What you need to know about this season's open enrollment

With all the discussion on The Affordable Care Act, aka "Obamacare," and political ads ensuring the fight on coverage for pre-existing conditions … there is one topic not being discussed, which is affordability and access for individuals and families who do not qualify for Advanced Premium Tax Credits.

Through The Health Insurance Marketplace that make coverage affordable and are left paying ridiculously high premiums for coverage, their preferred providers may or may not accept them. This demographic is those with an annual household income at or above 400 percent FPL, which happen to be self-employed individuals, or those who work full-time or part-time for a small employer that does not offer health insurance.

Yes, "Obamacare" works for those who have pre-existing medical conditions, and for those who are well below 400 percent FPL. But this discussion is for those who are above 400 percent FPL with or without pre-existing medical conditions that "Obamacare" does not work for and are left with unaffordable coverage options that fall very short on providing ACCESS to quality care.

Cook County county residents that rely on The Health Insurance Marketplace, have 3 insurance carriers to select from. With 80 percent of the available plans being HMOs and 80 percent of the HMO plans limiting your access to 2-3 hospital systems and their Medical Groups. Just like last year, residents will have only one PPO network to choose from that does not include local teaching hospitals and there is a likely chance that a persons providers do not participate in the network. Even with there being a PPO plan option, which would provide out-of-network benefits, there is a $15,000 out-of-network deductible to satisfy in allowable charges before receiving any reimbursement.

Now that the annual Open Enrollment Period has begun, there will be major decisions to make, especially with Short Term Medical plans being sold for up to or greater than 12 months. While STM plans may come with larger provider networks than what is available under "Obamacare" and also come at a lower premium, one thing for certain is that they do not cover the following: pre-existing medical conditions and the majority of preventative care services have annual limits on prescription drug coverage and have annual benefit maximums. For example: If you are self-employed with at least one part-time (not spouse) or full time (not spouse) W2 employee or work full-time for a small employer who does not offer employer sponsored health insurance, you will want to consider looking into the little-known Small Business Special Enrollment Period.

The Small Business Special Enrollment Period is between Nov. 15- Dec. 15 for a Jan. 1, 2019 effective date and for a small business (less than 51 employees) that does not offer health insurance coverage. During this window a small business can apply for a plan of coverage on behalf of his/her full-time employees without having to satisfy a minimum employee premium contribution or minimum employee participation requirements that are set in place by insurance carriers throughout the year. This means that an employer can choose to pay $0, and just need at least one employee/owner to enroll. Under this SEP, employees that rely on the marketplace for individual coverage and do not qualify for APTC's will have the opportunity to acquire the same coverage with premiums that will be 20-32 percent lower, or can acquire better coverage that provides access to all of the top Chicago hospitals (not available in the individual market) and still be at a lower premium, and will be able to pay premiums pretax compared to paying current premiums post tax.

Employees who would like a large PPO network that provides access to their preferred providers would find their monthly premiums 9 percent lower compared to an individual plan that does not offer provider access. However, should an employee be satisfied with their current provider network that they have with their individual plan, the premiums for the same if not better coverage through an employer sponsored plan will come in 26 percent-28 percent lower. Plus, these premiums can be paid pretax through payroll deduction.

While this Special Enrollment Period allows for 0 percent employer contribution, the above illustration only proves why this it still is a benefit for employees even without an employer contribution, and should the employer want to make a contribution toward premiums it will be a benefit to both the employer and employee.

• Jordan Wishner is president of The Health Insurance Shoppe.