It’s that “happy” time again right now, healthcare open enrollment time. It’s a subject we don’t like to think about. If you are very, very lucky, you can avoid serious health problems now and maybe for years to come and not need health insurance. But seriously, back here on planet earth…that’s just not a good idea to go without it. Depending on how you obtain your healthcare, the enrollment period is now and officially ends in early December, so there’s no time to lose.
Healthcare coverage is critical to your finances as well as your health. Even if you are healthy now, an accident or sudden health issue could put both your well-being and your finances in jeopardy. That’s why right now is healthcare crunch time!
Healthcare Open Enrollment
Healthcare open enrollment is here and over the next few weeks, you will likely have to make some very important decisions regarding your medical insurance coverage for 2021. Whether it’s your healthcare insurance options from your employer or union, your Medicare choices, or your Affordable Care Act options known as “Obamacare”, the decisions you make now will have a significant impact on how much your healthcare costs will be in the next year. Obamacare, under siege for the past several years, has protected millions of Americans and doesn’t appear to be going anywhere soon.
Around this time each year, open enrollment allows you to make choices about your medical insurance coverage without having a “qualifying event”. Such events include losing your existing coverage, getting married or divorced, starting or leaving a job, etc. But for many of us, these coverage decisions can be confusing. So how do you know if you’re choosing the right plan?
How to Compare Plans
When you compare plans to find the best one for your situation, there are a number of things you’ll need to look at:
- Monthly Premium: how much you pay for the coverage itself, some plans (such as some Medicare Advantage plans) have no premiums at all!
- Deductible: how much you pay for your care out of pocket before the coverage begins, there may be separate deductibles for medical treatment and prescription drugs, there are high deductible health plans (HDHP) which allow you to take advantage of a pre-tax health savings account (HSA)
- Co-Pay: a set amount you pay each time you see a provider (a doctor, hospital, or lab for example) or purchase a prescription
- Co-Insurance: like a co-pay, but typically a percentage of the total cost as opposed to a fixed amount
- Maximum Out-of-Pocket Expense: the amount you would need to pay for the year before your coverage pays for all remaining expenses
- Formulary: list of prescription medications which are covered by the plan
One of the most important aspects to some people is finding out if their providers are available in the plan they want so that you can see the doctors with whom you already have a relationship. Depending on the type of plan, you may only be covered for in-network providers (those who agree to a discounted rate with your insurer), or you may be able to see out-of-network providers for an additional cost. Also pay attention to whether you will need referrals from your primary care doctor in order to see any kind of specialist.
If your employer or union offers coverage, your human resources department or union representative should inform you of your choices and the timeframe you will have to make your selection. These plans are usually group plans that are less costly than outside options and they are often subsidized by the employer. Premiums may be deducted directly from your paycheck, or you may need to make separate payments.
If you are an American 65 or older, disabled, or a veteran, you likely qualify for Medicare coverage. Basic Medicare coverage must be selected during the first few months you qualify, but supplemental insurance coverage is chosen each year from October 15 through December 7.
Supplemental insurance provides additional coverage compared to basic Medicare (either through a Medi-Gap policy or a Medicare Advantage plan) and can also include Part D prescription drug coverage.
You should have already received a complete guide to Medicare from the government which details your options and choices. You can also look for tailored options on the Medicare Plan Finder, including estimates of costs under each plan. If you need more assistance, you can contact Medicare at (800) 633-4227 (or (877) 486-2048 for the hearing impaired).
Finally, if you are satisfied with your existing Medicare coverage after reviewing any changes to your plan, you do not need to do anything to keep that coverage.
Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 75 million low-income and disabled people (23% of Americans) as of 2020. It is a means-tested program that is jointly funded by the state and federal governments and managed by the states, with each state currently having broad leeway to determine who is eligible for its implementation of the program.
If you believe you may qualify for Medicaid, check online for your state contacts to apply. While there isn’t a specific open enrollment window, you want to be sure you’re accepted before the open enrollment for your other option closes.
Health Insurance Marketplace Coverage via the ACA (Obamacare)
The Good News About Obamacare
Before Obamacare, healthcare premiums were too expensive for many families to afford. And even if you could afford it, insurance companies could deny coverage to anyone who had a pre-existing medical condition, making it near impossible to get coverage if you weren’t 100% healthy. Obamacare, officially known as the “Affordable Care Act”, changed all of that. Now, by law, healthcare has become much more affordable and universally available. You don’t need a high income or perfect health to get insured.
The Bad News About Obamacare
Obamacare can be very confusing. People have been overloaded with information, some of which has been inaccurate. Websites have also been limited in terms of ease of use and health options offered. All this has made it difficult for people to know their options, shop around, and enroll in the plan that is truly the best fit for their income and coverage needs.
Obtaining or Changing Coverage
If you do not receive coverage through an employer or Medicare, you can obtain medical insurance coverage through the Health Insurance Marketplace. Open enrollment runs from November 1 through January 31. There are a wide variety of plans, divided into Bronze, Silver, Gold, and Platinum with varying coverage levels and premiums. What you will ultimately pay depends on your income and whether you can obtain tax credits to make these plans more affordable. To find out your available options, check out the Health Insurance Marketplace online. If you need more assistance, you can contact them at (800) 318-2596.
Healthcare Sharing Ministries
While many have not heard about them, there is another option known as a healthcare sharing ministry (HCSM). These organizations enable the sharing of health care costs between members who have common religious beliefs. Technically, this is not insurance, but it functions in a similar way. Before you sign up, be sure to understand the limitations, exclusions, and requirements of that organization. To find a healthcare sharing ministry for you, check out christianhealthcareplan.com or call (800) 918-5344.
Healthcare coverage is so very important and is key to keeping not only in good health, but good finances as well. The main cause of personal bankruptcy in the U.S. today is due to medical expenses which can destroy a lifetime of finances.
The crunch time is right now for healthcare open enrollment. So carefully consider your options and make the right decision for you and your family. You will benefit if you do, and may regret it if you don’t!
Have you made your 2021 coverage choices yet? You should be making your decision soon as the deadlines are coming in the next month.