10/20/2022
OPEN ENROLLMENT STARTS NOVEMBER 1st! DON’T HESITATE!
If you suddenly find yourself without employer-based health insurance coverage, or maybe you are running your own business, you will likely be needing an individual or family policy to protect you and your loved ones.
We can help you get started on the process and help you select a plan that meets your health needs and your wallet. While you can choose a plan on your own on the government’s website, our expertise can guide you towards a plan you’re most suited for.
Open enrollment for individual health plans starts on Nov. 1 and runs through Dec. 15 if you want to secure a plan that starts Jan. 1. Open enrollment actually runs through Jan. 15, 2023, but you shouldn’t wait until the last minute to apply for coverage. If you purchase a plan in January, it won’t take effect until Feb. 1, so you would likely be without coverage for at least a month.
If you are worried about the cost of coverage, generous federal government subsidies make marketplace-based health insurance affordable for most people. Many people pay less than $100 a month for coverage, some just a few dollars.
These more generous subsidies were introduced in COVID-19 pandemic legislation in 2021 and they were recently extended to run through 2025. Under current rules, if health insurance premiums would account for more than 8.5% of your income, you could qualify for subsidies.
Your plan options
Plan options will vary depending on where you live, including city and state. Some states only have a few insurance companies that participate in Obamacare exchanges, others have many vying for business in the same city or county.
You’ll be faced with three choices, which are ranked from lowest premium/more out-of-pocket costs to high premium/low or no out-of-pocket costs.
If you’re buying a health plan in the individual market, you have a choice of four metal levels and a fifth, limited option:
Bronze
Silver
Gold
Platinum
Catastrophic (available to people younger than 30, or older than 30 if you’re eligible for a hardship or affordability exemption).
The metal tiers each have different premiums and out-of-pocket costs. Bronze plans have the highest deductibles and copays, while platinum plans have the lowest. However, the premiums for the bronze plans are the lowest, while platinum plans cost the most each month.
When deciding what plan is best for you, think about your health and your family’s health and financial situation.
Do you see a doctor or other health care provider regularly to help you manage a chronic disease or condition? Do you take costly medications? You may want a health plan that has lower copays and deductibles if you’re a frequent user of services.
If you are young and healthy and use few medical services, you may want a plan with lower premiums, such as a bronze plan. But of course, you never know what can happen.
Look at the out-of-pocket maximums for the plans you’re considering. Here’s what you need to consider:
Can you afford the premiums?
Can you pay the out-of-pocket costs and deductibles if you need care?
Are your doctors and hospitals in the plan’s network?
Do you mind getting a referral to see a specialist?
Do you want the flexibility to see providers outside of your network?
Once you answer these questions, you can compare plans and see what’s best for you.
If you have a physician you want to continue seeing, you should check to see if they are in the provider network of the insurance plan you are considering. Even if you already have a plan, it’s smart to check every year to see if your doctor or hospital are still in network.
You’ll want this as out-of-network costs are exorbitant and are not typically covered by your insurance.
The same goes for covered medications. If you have a particular medication that you need for a chronic condition, you will want to make sure the plan you are considering covers it.
You should also revisit your plan to see what next year’s premium is going to be. Some insurers will raise rates more or less than others, so it pays to stay on top of your plan.
And finally, don’t hesitate to contact us at 605-360-6837 if you have questions. We can help you choose a plan that meets your health needs and your financial situation.
