Updated September 24, 2020.
Open Enrollment for 2021 health insurance coverage is just around the corner. It starts November 1, 2020 and continues through December 15, 2020.
You won't want to miss it. If you do, you will be unable to enroll in health insurance for 2021 unless you qualify for a special enrollment period.
Health insurance can help defray the costs of medical care. Many employers make health insurance available to their full-time employees. If your employer offers health insurance as part of a benefits package, you should be getting information from them about how to enroll during open enrollment.
If you do not have health insurance through an employer, you can purchase health insurance independently through government-run exchanges or by working directly with health insurance companies.
Navigating the health insurance industry can be daunting, especially for those purchasing health insurance independently for the first time. Following the tips below will help you purchase health insurance confidently.
This suggestion almost goes without saying. Before making a choice as significant as choosing a health insurance policy, you should understand your options and what kind of health insurance coverage you need.
“It is important to spend some time researching the various options each year to find the one that is best for you,” says Dr. Nicole Rochester, MD, physician, private health advocate, and CEO of Your GPS Doc, LLC.
Many resources are available to give you more information about health insurance. HealthCare.gov is a great resource with information about the laws governing health insurance.
Some states have their own online health insurance marketplaces. Through the marketplace websites, you can see health insurance options and see if you qualify for a government subsidy or a government health insurance program, like Medicaid.
It may also be useful for you to talk to an independent health insurance broker or financial planner to receive personalized advice about purchasing health insurance.
Do an assessment of your health needs to better understand what kind of coverage you should purchase.
Health Care Transformation founder and CEO Meghan Nechrebecki, MSPH, says, “Weigh your options by writing down your expected utilization in the coming year (all clinic visits, prescriptions, potential emergency room visits, surgeries, hospitalizations) and then calculating the expected costs based on the deductible, premiums, coinsurance, and copayments.”
Taking into account how you used your health insurance this year can help you predict your health needs for 2021.
Nechrebecki adds, “You might want to also take into consideration the what-ifs (what if I get in a car accident, etc.), not just expected utilization.”
In addition to considering potential unexpected events, it’s a good idea to think about how your or your family’s health may be different now than in previous years.
“No one likes change, and health insurance is incredibly confusing. As a result, most individuals merely auto-enroll in the same health insurance plan year after year, without doing research to ensure that plan is still the best option for them and their family,” says Rochester.
It’s also a good idea to think about your current doctors. Adria Gross, founder of MedWise Insurance Advocacy and New York State-licensed insurance broker and consultant, suggests asking: “Are your medical providers, doctors, therapists, hospitals, and medications on the health insurance plans available to you?”
If you travel frequently, you may want to make sure your insurance plan has out-of-network coverage. Some health plans have strict rules about out-of-network coverage. Other plans don’t offer out-of-network coverage.
Taking the opportunity to review your health needs and this year’s use of health insurance benefits will help you better predict the kind of coverage you need for 2021. It will also help you evaluate your health insurance options better.
Gross recommends answering these questions as you review the cost of a health insurance policy:
As you look at your current expenses, think about ways you can shift your budget to purchase health insurance or pay for an unexpected medical bill.
Nechrebecki adds, “Make sure to weigh your options by adding up the upfront costs (premiums) with backend costs (deductible, coinsurance, and copayments) of expected utilization.”
Understanding the full cost of health insurance and the cost of medical bills will provide a better picture of the costs and savings of your health insurance.
Investigating your options for purchasing health insurance from state-run marketplaces — including what subsidies you qualify for — can also help you find more affordable insurance.
Considering all of your options when enrolling in health insurance is important, even when you’re not purchasing health insurance independently for the first time.
“It is possible that your health or that of your spouse, domestic partner, or children has changed over the years. As your health needs change, the insurance plan you've had for years may no longer be the most cost-effective. In addition, the plans themselves change,” says Rochester.
Health insurance plans and their availability change year-to-year. Changes to health insurance law, government policy, or company changes affect your options for health insurance.
Options within the United States include the following:
Government-provided Health Insurance
The government provides health insurance to certain qualifying groups:
People in these groups and meet other requirements can receive health insurance through the government. The Veterans’ Affairs Office takes care of U.S. military veterans.
Medicare is for elderly U.S. citizens. Original Enrollment in Medicare occurs during the time that an individual turns 65. Annual Enrollment for 2021 began October 15, 2020 and will continue until December 7, 2020.
Medicaid plans are available to low-income individuals and families. Some insurance companies offer these plans. CHIP (Children’s Health Insurance Program) provides coverage for children whose families do not qualify for Medicaid. People enrolling in Medicaid or CHIP do not have to enroll during open enrollment; they can enroll at any time.
On-exchange Plans (Marketplace Plans)
On-exchange plans are sold on government-run health insurance websites. These plans have to cover basic health services, like preventive care, maternal and child care, mental health, and emergency room visits.
Marketplace plans can have lower premiums for those with pre-existing conditions or come with government subsidies.
Jack Glasker, Designated Partner at Affordable Healthcare Solutions, LLP, says, “Determining whether marketplace coverage makes sense depends on your income, which is roughly calculated as the adjusted gross income of the policyholder and all others who file on the policyholders tax return. If the resulting income falls below 400 percent of the Federal Poverty Level, you could qualify for an Advance Premium Tax Credit (APTC) that lowers the cost of your monthly premiums for insurance coverage.”
An Advance Premium Tax Credit is an advance of the next year’s tax return that can be applied to your health insurance premium payment. Any difference between the amount of money you used for an APTC and the amount of money you were supposed to use will be reconciled when you file taxes.
Even if you don’t qualify for an APTC, it still may be beneficial to enroll in a marketplace plan.
“If your income is below 250 percent of the FPL, cost-sharing, like help paying copays, coinsurance, and deductibles, on silver-level plans also exists,” says Glasker.
Off-exchange plans are still required to cover essential health services like on-exchange plans. However, off-exchange plans do not have to meet all of the requirements that on-exchange plans do.
In some circumstances, an off-exchange health insurance policy may be less expensive. Off-exchange options can be found by contacting insurance companies directly.
As will all health insurance policies, make sure that you understand the specifics of your health insurance coverage and the cost before making the final decision to enroll. Health insurance is an important expense, and you want to be confident in your choice.
Need more Open Enrollment tips? Check out these articles:
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