enrollment season

Most consumers who have access to employer-backed health care will be making choices about their health plans in October and November, and the landscape isn't getting any easier to navigate.

For many, premiums continue to climb.

"We'll be even less able to afford it (health care) than we already are," says Kristi Deeley, of Newport News.

On average, health care costs will rise by 7 percent for employees at the nation's largest companies in 2014, according to the National Business Group on Health.

To help make sense of the changing health care system, the Daily Press asked Kelly Alvord, an expert with the Patient Advocate Foundation, for some advice.

The foundation is a Hampton-based non-profit organization that helps consumers navigate health care issues.

Here is what Alvord had to say.

Q. What is changing this year for consumers who have access to employer-backed health care?

Alvord: Starting in 2014, all plans, both employer-based and individual policies, cannot impose an annual cap on coverage or exclude coverage of care associated with the treatment and management of pre-existing conditions. Plans cannot impose varied premium rates based on gender, and plans must provide coverage for the Essential Health Benefits, such as emergency services, maternity care and prescriptions.

(A list of "Essential Health Benefits" can be found at

The employer mandate, which requires businesses with more than 50 full-time employees to offer health insurance, has been delayed a year and will now not be required until Jan. 1, 2015.

Some small businesses may still decide to investigate or purchase their insurance through the Small Business Health Options Program exchange (SHOP) in their state, even though the mandate and penalty has been delayed. If your employer decides to go this route, you will be guided to the SHOP website where you can finalize your plan selection.

Q. Should consumers with employer-backed health care take a look at the health exchange, even though they likely won't qualify for a tax credit?

A: If you are looking to switch plans, you may shop on the marketplace/exchanges during the open enrollment period for an alternate plan. However, you will forfeit any premium assistance that is contributed by your employer currently, and will most likely not be eligible for the financial assistance programs offered through the marketplace if your coverage is considered affordable.

(If the cost of a plan from your employer that would cover you — and not any other members of your family — is less than 9.5 percent of your household income for the year then the plan is considered affordable).

In the exchange or marketplace in your state, you can go through the application process and see the plan benefits and pricing options before committing to enroll, so there is no downside to checking out your options.

Do keep in mind, however, that your employee contribution to the employer-offered coverage, is often excluded from income for federal and state income tax purposes, thus, often lowering your tax liability each pay period. Your payments for coverage through the marketplace are made on an-after tax basis.

Q. What options are there for someone whose costs are increasing exponentially?

A: If you are researching plans and coverage options for you and your family, it is definitely wise to evaluate and compare your options on the marketplace, even if you ultimately end up securing insurance through another avenue. Education and research will help you make the best decision for you and your family.

It is important to note that the only way you may receive the new financial assistance options such as tax credits or cost-sharing subsidies to get lower costs for your health coverage based on income is by purchasing your insurance through the marketplace.