Open Enrollment Checklist for Self-Employed Texans

If you work for yourself, Open Enrollment is the one window each year when you can choose or switch an ACA Marketplace plan without needing a qualifying life event. For most Texans that happens on HealthCare.gov. The dates are set by HealthCare.gov and can change from year to year, so check the current window there or ask a broker before you plan around it.

This checklist is the order Dagan Martinez-Vargas of CHA Lifeguard walks through with self-employed clients. None of it requires you to pick a plan yet. It just makes the comparison faster and more accurate.

Write down your doctors

Start with the people you actually see: your primary care doctor, any specialists, your children's pediatrician if you are covering a family, and the hospital you would want to use. Networks differ plan by plan, and a plan that looks cheap on paper can cost more over the year if your doctors are outside it.

For each provider, note the practice name and city. That is what you will check against each plan's provider directory.

List your prescriptions

Write down every medication you take regularly, including the dose. Each plan has a drug list, called a formulary, and the same medication can sit in a different cost tier from one plan to the next. If a medication is expensive, this step alone can decide the comparison.

Estimate next year's household income

Marketplace savings are based on your estimate of household income for the coming year, not last year's tax return. For self-employed people that estimate is a judgment call. A reasonable approach is to start from this year's net income and adjust for what you already know about next year: contracts ending, rates going up, a planned slowdown.

HealthCare.gov decides who qualifies for savings and how much. If your income changes during the year, you can update the application, and it is better to do that than to be surprised at tax time.

Gather the basics for the application

You will need Social Security numbers for everyone being covered, dates of birth, your mailing address, and your income estimate. If you have coverage now, keep the insurance card nearby so you can compare like with like.

Decide how you use care

Think honestly about the past year. Did you see specialists? Would you be fine getting a referral first, or do you want to book directly? Do you travel for work and need coverage outside your home area? These answers point you toward an HMO or a PPO before you ever look at prices.

Compare total cost, not the premium

The monthly premium is the number everyone sees first. Over a year, the deductible, copays and out-of-pocket maximum matter as much or more. A plan with a higher premium and a lower deductible can cost less for someone who uses care regularly, and the reverse is true for someone who rarely does.

Check dental and vision separately

Dental and vision are usually separate plans, and your dentist and eye doctor are often in different networks than your medical plan. Compare them on their own rather than bundling by default.

Ask about income protection while you are at it

Open Enrollment is for health coverage, but it is a natural moment to ask a second question: if you could not work for three months, what would happen? For many self-employed people the honest answer is that there is no plan. Disability insurance is bought separately, any time of year, and it is worth a conversation.

Where to get help

HealthCare.gov publishes the official rules and dates. An independent broker like Dagan can compare the plans available in your county against your doctors, prescriptions and income estimate, and help with the application. Book a health insurance call or read more about health insurance help in Austin.

Plan availability, benefits and costs vary by carrier, county and plan year. CHA Lifeguard is not affiliated with HealthCare.gov or CMS.