Navigating Open Enrollment Period

Navigating Health Care

It’s Open Enrollment for Qualified Health Plans — What you need to know

November 1 marks the beginning of the open enrollment period for qualified health plans (QHP). The annual period allows individuals and small groups (employers with 100 or fewer employers) to enroll in health care plans for the coming year.

If you’re new to the world of QHP, don’t stress. There are a range of plans with varying costs and features that can meet your specific health care needs. Whether you have been covered by a plan in the past or this is the first year you’ve been in the market to enroll, you should be aware of some of the main terms and what to look for when you enroll.

What is a Qualified Health Plan?

In 2013 the Affordable Care Act (ACA), commonly known as “Obamacare,” required that every person have access to a health plan that would cover a set of 10 essential health benefits. These include common health needs like hospitalization, doctor and counselor visits and chronic disease management. All QHP cover the same benefits, but there are differences in other treatments and services that are included as well how much they cost through monthly premiums, deductibles and out of pocket expenses. (We’ll discuss those below.)

To help differentiate the differences in each plan, the ACA designated “metal” levels. These are platinum, gold, silver and bronze. The names only serve to help you figure out which medical expenses are covered under each plan and what it may cost you to have that level of coverage.

Financial terms you should know

Here are some of the most common terms related to the costs that would be associated with a QHP. It’s smart to have a basic understanding before you start comparing plans and coverages!

Premium: The amount you pay for your insurance each month. It varies from plan to plan and whether you are paying to cover yourself, you and your spouse or partner, or your family unit.

Deductible: The amount you are responsible to pay for services and treatment over time (usually one calendar year) before your insurance starts to pay. (In general, the lower the premium you pay for your plan the higher the deductible is likely to be.)

Co-Payment: The amount you pay for specific health care services at the time you receive them.

Out-of-Pocket Maximum: These are made up of your deductible, any co-insurance, and any co-payments. You are responsible for these costs when you seek care.

Co-insurance: The share of a medical cost you are responsible to pay after you meet your deductible. For example, if you have a 20% co-insurance, your health plan pays 80% of the cost and you pay 20%.

What is a Consumer-Directed Health Plan?

Another part of the ACA allowed for some QHP to be set up as “high deductible health plans.” Even though they have a higher deductible (see the definition above), you can set up a special health savings account (HSA) that isn’t subject to taxes and use that to pay some or all of your out-of-pocket expenses to meet your deductible (like co-payments and prescription drug costs.)

We have a special name for our high deductible health plans. Our Consumer-Directed Health Plans (CDHP) pair with an HSA and give you more control of your health care and dependent care spending. You can see specific details about our CDHP here.

Enrolling in a QHP

You can enroll in a QHP directly through us or, if you qualify for subsidies and want to take advantage of them, you can purchase one of our plans through Vermont Health Connect. (Plan premiums are the same whether you get them directly from us or through VHC; you can only get subsidies to help pay the cost if you’re enrolled through Vermont Health Connect.)

Hopefully, these brief descriptions help you get a better sense of how QHP work and how you might benefit from enrolling in one. If you’re interested in enrolling in a QHP and you’re not eligible to do so through your employer, we can guide you through the entire process. You can talk directly with one of our consultants at (800) 255-4550 or by emailing them at We also have some great information on our website! You only have until December 15 to enroll, so don’t wait. We’d be happy to help you understand your options and find the right QHP for you and your family!