Topics:Buying health insurance health care Open Enrollment health insurance guides Health and wellness Medicare research
May 7th, 2021
May 7th, 2021
Updated October 26, 2020 2020 Open Enrollment is just around the corner. With health care concerns from the pandemic and increased health care access concerns resulting from shutdown layoffs, health insurance's role in removing barriers to health care access is much clearer. Since health insurance companies can change their offerings and even your current plan, you should shop around each year to make sure that you have health insurance that fits your budget and meets your needs. For helpful information on choosing a health plan, read "4 Things to Look For in a Health Plan [Video]". In addition to finding a good health plan, it's important to choose a trusted and reliable insurer. To help you identify the best health insurance companies to work with, we'll review what this year's customer reviews say about nine companies. While Best Company lists more than nine health insurance companies, only these had a worthwhile number of reviews to analyze. These nine are listed from most 2020 reviews to fewest 2020 reviews. (In other words, we're the most confident about our findings for BlueCross BlueShield because there were more reviews. We're the least confident about our findings for Molina Healthcare because there were fewer reviews to analyze.) BlueCross BlueShield UnitedHealthcare Oscar Kaiser Permanente SelectHealth Ambetter Cigna Aetna Molina Healthcare 1. BlueCross BlueShield Best Company Rank: #12020 Best Company User Rating: 4.10/52020 Review Breakdown: 54% 5-Star 24% 4-Star 7% 3-Star 7% 2-Star 8% 1-Star 2020 Reviews by State: 12% from Utah 8% from Texas 7% from Mississippi 6% from California 6% from Florida 2020 Most Common Complaint: Cost (10%)2020 Most Common Praise: Customer Service (30%) Coverage dissatisfaction (8%) and concerns with red tape (6%) both followed cost dissatisfaction. Praise was much more common in BlueCross BlueSheild's 2020 reviews than complaints were. Other common praise included coverage satisfaction (22%), cost satisfaction (21%), general satisfaction (17%), network satisfaction (17%), and claims satisfaction (15%). Note: Qualitative analysis based on a random sample of 114 out of 194 reviews left on Best Company for BlueCross BlueShield as of October 15, 2020. The analysis has a 90 percent confidence level with a 5 percent margin of error. The quantitative data points (i.e. 2020 user score, 2020 reviews by state, 2020 geography breakdown) are based on the total number of reviews. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Vantresa Scott from Annapolis, Maryland "I've been with BCBS for most of my life. They have been great. I started when I was 26 years old and I am now 57. Their physician network is terrific and plans are great and I have never had a problem with them covering my expenses. NEVER EVER. I started my own company 5 years ago and we only offer BCBS plans because of the exceptional quality. Their national and international coverage is top notch." Our Advice With 78 percent of this year's reviews hitting 4 or 5 stars, BlueCross BlueShield is a great company to work with. Before enrolling in a plan, be sure you understand what's covered and what requires prior authorization. Having this understanding will help you be prepared for prior authorization and can prevent coverage concerns. While the most common concern was cost (10%), 21 percent of reviews were happy with the cost. As you look at plans consider whether the monthly premiums fit into your budget and do your best to estimate what your out-of-pocket costs may be next year. After evaluating BlueCross BlueShield plans, you can be confident in your insurance company choice since reviewers had more positive comments regarding customer service, provider network, coverage, and claims than negative ones. Keep in mind that BlueCross BlueShield is a national company and works through many subsidiaries. For more specific information on the BlueCross BlueShield subsidiary in your area, look for reviews for it by name. Subsidiaries include Regence, Anthem, Florida Blue, Independence BlueCross, and others. BlueCross BlueShield Health Insurance Learn more about BlueCross BlueShield by reading customer reviews and our expert analysis. Learn More Back to Company List 2. UnitedHealthcare Best Company Rank: #62020 Best Company User Rating: 3.61/52020 Review Breakdown: 51% 5-Star 16% 4-Star 2% 3-Star 7% 2-Star 25% 1-Star 2020 Reviews by State: 15% from Utah 10% from Florida 7% from California 7% from Texas 5% from Arizona 4% from New York 2020 Most Common Complaint: Customer Service (21%)2020 Most Common Praise: Customer Service (25%) The two other most common complaints were about claims (14%) and coverage (14%). Network satisfaction (14%) and general satisfaction (12%) followed praise for customer serivce. Note: Qualitative analysis based on a random sample of 85 out of 122 reviews left on Best Company for UnitedHealthcare as of October 15, 2020. The analysis has a 90 percent confidence level with a 5 percent margin of error. The quantitative data points (i.e. 2020 user score, 2020 review breakdown, 2020 reviews by state) are based on the total number of reviews. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Dorothy from Omaha, Nebraska "I have been a UnitedHealthcare customer for 2 years and highly recommend this reputable company. I was enrolled in their student health insurance plan and the plan's details were easy to understand, the plan was accepted at all of my providers, and customer service was always helpful!" Our Advice Based on this year's customer reviews, it's harder to give a clear recommendation of UnitedHealthcare. It's promising that a majority of its reviews (67%) are 4 or 5 stars. However, 25 percent of this year's reviews are 1 star. It's also concerning that reviewers offered more specific complaints than praise. As with most health insurance companies, your coverage, network, and cost vary depending on the plan you choose. Health plan offerings can also vary by location. Because of this variation, you need to review any health plan you consider carefully to ensure it covers the medical services you need. You also need to ensure that the monthly premiums fit your budget and that the health plan will help you control your out-of-pocket expenses. Since a majority of UnitedHealthcare members reported a good experience this year, UnitedHealthcare is worth considering. However, carefully review the coverage offered in each plan you consider before you enroll. You'll want to avoid issues with claims and coverage. Double-checking that the services you need are covered will increase the odds that you'll have a good experience with UnitedHealthcare. UnitedHealthcare Health Insurance Learn more about UnitedHealthcare by reading customer reviews and our expert analysis. Learn More Back to Company List 3. Oscar Best Company Rank: #32020 Best Company User Rating: 3.54/52020 Review Breakdown: 42% 5-Star 22% 4-Star 7% 3-Star 6% 2-Star 23% 1-Star 2020 Reviews by State: 33% from Texas 22% from California 12% from Florida 12% from New York 2020 Most Common Complaint: Provider Network (21%)2020 Most Common Praise: Customer Service (41%) Poor customer service was the next most common complaint at 16 percent. Praise was more common in Oscar reviews and included satisfaction with the app (20%), satisfaction with perks and incentives (18%), general satisfaction (14%), network satisfaction (14%), and cost satisfaction (14%). Note: Qualitative analysis based on a random sample of 56 out of 69 reviews left on Best Company for Oscar as of October 15, 2020. The analysis has a 90 percent confidence level with a 5 percent margin of error. The quantitative data points (i.e. 2020 user score, 2020 review breakdown, 2020 reviews by state) are based on the total number of reviews. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Brock Williams from Los Angeles, California "Oscar has been the best health insurance company I've ever had. I've been self-employed my entire adult life, so I've paid for my own health insurance and I've had a lot of different policies with different companies, in multiple states. Oscar has been the most affordable, easiest to navigate and best coverage I've ever had." Our Advice While 64 percent of Oscar's reviews are 4 or 5 stars, 23 percent are 1 star. As you consider Oscar health plans, pay attention to the provider network in your area. Make sure that the doctors you need are reasonably close. Fortunately, Oscar reviewers had more positive things to say than negative ones. If you're looking for a good app, nice perks and incentives, and good cost, Oscar is worth investigating further. Again, be sure to review each plan's network, coverage, and cost to ensure that you find an affordable health plan that meets your needs. Oscar Health Insurance Learn more about Oscar by reading customer reviews and our expert analysis. Learn More Back to Company List 4. Kaiser Permanente Best Company Rank: #42020 Best Company User Rating: 3.97/52020 Review Breakdown: 57% 5-Star 15% 4-Star 10% 3-Star 3% 2-Star 15% 1-Star 2020 Reviews by State: 41% from California 15% from Utah 7% from Colorado 7% from Georgia 5% from Oregon 2020 Most Common Complaint: Doctors and Staff (17%)2020 Most Common Praise: Doctors and Staff (42%) Other complaints included issues with member services or red tape (13%) and concerns that Kaiser Permanente was expensive (10%). Other common praise included general satisfaction (17%) and convenience (12%). Note: Qualitative analysis based on a random sample of 52 out of 61 reviews left on Best Company for Kaiser Permanente as of October 15, 2020. The analysis has a 90 percent confidence level with a 5 percent margin of error. The quantitative data points (i.e. 2020 user score, 2020 review breakdown, 2020 reviews by state) are based on the total number of reviews. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Luna from Rockville, Maryland "The doctors and nurses there are very nice. They have clean and high technology equipment. I think it worth the money." Our Advice A majority of Kaiser Permanete's reviews this year were 4 or 5 stars (72%), it still received a fair number of 1-star reviews (15%). Considering other years, Kthe proportion of 5-star and 1-star reviews are similar. It's tricky to make a clear recommendation. Kaiser Permanente stands out from other health insures because it employes doctors and runs hospitals instead of negotiating and contracting with doctors and hospitals to build a provider network. When you enroll in a Kaiser Permanente plan, you'll be limited to its doctors, clinics, and hospitals. Since both the most common complaint and most common praise this year were about Kaiser Permanete's doctors, you'll want to know how many Kaiser Permanente facilities and doctors are in your area and how good they are to gauge how well a Kaiser Permanente plan might work for you. You'll also want to pay attention to how your plan's coverage works and whether any services require prior authorization. Doing so will help you use your health plan better and be prepared for the prior authorization process. Kaiser Permanente Health Insurance Learn more about Kaiser Permanente by reading customer reviews and our expert analysis. Learn More Back to Company List 5. SelectHealth Best Company Rank: #22020 Best Company User Rating: 4.41/52020 Review Breakdown: 57% 5-Star 33% 4-Star 6% 3-Star 2% 2-Star 2% 1-Star 2020 Reviews by State: 78% from Utah 8% from Minnesota 4% from California 2020 Most Common Complaint: Cost (8%)2020 Most Common Praise: Customer Service and General Satisfaction (tied at 35%) Praise was far more frequent in SelectHealth reviews than complaints. Other common praise included provider network satisfaction (29%), coverage satisfaction (27%), and clarity regarding coverage (12%). Note: Qualitative and quantitative analysis based on 51 reviews left on Bes tCompany for SelectHealth as of October 15, 2020. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Aidan Keogh from Ogden, Utah "We have like Select Health Insurance. The coverage is great and the number of available facilities and providers is large. They are quick to pay out benefits and to inform us what they plan on paying." Our Advice SelectHealth offers health plans in Utah and Idaho. With 90 percent of this year's reviews earning 4 or 5 stars, SelectHealth is a recommended health insurer. Even though SelectHealth received only 51 customer reviews on Best Company this year, it has consistently received a high proportion of 4 and 5 star reviews. Based on this year's reviews, you're likely to find good customer service, good provider networks, coverage, and be generally satisfied. While 2020 SelectHealth's reviews were full of general satisfaction and praise, cost was the most common complaint. You'll want to review your health plan's costs before enrolling. Your costs include monthly premiums and out-of-pocket expenses. Review the copays or coinsurance for the health services you think you'll need next year. Since most of this year's reviews come from Utah, it's difficult to say whether SelectHealth is as good in Idaho as it is in Utah. If you're in Idaho, review SelectHealth plans for the provider network, coverage, and cost. Compare these three aspects to plans offered by other insurers in your area to see which best meet your coverage and financial needs. SelectHealth Health Insurance Learn more about SelectHealth by reading customer reviews and our expert analysis. Learn More Back to Company List 6. Ambetter Best Company Rank: #72020 Best Company User Rating: 1.98/52020 Review Breakdown: 18% 5-Star 7% 4-Star 2% 3-Star 2% 2-Star 71% 1-Star 2020 Reviews by State: 31% from Texas 14% from Georgia 11% from Arizona 11% from Florida 2020 Most Common Complaint: Coverage (36%)2020 Most Common Praise: Customer Service (13%) Complaints were quite common in Ambetter's reviews. Other common complaints included network dissatisfaction (27%), claims issues (24%), and poor customer service (24%). Note: Qualitative and quantitative analysis based on 45 reviews left on Best Company for Ambetter as of October 15, 2020. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Our Advice Even though Ambetter received only 45 reviews this year, 71 percent of them are 1 star. Ambetter has also consistently earned a high proportion of 1-star reviews on Best Company, which means that Ambetter is not a recommended insurance company. If you don't have another option in your area, ask questions about the provider network, the claims process, and be sure to throughoughly understand what coverage your plan offers. Learn more about Ambetter by reading customer reviews and our expert analysis. Back to Company List 7. Cigna Best Company Rank: #52020 Best Company User Rating: 3.33/52020 Review Breakdown: 36% 5-Star 15% 4-Star 18% 3-Star 8% 2-Star 23% 1-Star 2020 Reviews by State: 27% from Utah 13% from Texas 2020 Most Common Complaint: Coverage (18%)2020 Most Common Praise: Customer Service (21%) Other complaints included network dissatisfaction (15%), cost dissatisfaction (10%), and claims dissatisfaction (10%). Praise also included coverage satisfaction (15%) and claims satisfaction (13%). Note: Qualitative and quantitative analysis based on 39 reviews left on Best Company for Cigna as of October 15, 2020. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Kevin Liu from Sandy, Utah "Cigna has good coverage options for my primary care doctors. Their web ports is very transparent and easy to use to find physicians and see what I’ve paid towards my deductible." Our Advice A clear recommendation is also difficult to make for Cigna. The insurer only received 39 reviews this year. While 51 percent of these reviews are 4-stars or 5-stars, a good chunk (23%) were 1 star. Considering all of the reviews left on Best Company regardless of year, Cigna has received a majority of 1-star reviews (40%). 4-star and 5-star reviews account for 43 percent of Cigna's overall reviews, 20 percent and 23 percent respectively. While it's promising that Cigna received a lower proportion of negative reviews in 2020, be careful as you look at plans from this company. Pay attention to the coverage offered, provider network, and cost to be sure you find a plan that meets your needs. Learn more about Cigna by reading customer reviews and our expert analysis. Back to Company List 8. Aetna Best Company Rank: #82020 Best Company User Rating: 3.53/52020 Review Breakdown: 41% 5-Star 22% 4-Star 6% 3-Star 6% 2-Star 24% 1-Star 2020 Reviews by State: 15% from Florida 15% from Utah 12% from California 2020 Most Common Complaint: Claims and Customer Service (tied at 18%)2020 Most Common Praise: Coverage (35%) Complaints were less common. Other complaints included network dissatisfaction (6%) and general dissatisfaction (6%). Praise also included good customer service (21%), cost satisfaction (18%), network satisfaction (18%), and plan choice (18%). Note: Qualitative and quantitative analysis based on 34 reviews left on Best Company for Aetna as of October 15, 2020. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Customer Review: Phil Carriere from Cambridge, Iowa "Looked at several other plans from various other companies , but felt like the Aetna plan was best for my wife and I. Low cost,covered everything we needed covered, and includes a dental rebate program. When i needed an answer to a question they have always been there for me and are always concerned about improving my well being." Our Advice Although Aetna received 63 percent 4-star and 5-star reviews this year, it also received a good chunck of 1-star reviews (24%). If you opt for Aetna, be prepared for potential issues with claims and customer service. Keep in mind that Aetna doesn't offer individual and family plans. It offers Medicare and Medicaid. If you qualify for those plans and find one that meets your needs, Aetna can be a good option. Learn more about Aetna by reading customer reviews and our expert analysis. For specific information about Medicare, read Aetna's Medicare profile. Back to Company List 9. Molina Healthcare Best Company Rank: #152020 Best Company User Rating: 3.56/52020 Review Breakdown: 4% 5-star 13% 4-star 8% 3 star 0% 2-star 75% 1-star 2020 Reviews by State: 17% from Utah 17% from Washington 13% from South Carolina 13% from Texas 8% from Wisconsin 2020 Most Common Complaint: Coverage (38%)2020 Most Common Praise: General Satisfaction (8%) Other common complaints included poor customer service (33%), dissatisfaction with network (33%), issues with red tape (25%), and premium or billing difficulties (21%). Note: Qualitative and quantitative analysis based on 24 reviews left on Best Company for Molina Healthcare as of October 15, 2020. Best Company Rank is the current ranking which considers all reviews left on a company's profile regardless of year. Our Advice Since the number of reviews is so small and this year's reviews are almost half of the reviews on Best Company for Molina Healthcare, it's hard to make a certain recommendation. It's concerning that 75 percent of this year's Molina Healthcare's reviews were 1 star while only 17 percent were 4 or 5 stars. If you're considering Molina Healthcare, call your current doctors — and even doctors you may need to visit — to ask if they accept Molina Healthcare insurance plans. You'll also want to carefully review the coverage Molina's plans offer so that you know how to use your plan and how to approach prior authorization when needed. You should also review your plan's costs, including the premium, deductible, copays, coinsurance, and out-of-pocket maximum. Keep an eye out for billing issues as well. Learn more about Molina Healthcare by reading customer reviews and our expert analysis. Back to Company List
Guest Post by AJ Cohen Despite a myriad of efforts to make health care more affordable, costs continue to rise. Medical costs have outpaced income by 14 percent over the last 10 years, and 2020 is predicted to see the largest jump in costs yet — up 5 percent from 2019, which was already up 3.6 percent from 2018. Finding affordable care is an issue that hits at the heart of most Americans. Few families can absorb even a modest health care crisis when the average cost of a three-day hospital stay is $30,000 and the average cost of an ER visit is anywhere from $3,000 (with insurance) to upwards of $20,000 (without insurance). And if you need to get to the hospital via ambulance? Plan on at least another $1,000. Cost has become such a prohibitive factor in U.S. health care; many patients prolong needed medical care or forego it altogether to try and spare themselves the expense. As the saying goes, "When you have your health, you have everything," which is why everyone should have the benefit of being able to afford quality medical care when they need it and as long as they need it. Government officials and health care experts have long tried to devise a plan that makes sense for everyone, but until they do, I’ve compiled a few tips to help you stay on top of your health in 2020 without finding yourself in the poorhouse. First, take stock of what you’re paying now for health care and whether you can afford it.Insurance premiums and copays add up quickly. You may not find out if you’re carrying enough insurance, or the right kind of insurance, until it’s too late. No one wants to find themselves in the middle of a medical emergency only to discover they don’t have the necessary insurance to cover at least part of the costs. This is the time of year for open enrollment on most health care plans, and a good time to assess your needs in 2020. Will the size of your family be changing? Do you anticipate new medical needs for the coming year? Will there be out-of-pocket expenses, or expenses deemed not medically necessary, that you’ll need to account for over the next 12 months? Are you taking advantage of a Health Savings Account? Does your deductible seem reasonable? These are questions you should consider when determining what type of medical insurance you have and whether it will fit your needs in the coming year. Now is the time to make changes without penalty. Be realistic with how much you can afford each month and make sure it will deliver value when you’ll need it most. Next, shop around and take advantage of freebies.Surprisingly, most Americans don’t look for a bargain when they seek out medical care. A survey of nearly 3,000 individuals revealed only 13 percent of respondents who had to pay out-of-pocket for recent medical treatment had sought information about expected spending before receiving that care, and only 3 percent had compared costs across providers before receiving care. Reasons vary, but there is a long held belief that health care that costs less isn’t as valuable or effective as health care that costs more. This couldn’t be further from the truth. For some procedures, medical clinics are a far better bargain that in-hospital treatment, for example. Not to mention one doctor or hospital may charge significantly more for a service than another. It’s worth the time to ask around and compare your best deals. The government has even made it easier for all of us, requiring hospitals to publish the costs for common procedures. Don’t forget to take advantage of free and low cost services as well. Preventive care is free with many medical plans and for a healthy individual, this can cover the bulk of your medical needs in a given year. Ask for generic versions of prescriptions and shop your services around to various pharmacies. Many stores offer incentives on groceries and other items to have your prescriptions filled with them. Finally, don’t overlook free or low cost services for things like flu shots, wellness exams and sports physicals. There is no reason you need to see a primary care physician for some of these routine treatments. Finally, make a plan to pay your medical debts off now.Sounds easy on paper right? Medical debt can be scary, because the numbers can be large. There’s also the psychological issue at play — you feel better, so why do you need to go back and spend money on something that is fixed and done? Medical debt can quickly get out of hand however, and hospitals, clinics and doctors offices are feeling the pain of not being paid. For this reason we are seeing larger numbers of medical providers suing their patients for payment. Once a judgment has been rendered against you, you have little choice but to pay the bill in full — often with zero negotiating power. There is no need to let it get to that point. As tempting as it is to ignore medical bills, take the time to open those letters and understand what you owe and why. If something seems wrong to you or overly inflated, call your provider and discuss it. Most are willing to negotiate if you offer to pay in cash or pay the bill in full. If the costs are more than you can pay right now, consider a medical loan. Unlike credit cards, medical loans can have a far lower interest rate and more flexible repayment terms. At BetterMed, for example, we offer loans as high as $350,000 with a fixed 3.9 percent APR, and we approve 97 percent of our borrowers without a credit check. health care costs can feel insurmountable as they continue to rise, unabated. While no one can predict with any certainty what kind of medical needs you or your family may have in the coming year, there are ways to prepare now so those events don’t come with the added burden of how to pay for it. AJ Cohen founded BetterMed in 2011 and has served as Managing Partner since its inception. BetterMed is a global health financing company that provides holistic medical loans for patients facing critical, chronic or cosmetic health care costs. AJ started BetterMed with a mission to meet the needs of today’s borrowers, and has defined the company’s vision and strategy while leading the company through rapid growth. Today, BetterMed offers the lowest interest rate and most compassionate borrowing terms of any medical loan provider on the market, enabling borrowers to pay anywhere from four to six times less than they would with any other medical loan. AJ received a Doctor of Law at New York University, as well as a Masters in Finance from London Business School.
Open Enrollment is the annual period when anyone can enroll in health insurance for the following year. It ends every year on December 15th. If you missed it, don’t think that you’re out-of-luck when it comes to health insurance coverage next year. You may still have time to enroll in a health plan for the coming year, even if it’s not a qualified health plan. Here are five things you should do to see if you can still get coverage: Check the Open Enrollment dates in your state See if you qualify for a Special Enrollment period Review eligibility for government-sponsored health plans Find a job with health insurance benefits Consider other options Check the Open Enrollment dates in your state While most states end Open Enrollment on December 15th, some have extended it. For example, California, Colorado, and Washington, D.C. have permanently extended their open enrollment periods. California and Washington, D.C.’s open enrollment periods end on January 31st. Colorado’s open enrollment period ends January 15th. If you enroll after December 15th, your Affordable Care Act (ACA) coverage may start February 1st instead of January 1st. Other states may choose to extend the enrollment period on an annual basis. However, states that have lengthened the period in the past may not lengthen it in the current year. A quick Google search can help you find out what your state is doing. You may still have time to enroll in a health plan for 2022. See if you qualify for a Special Enrollment period Whether or not your state has extended open enrollment, you may qualify for a special enrollment period if you experience a qualifying life event, like getting married or divorced, having or adopting a child, or moving to a new state. Missing open enrollment alone doesn’t usually qualify you for a special enrollment period. Review eligibility for government-sponsored health plans Government-sponsored health plans like Medicaid and CHIP typically allow enrollment throughout the year. Medicaid and CHIP are available in all 50 states, U.S. territories, and Washington, D.C. Medicaid and CHIP eligibility is based on your income level. Eligible income levels vary by state. The Medicaid website for your state can give you more information on eligibility requirements and enrollment. Find a job with health insurance benefits If your current employer does not offer health insurance in its benefits package or if you can’t afford what your current employer offers, you can start applying for other jobs with employers that do offer an affordable benefits package. Keep in mind that it’s best not to ask for details about the benefits package until you have an offer. If you ask for details about the benefits package before, it can show the company that you’re more interested in what they can do for you than what you can bring to their company. The company may not be convinced of the value you bring and decide not to make an offer. Once you have an offer, asking questions about the benefits package is totally appropriate. Some jobs have a waiting period for benefits to start. Keep this in mind as you consider job offers. Look into other health insurance options, like government-sponsored plans and short-term health insurance, to give you some coverage while you wait for full benefits. Consider other options If you are unable to enroll in an Affordable Care Act (ACA) plan, you can consider other ways to manage your health expenses, like short-term health insurance and prescription discount finder tools. Short-term health insurance “The ACA is the only health insurance coverage that limits consumers to buying within the open enrollment period, and there are several options available throughout the year,” says Jan Dubauskas, Vice President at Health Insurance Innovations, Inc. (HIIQ). Short-term health plans don’t cover everything a qualified health plan does, like pre-existing conditions, but they can help cover preventive care and emergency care. Some plans include coverage for prescriptions. Carefully review what each short-term health plan covers because there is variability. Be aware that you and anyone else on the health plan will need to go through the underwriting process to be accepted on the plan at specific rates. When the Affordable Care Act first became law, it included a tax penalty for not having qualified health coverage. “Starting in 2019, there is no longer a penalty for choosing to forego an ACA plan, which means that if someone doesn’t need the robust coverage available under the ACA, they can buy another, more affordable type of health insurance like short-term medical without risking a tax penalty,” says Dubauskas. While there is no longer a federal penalty, you may be subject to tax penalties at the state level depending on your state’s laws. States also have different guidelines regarding short-term health insurance. “Short term medical is now available in many states for up to 36 months,” says Dubauskas. While short term health insurance may be available for long periods of time in many parts of the United States, some states may have different rules. Double-check the guidelines in your state and keep them in mind as you navigate purchasing health insurance. Prescription pricing tools Prescription pricing tools are becoming increasingly common. While these pricing tools aren’t considered insurance, they can help you manage your medication costs. One example is RxSaver by RetailMeNot. “RxSaver is a website and an app that shows you the lowest retail prices at pharmacies in your neighborhood. You just put in your drug name and choose from a list of prices at nearby pharmacies,” says Dr. Holly Phillips, Board Certified General Internist in Manhattan and a Medical Expert for RxSaver by RetailMeNot. Knowing your options can help you ensure that you have the health coverage you need to maintain your physical, mental, and financial health.
"It's complicated," said your ex about breaking up with you. Or were they talking about health insurance? Health insurance has lots of terminology and specific processes that can be daunting and difficult to understand at first. Luckily, there is plenty of information available regarding health insurance terms and how health insurance works. “Although the United States is considered a leader as it relates to delivering healthcare services to our populous, we typically lack in providing the basic education on how the health care ecosystem as a whole operates. From a customer perspective, this becomes increasingly confusing and overwhelming during the Open Enrollment Period,” says Austin Ridgeway, HGS Director of Sales Support and Business Development. Open Enrollment is one of those terms. So, here’s a quick definition: the time period you have to enroll in a health plan for the following calendar year. Open Enrollment typically runs November 1 through December 15. Buying health insurance also presents its own challenges. To make an educated choice and find the best fit for your situation, you need to be able to analyze and understand your options properly. So, here are five things that can cause confusion during Open Enrollment: Open Enrollment vs. Medicare Annual Enrollment Enrollment deadlines Where to shop Plan classifications Plan costs Open Enrollment vs. Medicare Annual Enrollment Medicare has an Annual Enrollment period that allows Medicare beneficiaries to review their current coverage to make sure it will meet their needs and make changes as needed. It wouldn’t cause so much confusion, except that sometimes it’s also called Medicare Open Enrollment. It also usually runs October 15 through December 7. The overlapping time frames and unclear references don’t help prevent the confusion, but now you know. Enrollment deadlines Another point of confusion: the deadlines. “Many people assume you should just be able to enroll, but there are very good reasons to not have ongoing open enrollment,” says Jason B. Ball, CFP® ChFC® CLU®. However, this confusion is understandable because health insurance didn’t always require enrollment during a specific annual period. “Before the Affordable Care Act, plans could deny people based on pre-existing conditions and therefore if someone wanted to apply say in April, they could, but the company could deny them due to a pre-existing condition or pending surgery. The enrollment period is put in place to discourage people from trying to game the system by applying for coverage only when needed since companies would have to accept them,” says Lorena Tomasini, owner of the MALM Life and Health Insurance Agency. While having deadlines can be one more thing to keep track of, it also benefits health insurance shoppers and helps keep enrollment stable for health insurance companies. Repeat to yourself: Open Enrollment is November 1 through December 15. Say it three times. Set a reminder on your phone so that you don’t end up without coverage next year. But, if you miss Open Enrollment or lose your current health insurance coverage, you may be able to buy health insurance outside of Open Enrollment if you have a Qualifying Life Event. These events trigger Special Enrollment Periods. “People can apply outside of open enrollment if they have a special enrollment period. This can be triggered due to recently (past 60 days) getting married, having or adopting a child, a death, losing health coverage (such as changing jobs but not because they missed payments), obtaining a legal immigration status (parole, work permit, residency), change in address (not within the same county) or going to happen in the future (60 days) will lose health coverage in the next 60 days,” says Tomasini. Where to shop With the all the resources available on the internet and licensed insurance agents willing to help, it can be difficult to know the best way to find a good health insurance plan. Health insurance carriers also can change plan offerings and features year-to-year. Even if you liked your plan this year, it may not still be a good health plan for you next year. So, you should know your options. If your employer offers health insurance as part of its benefit package, you can enroll in that. You can also look for options in the Health Insurance Marketplace. These plans also also called on-exchange plans. “Some individuals are also confused about whether they can still purchase health insurance through the ACA. With the repeal of the individual mandate and the subsequent ruling that it is unconstitutional, some are not sure an ACA plan is still an option,” says Dr. Nicole T. Rochester, Your GPS Doc, LLC CEO and Founder. Even with all of the political changes and challenges to the Affordable Care Act, the Health Insurance Marketplace still exists. You can find plans that cover the Essential Health Benefits and offer affordable premiums on HealthCare.gov. Most states use HealthCare.gov to list on-exchange health plans in their state, but some states have a separate site. In addition to on-exchange plans, you can consider off-exchange plans. These plans are not required to meet the same coverage requirements that on-exchange plans must, though some do. Be sure to understand the covered services included with these plans before enrolling. Off-exchange plans that do not offer the same coverage as on-exchange plans include short term health plans and health sharing plans. “Most are unaware that you can find decent, affordable health insurance choices off the exchange. Off-exchange websites, like Kind, offer more choice for families and individuals shopping for health insurance and choice allows you to pick a plan that is more customized to your needs,” says Nick Soman, CEO of Decent. Whether you’re looking for an on-exchange or off-exchange health plan, you can use health insurance comparison websites, work with an insurance agent, or reach out to insurance carriers directly yourself. However, as you research and evaluate plans, you should know the limits of each source. “You can use a broker to find the right plan, but they are typically a sales person who may have an ulterior motive, like higher sales commissions, for you to select a particular plan,” says Ridgeway. Check with the insurance agency to see how they pay their insurance agents. Are they commission-based or salaried? Even if you’re just looking at commercial health insurance comparison websites, like HealthCare.com, it’s important to pay attention to the order in which the site displays available health plans in your area. In some cases, these sites prioritize plans based on contracts with insurance carriers. “You can ask your friends and family what options they use. This typically will give you an unbiased review of their plan, but, as described above, they are not typically experts within the health care industry and are typically given based on a singular point of view, which is harder to get a complete picture from," says Ridgeway. Online reviews have similar issues. However, online reviewers likely represent a more diverse range of health needs than your friends and family. It’s not easy to pin representation down, but if you look at ratings and reviews in aggregate, they can help you identify a good insurance company from a bad one. “There are aggregator sites and applications that bring together a number of nonbiased user reviews of health plans and the services they provide. Although a great option, to get a number of individual opinions through this channel, users have been jaded by 'fake' reviews often provided by the company themselves to ensure that they appear more favorable to the general public,” warns Ridgeway. If you’re looking at online reviews, check a few review sites and read how each one vets reviews before publication. While Best Company doesn’t list specific health plans from various carriers, it does offer customer reviews of health insurance companies. Each review is vetted to prevent fake reviews from being published. Ridgeway recommends doing your health plan research by diversifying your sources. “My advice would be to find a hybrid approach that will combine all of the above: speak with family and friends, do your research, and possibly speak with a broker about what options are available that fit your particular situation. No matter what route you choose, always remember to be informed as to what your family needs and how much impact the selected plan will have on your life because you will not be able to choose another plan until next year’s Open Enrollment Period,” he says. Plan classifications Understanding plan classifications and costs will help you determine whether a plan meets your needs. “While there have been concerted and successful efforts to improve the HealthCare.gov website, many continue to be confused about open enrollment. This is largely due to the sheer volume of information you have to sift through and interpret while searching the site. In some cities, there are more than 40 available plans from which to choose. Understanding the differences between the various metal levels (Bronze, Silver, Gold) and the meaning of all of the terminology (deductibles, coinsurance, etc.) is daunting, even for those of us in the health care field,” says Rochester. Understanding health plan classifications is the first step to being able to evaluate and choose a health plan. Health plans are classified several different ways to indicate the kind of plan they are, the kind of network offered, and how plan costs are broken down. Here are two common abbreviations for classifying plan-type: CDHP — Consumer-Directed Health Plans. These plans tend to have lower premiums and come with accounts to set aside money for medical expenses. These accounts include Health Savings Accounts (HSAs), Flexible Spending Accounts (FSAs), and Health Reimbursement Accounts (HRAs). HDHP — High-Deductible Health Plan. These plans have high deductibles that put a greater responsibility for out-of-pocket costs on the policyholder. These plans often have low monthly premiums and can include HSAs, FSAs, or HRAs. Here are a few common abbreviations for classifying network type: HMO — Health Maintenance Organization. These plans typically offer coverage for care received in-network. If your doctor is not included in the plan’s network, you’ll fully pay those costs yourself. PPO — Preferred Provider Organization. These plans offer coverage in- and out-of-network. However, there are separate deductibles and cost-sharing rules for in-network and out-of-network coverage. Out-of-network care typically places greater cost-sharing responsibility on the policyholder. In addition to plan-type and network categorization, the Affordable Care Act created metal tiers to show how total plan costs were determined. “The most confusing part of buying health insurance for most people is understanding the tiers of coverage: bronze, silver and gold,” says Lev Barinskiy, SmartFinancial CEO. While there is a variety of plans and costs within each tier, the costs fit the following trends: Bronze — These plans have the lowest monthly premiums and highest out-of-pocket costs. Policyholders are typically responsible for 40 percent of care costs out-of-pocket. Silver — These plans have higher monthly premiums and lower out-of-pocket costs than Bronze plans. Policyholders are usually responsible for 30 percent of medical expenses. Gold — These plans have higher monthly premiums and lower out-of-pocket costs than Silver plans. Policyholders are generally responsible for 20 percent of their medical expenses after the plan pays 80 percent. Platinum — These plans have the lowest out-of-pocket costs and highest monthly premiums. Policyholders are responsible for about 10 percent of their medical costs. Keep in mind that these tiers typically only apply to health plans offered on the Health Insurance Marketplace. As you’re shopping for cost-effective plans, these tiers can help you evaluate the overall cost of a plan. Understanding these costs and your health needs, will help you find a good fit. “You can't compare a bronze plan with a gold plan, but this tends to leave many people wondering which to choose. Your premium may be lower with a bronze plan, but you'll likely pay more in doctor visits and for care from specialists. If you see several doctors and anticipate continuous care, it may cost less to buy the more comprehensive gold plan," says Barinskiy. Plan costs While the tiers can help you understand how costs are spread out in a health plan, it can still be tricky to understand how much a health plan actually costs. “People are typically most confused by what plans will end up saving or costing them when trying to project out-of-pocket expenses along with premiums, deductibles, and prescriptions,” says Vinay Amin, health and wellness expert and Eu Natural CEO. It’s important to analyze each plan you consider, including the deductible, out-of-pocket limit, copays and coinsurance, and monthly premiums. Because there are different kinds of costs to consider, how much a health plan costs is tricky to pin down. It also can vary based on your health needs. Talking to your health care providers can help you understand your health needs. “The best approach is to plan ahead and have a talk with the right people, notably your doctor and your pharmacist. Your pharmacist is familiar with your medications and is an ideal source of consultation regarding a plan for prescriptions. Your doctor knows your medical history. Review your options with the appropriate medical professionals and don't wait until the last minute,” suggests Amin. Once you can anticipate your health needs, you can ask the insurer to project out-of-pocket costs for services you may need. Soman recommends asking the following questions when considering health plans: Do you have access to free primary care? If not, how much is your copay to see a doctor when you’re sick? What about telemedicine options? What is your prescription medicine benefit? If you focus too much on lower premium costs instead of the overall cost and coverage of a plan, you may end up with higher out-of-pocket costs and more limited coverage. “Choosing skimpy short term or health sharing plans may be cheap in the short-term but carry a big risk if you get ill or are injured,” warns Soman. If the premiums or out-of-pocket max for a better plan are difficult to fit into your budget, you should investigate the Advanced Premium Tax Credit (APTC) and the Cost Sharing Reduction (CSR). The APTC subsidizes monthly premiums based on your projected income for the following year. When you file taxes for that year, the difference between the subsidy you took and the actual subsidy you qualify will be reconciled. “The Cost Sharing Reduction (CSR) also known as ‘extra savings’ means that a family not only qualifies for the tax credit, but if they choose a silver plan will also benefit in lower deductibles, copays, and out-of-pocket maximums,” says Tomasini. To see if you qualify for the APTC or CSR, you can complete this form on HealthCare.gov. Open Enrollment success and clarity It’s complicated. So what? It doesn’t mean you can’t understand health insurance and navigate Open Enrollment successfully. Understanding the processes, terminology, costs, and coverage will help you analyze health plans. The clearer your health needs are to you, the better you’ll be able to identify a health plan that will fit your coverage and financial needs. Doing your research using the help of licensed insurance agents, online reviews and tools, and talking with friends and family will allow you to gather more information from a variety of perspectives. This variety will help counterbalance the shortcomings of relying on one source for information. Ready to find a good health insurance company? See the top carriers in your state. Still need more information on health insurance and Open Enrollment? Check out these articles: 4 Things to Look For in a Health Plan Pitfalls to Avoid During Open Enrollment
Health insurance is an important way to get the health care you need while protecting your finances from large medical costs. It's also important to find a health plan that fits into your budget from a trustworthy insurer. However, not all health plans are equally beneficial. So, how do you know if you have a good plan? There are four essential things to look at when evaluating your health insurance options: Coverage Health services costs Prescription costs Premiums Analyzing these four aspects will help you understand how good your health plan is and its overall affordability. Coverage The most essential part of your health plan is what it covers. If there are medical services or prescriptions that you know you will need, check to make sure that the health plans you’re looking at covers those. Health insurance plans on the Health Insurance Marketplace (on-exchange plans) cover the Essential Benefits outlined in the Affordable Care Act. Off-exchange plans offered by private insurers also meet these guidelines. Essential benefits include preventive care services like your annual physical, certain prescriptions and vaccinations, and care for pregnant women, children, and infants. Plans that are not compliant with the Affordable Care Act may not cover all of the essential health benefits. These include short term health plans and indemnity plans. It’s especially important to carefully review the coverage on these plans before choosing one. Some plans may also cover medical devices like crutches and blood sugar monitors. Coverage rules can vary by plan, so check your plan to learn more about what's covered. Coverage also goes beyond covered services and medical devices. It includes the network of doctors and specialists included with your health plan. If you already have doctors that you like or prescriptions you require, it’s worth checking to make sure they would be covered under any new plan you’d choose. When it comes to networks, some plans only offer in-network coverage. Other plans offer in- and out-of-network coverage, though the cost-sharing rules may put a higher burden on policyholders for out-of-network services. Emergency services are always covered, regardless of where they were received. Keep in mind that health insurance companies have negotiated discounted rates with in-network providers, which makes visiting those providers cheaper for them. Since they do not have discounted rates from out-of-network providers, it's more expensive for the company when you receive out-of-network care. The company passes some of this expense on to you by charging higher rates in these cases. Questions to ask yourself What health services do my family and I need? Are there procedures or surgeries that my family and I will need in the next year? What medications, medical devices, and prescriptions do my family and I need? Know the answers to these questions before shopping for health insurance. This will help you quickly eliminate plans that won’t meet your health needs. Health services costs Many people assume that the monthly premiums reflect the full cost of the insurance plan. While premiums are the most frequently occurring cost for a health plan, the full cost also includes the cost-sharing burden on the policyholder. Each health insurance plan has its own cost-sharing rules, so be sure to look at how much the health insurance plan covers for different medical services. This will be listed in your plan’s Schedule of Benefits. Depending on your plan’s cost-sharing rules, you may be responsible for a portion of the cost of the medical services you receive. This is in addition to the monthly premiums. Fortunately, there are annual caps on how much you’ll have to pay for cost-sharing expenses. These are called the deductible and out-of-pocket limits. The deductible is the amount you must pay for your health expenses yourself before the insurance company will start paying some of the costs. Don’t worry — many health plans cover preventive services fully, at no cost to you. Health insurance also gives you access to discounted, negotiated rates from health care providers in your plan’s network. These discounted rates are advantageous, even when additional coverage and cost-sharing is delayed. The out-of-pocket maximum is the total amount you’d have to pay for health care costs for the year. Once it’s met, your insurance company will pay fully for covered services, other than your monthly premium. The deductible is often lower than the out-of-pocket max for this reason. Copays and coinsurance count towards your deductible and out-of-pocket maximum. Look at how high the deductible and out-of-pocket limits are for each health plan you consider. Compare the deductible and out-of-pocket limits across plans. It can also be useful to look at differences in copays and coinsurance. Copays are a set amount that you pay when you receive medical services. Coinsurance is a set percentage of the cost of services that the policyholder is responsible for. Coinsurance can be trickier to estimate because it depends on the negotiated price the insurance company has with the doctor. Questions to ask yourself What would the health services my family and I need cost under each health plan? (General information about these costs is available in each plan’s Schedule of Benefits. For specific pricing and cost information for your current providers, you can contact the insurance company directly.) Which plan has the best cost-sharing for specialist visits and urgent care clinics? Which plan has the best overall cost-sharing for the health services my family and I need? Prescription costs The cost sharing methods for prescriptions varies based on what tier the prescription falls under. Depending on the plan, you’ll either pay copays or coinsurance on prescriptions. Some health insurance plans may have different deductibles and out-of-pocket limits for medications than for other health services. Once these are met, the insurance kicks in at a higher level. Questions to ask yourself What tiers are my family’s and my prescriptions in? What would the regular prescriptions that my family and I need cost? (General information about these costs is also available in each plan’s Schedule of Benefits. For specific pricing and cost information for your current providers, you can contact the insurance company directly.) Premiums While the monthly premiums do not reflect the full cost of a health plan, they still contribute to the total cost of the plan and you need to make sure that they fit into your monthly budget. Look at a few health plans to get a better sense of what current premium rates are in your area. You can also check to see if you qualify for a government subsidy that can make premiums for an on-exchange plan more affordable for you. Questions to ask yourself What is the most I want to spend on health care next year? (Take the overall cost into account.) What is the most I can comfortably spend on premiums? What would I ideally spend on premiums? Answering these questions will help you narrow down your options further and choose the most affordable plan for your situation. Affordable health care Fully evaluating your health insurance plan before enrolling will help you make an informed decision. Understanding the details of each health plan will help you find one that covers the medical services you need. Looking at the deductible, out-of-pocket max, and cost-sharing amounts will give you a sense of what you’ll spend on medical care and medications in addition to the monthly premium. Working with the insurance company to get pricing on what different medical services and prescriptions would cost with a certain policy will help you understand the total cost of the plan in more detail. Analyzing your budget, premium rates, cost-sharing expenses, and coverage are key to finding affordable health care. Oscar Health Insurance and "GAUZE: Unraveling Global Healthcare" executive producer and director Suzanne Garber consulted on this article. Need more health insurance enrollment tips? 4 Ways to Prepare for Open Enrollment Pitfalls to Avoid During Open Enrollment 5 Questions to Ask About Special Enrollment Periods
Updated January, 2020. In general, people can only enroll in a health insurance plan during Open Enrollment. Medicare also has its own Annual Enrollment Period and its Initial Enrollment Period varies depending on your birth date. However there are some exceptions, including Medicaid, CHIP, and qualifying for a Special Enrollment Period (SEP). If you qualify for a Special Enrollment Period, you have a certain amount of time to make changes to your health insurance plan or enroll in a new one to ensure that you maintain the health insurance coverage you need. Here are some of the most common questions regarding Special Enrollment Periods (SEPs): What is a Special Enrollment Period? What qualifies as a Special Enrollment Period? What are my health insurance options? How do I apply for a Special Enrollment Period? What is a Special Enrollment Period for Medicare? What is a Special Enrollment Period? Special Enrollment Periods (SEPs) let you make adjustments to your health insurance coverage or enroll in a new plan outside of Open Enrollment under certain circumstances. These circumstances are referred to as a Qualifying Life Event. Having missed Open Enrollment does not make you eligible to apply for a Special Enrollment Period. Special Enrollment Periods typically last 30-60 days, which allows plenty of time for you to look at your health coverage options and make the necessary insurance coverage adjustments. “Don't forget about deadlines, and keep in mind that they're different for employer-sponsored plans versus individual market plans. For employer-sponsored plans, you'll generally have 30 days, whereas in the individual market, you'll have 60 days (some qualifying events trigger a special enrollment period both before and after the event, whereas others are only after it),” says Louise Norris, licensed agent and author of Insider’s Guide to Obamacare’s Special Enrollment. Whether you receive health insurance from your employer or purchase your own separately, you may qualify for a Special Enrollment Period as your life changes. If you purchase health insurance independently, you can work with an insurance agent or use online tools that make it easy to explore all your options before you make a change. “Never buy from an agent who only has one product. You need someone who can shop around effectively and give you options. Never call the health insurance marketplace on your own without guidance from an agent. The customer service reps are not agents, and you may not understand the rules and regulations they have,” Maria Townsend, Insurance Advisor, says. HealthCare.gov shows all of the group health insurance plans created by the Affordable Care Act. After you complete a questionnaire, it will include any subsidies you qualify for in the listed premium quotes. If you don’t want to buy a Marketplace plan, you can view covered benefits and costs (monthly premiums, deductibles, out-of-pocket expenses, etc.) offered by multiple companies by looking at a comparison website. A few health insurance comparison websites are HealthMarkets, HealthCare.com, and GoHealth.It’s a good idea to be careful when shopping online. Some websites are designed to generate leads for health insurance providers and sell customer information to multiple insurance companies, instead of just connecting the customer to the company and plan they requested. If you can’t see price estimates and plan details before providing contact information, it may not be the best resource.Townsend says, “I would stay away from the insurance sites that sell off your info for a price comparison, and later get 100 calls from different reps. Those sites never check your medications or doctor network to even know if it's a plan that meets your needs personally. I recommend sites like FreeInsuranceGuru.com, where you can chat, call, or even video chat with an agent licensed in your area and your information isn't sold.” Back to Menu What qualifies as a Special Enrollment Period? A Special Enrollment Period occurs when you experience a Qualifying Life Event. These events are life changes like Losing current health insurance Moving Getting married Having a baby or adopting Income changes Gaining Tribe membership Gaining U.S. citizenship Release from prison Starting or ending Americorps service You can also qualify for a Special Enrollment Period if the company you enrolled with made an error in the information they provided or breached their Marketplace contract. If you experience a qualifying event, you can make changes to your insurance coverage, like adding people to your current health plan. Keep in mind that even if you have a Qualifying Life Event, other rules still govern Special Enrollment Periods.Norris says, “In the individual market, keep in mind that most special enrollment periods now require that you had coverage prior to the qualifying event, so they serve as an option to change coverage rather than go from being uninsured to having coverage. So while getting married or moving to a new area used to allow a person to gain coverage after being uninsured, that's no longer the case (for marriage, at least one spouse must have had coverage prior to the marriage, although the other could have been uninsured). Some individual market rules limit enrollees' ability to use special enrollment periods to upgrade their coverage during the year. All of this is opposed to open enrollment in the fall, when anyone can sign up or change their coverage, regardless of their prior insurance status.” Back to Menu What are my health insurance options? For the most part, Special Enrollment Periods allow people to add a person to their current plan or enroll in a new plan. If you’re enrolling in a new plan, you can enroll in An employer-sponsored plan A Marketplace plan A private insurance plan Research to learn the health insurance plans available to you and what they cost. If you’re losing insurance coverage because you left a job and are starting a new one, it’s a good idea to enroll in some kind of health insurance plan. Most employers have a waiting period before new employees can enroll in health insurance. To ensure that you have coverage during the waiting period, you can buy temporary health insurance, enroll in a Marketplace plan, be added to your spouse’s employer plan, or extend your employer’s health insurance coverage using COBRA.“Nobody needs a qualifying event to enroll in a short-term plan, as they're available year-round but with medical underwriting. However, it's also common to see short-term plans being marketed to people who are aging off their parents' health plan or losing access to an employer-sponsored plan when they quit their job. In both cases, the person is actually eligible for a SEP in the individual market (where there's no medical underwriting, pre-existing conditions are covered, and the plans include essential health benefits coverage), but people sometimes enroll in short-term plans because they aren't sure what other options they have,” Norris says.Short-term health insurance plans are an option that’s always available. They can be a good choice, but don’t offer the complete coverage that standard health insurance plans offer.If your spouse has insurance through their employer, you can also be added to their plan. “The qualifying event that triggers COBRA eligibility (and the SEP in the individual market) will also trigger a SEP that would allow the person to join their spouse on the spouse's employer-sponsored health plan (assuming the spouse has such coverage and the plan offers spousal coverage). But as noted above, that SEP only has to last 30 days, whereas it's 60 days in the individual market and there's a 60-day window for COBRA,” Norris says. What is COBRA Insurance? COBRA stands for the Consolidated Omnibus Budget Reconciliation Act. It is the legislation that allows former employees to continue health insurance coverage from their former employer for a certain amount of time until they find new coverage up to 18 months. Individuals who use COBRA coverage must pay the employer’s contribution and an administrative fee in addition to the monthly premiums. Norris says, “If you're being offered COBRA, take your time to compare individual market plans and COBRA — you don't want to jump into either option without understanding all the details, but you've got 60 days to make your decision.” When choosing between enrolling in a new plan or COBRA, research your options. Townsend suggests, “Reach out to an experienced insurance agent, who can provide you many options and speak to you intelligently about what options they have for you verses the COBRA route. Go online and shop if you enjoy shopping online!”Evaluating the costs and benefits of using COBRA versus another health insurance plan will help you make the best decision for your circumstances. The nice thing about using COBRA is that the coverage can be retroactive if you enroll later during your Special Enrollment Period.Norris offers a few scenarios in which COBRA may be ideal: “You're in the middle of a complicated course of treatment and don't want to have to worry about switching providers, dealing with a new drug formulary, etc. So a person going through cancer treatment, for example, might be better off with COBRA than with switching to the individual market. You've already met or nearly met your out-of-pocket maximum for the year. If you switch to a new plan in the individual market — even if it's from the same insurer that offers your group benefits — you'll have to start over with your out-of-pocket expenses. Your income is too high for premium subsidies and you're fairly certain you're going to have access to a new employer-sponsored plan soon. In that case, keeping COBRA will be less complicated than having to enroll in a new plan only to switch away from it again in the near future when you switch to the new employer-sponsored plan.” However, there are a few reasons why enrolling in a new plan might be better. “An individual market plan might be much less expensive, especially if you qualify for premium subsidies and/or pick a plan with higher out-of-pocket exposure than the one you had through your employer. Premium subsidies are available this year to a family of four with MAGI as high as $100,400, whereas there's no financial assistance available to offset the cost of COBRA. Depending on the specifics of the plan you had through your employer and the options that are available in the individual market in your area, you might find that you can pick an individual market plan that has a provider network and/or drug formulary that work better for you,” says Norris. If you’re eligible for COBRA and Medicare, you might want to enroll in both or opt for Medicare. “One serious mistake I see people make with COBRA is when they are also eligible for Medicare. They elect COBRA, but do not enroll in Medicare Part B. Medicare says you need to enroll in Part B even when electing COBRA and over age 65. Failing to do so can cause a lifetime Part B premium penalty because of a late enrollment fee,” advises Adam Hyers, owner of Hyers & Associates Insurance Agency. How do I sign up for COBRA? Employers are required to offer information on COBRA and enrolling in COBRA to their employees. Your employer’s human resources department can answer your questions and help you access coverage through COBRA. Back to Menu How do I apply for a Special Enrollment Period? For the most part, it’s not a matter of applying for a Special Enrollment Period, it’s a matter of enrolling in a health insurance plan or making adjustments to your coverage.If you have a qualifying life event, talk to your employer’s human resources department. The human resources team will help you through the process--whether you are enrolling in a different plan, making adjustments to add coverage, or using COBRA.If you don’t have insurance through your employer, contact your health insurance company. They will tell you what documentation they need and help you with the changes you need to make.If you’re choosing a new health insurance plan, research your options online. You can view your options by looking directly at company websites, looking at comparison websites, or looking at Marketplace plans on HealthCare.gov. Representatives from these websites can also help with the enrollment process.Getting advice from a licensed independent agent is always a good idea, especially if you’re working directly with a company. “I always stress the importance of sitting down with a licensed, non-biased insurance agent who can provide information on coverage and price on various policies from an array of carriers so you can find the policy that best meets your needs and budget. Whether you are enrolling in ACA or COBRA, understanding what is and is not covered and what the cost will be to you (and your family, if applicable) is very important,” says Chris Mason, Senior Vice President of Sales Distribution for HealthMarkets. If you are required to give documentation to show that you qualify for a Special Enrollment Period, do not send the originals. Make copies to send in and keep the originals for you records. Back to Menu What is a Special Enrollment Period for Medicare? Medicare Special Enrollment Periods are slightly different from regular Special Enrollment Periods, although the concept is the same. There are a few more situations that allow for a Special Enrollment Period. The length of the Special Enrollment Period also varied based on the circumstance that triggers it. Start dates also vary.Many of the Qualifying Life Events that trigger a Special Enrollment Period also trigger a Medicare Special Enrollment Period. However, some circumstances are distinct to Medicare.For example, you qualify for a Medicare Special Enrollment Period if you have an opportunity to purchase other non-Medicare coverage or if your current Medicare plan changes its Medicare contract. More information regarding Qualifying Life Events and corresponding Special Enrollment Period details, can be viewed on Medicare.gov.Understanding how Special Enrollment Periods work will help you be prepared, use the time offered to understand your options, and make sure that you have the coverage you need. For more information on Special Enrollment Periods, check out Health Insurance Marketplace’s Guide. Back to Menu
Updated February 2021. Most of the advice published about health insurance focuses on how to choose an insurance plan that meets your needs. This article focuses on choosing a health insurance company. Specific plans and costs discussed in this article may vary depending on your location, age, and other demographic information. If you’re considering plans from any of these three companies, this article will help you better understand what each health insurer offers and which insurance carrier may be best for you. We'll cover: Best Company user ratings and reviews Aetna vs. Cigna Kaiser Permanente vs. Aetna Kaiser Permanente vs. Cigna Best Company user ratings and reviews (Ratings as of February 3, 2021) Although each insurer has a fair number of 4- and 5-star reviews, each company also has a fair proportion of 1-star reviews. Aetna has 29 percent 1-star reviews. Cigna's is higher at 40 percent. Kaiser Permanente has 34 percent 1-star reviews. Negative reviews are common in the health insurance industry. For all health insurance reviews received by Best Company in 2020, 24 percent were 1 star. In 2019, 41 percent were 1 star. Since we considered reviews from all years for Aetna, Cigna, and Kaiser Permanente, it's hard to say exactly how these companies compare to annual industry findings. However, the proportions of 1-star reviews each insurer has don't stand out considering industry patterns. As you consider good and bad reviews about health insurance companies, keep in mind that insurers offer a wide variety of plans. Plans have different network structures, cost-sharing rules, and coverage restrictions. Health insurance plan offerings can also vary by location, so consider where the reviewer is from as you read reviews. Everyone's medical needs are also different, which can affect how plan members experience the insurance provider. If reviewers share details on why they had difficulty, that can help you know what questions to ask and decide whether or not to buy from an insurance company. Complaints about Aetna, Cigna, and Kaiser Permanente have similar themes. Reviews mention issues with claims, coverage denial, and difficulty resolving problems. These similarities show that the difficulties are common across these insurers. Choosing one over the other doesn't necessarily mean you'll avoid these problems. Aetna ratings and reviews As of February 3, 2021, Aetna had a 6.6/10 overall score and a 3.4/5 star rating based on 189 user reviews. Customer Review: Natalia Correa MDTribe from Miami, Florida "I had this insurance previously with one of my employments. I had a copay but I was able to go to the ER and outpatient. After my $40 copay, it covered everything else such as immunizations and routine lab work." 29 percent of Aetna reviews had a 1-star rating. Complaints include: Poor experiences with customer service Costs Claims denial Issues with filling prescriptions and the delivery process Pre-authorization delays Difficulty with the website Concerns with the network of providers Difficulty getting forms to fill-out 58 percent of Aetna reviews had a 4- or 5-star rating. Praise includes: Good communication around claims Satisfaction with customer service Satisfaction with coverage Quick claims process Satisfaction with the cost and value of plan Aetna Customer Reviews Learn more about Aetna's health insurance offerings and how it compares to other insurers by reading our expert review and customer reviews. Learn More Cigna ratings and reviews As of February 3, 2021, Cigna had an overall score of 7.7/10 and a 2.8/5 average star rating based on 204 user reviews. Customer Review: Melinda Olson from Goodyear, Arizona "Cigna has provided us with great insurance and to see the doctors we like. Customer service helped us figure out issues we had." 40 percent of Cigna reviews had a 1-star rating. Complaints include: Cost Coverage denial for treatment, tests, or prescriptions Customer service Approval process for pre-authorization Coverage restrictions Incorrect billing Poor organization Poor ability to resolve client issues Claims denial 44 percent of Cigna reviews had a 4- or 5-star rating. Praise includes: Good experiences with coverage and claims processing Satisfaction with provider networks Easy to use mobile app and website Satisfaction with customer service Cigna Customer Reviews Learn more about Cigna's health insurance offerings and how it compares to other insurers by reading our expert review and customer reviews. Learn More Kaiser Permanente ratings and reviews As of February 3, 2021, Kaiser Permanente has an overall score of 7.4/10 and a 3.2/5 average star rating based on 200 user reviews. Customer Review: Fay Falatea from Kaneohe, Hawaii "Me and my family have been insured by Kaiser Permanente for 13 years. The Drs I had were great and customer service from the receptionist was always pleasing. Was sad when I had to change to another insurance." 34 percent of Kaiser Permanente reviews had a 1-star rating. Complaints include: Poor customer service Difficulty resolving issues Dissatisfaction with Kaiser Permanente care providers and care facilities Coverage restrictions and denials Claims denials Scheduling difficulties Issues with prior authorization Cost 53 percent of Kaiser Permanente reviews had a 4- or 5-star rating. Praise includes: Convenience of all care providers in one facility Caring doctors and providers Network satisfaction Online portals Coordination between care providers Kaiser Permanente Customer Reviews Learn more about Kaiser Permanente's health insurance offerings and how it compares to other insurers by reading our expert review and customer reviews. Learn More Back to Menu Aetna vs. Cigna While Cigna has a higher overall score on Best Company, Aetna has a higher user star rating and a lower percentage of 1-star reviews. Remember that negative reviews across these companies hit on similar themes. Reading through each company's unique reviews can help you understand what to look out for with each company and make a better, informed decision for yourself. Since Aetna does not offer individual and family health plans, Cigna is the way to go if you're buying your own medical plan. Consumers seeking student health insurance coverage, Medicaid, or CHIP will find options from Aetna. Cigna and Aetna are also similar in their Medigap and Medicare plan offerings. The biggest difference is the inclusion of additional programs. Businesses of any size can find their needs met from either Aetna or Cigna. Both companieis also offer international health plans. Cigna has targeted offerings for NGOs. It's worth comparing cost specifics for domestic plans and cost specifics, coverages, and regions for international plans to find the best deal. Cigna Health Insurance Learn more about Cigna's offerings to see if it's a good fit for you. Learn More Back to Menu Kaiser Permanente vs. Aetna When it comes to Best Company user reviews, Aetna and Kaiser Permanente are fairly similar. However, Kaiser Permanente has a higher overall score. Aetna has a slightly lower percentage of 1-star reviews, which gives Aetna a slight advantage over Kaiser Permanete. Concerns reported in both companies' one-star reviews were similar, so read the most recent customer insight on their respective Best Company profiles. As Aetna does not offer individual and family health plans, Kaiser Permanente stands out. Remember that Kaiser Permanente only offers coverage for care received by the providers it employs, which is similar to a network-only health plan structure. Aetna stands out for its plan perks and offering of international insurance. While Kaiser Permanente stands out of its offering of Charitable Health Insurance. With Medicaid and CHIP, the biggest difference between the two is the states available. If both companies offer Medicaid and CHIP in your state, it's worth doing further research into what distinguishes the offerings of each company. Kaiser Permanente's and Aetna's Medicare plans are also similar. What makes Aetna stand out with its Medicare offerings are the perks and Medigap products. Employers seeking domestic health insurance for their employees can find good plans from both Aetna and Kaiser Permanente. However, if global health insurance is necessary, Aetna is a good option because Kaiser Permanente focuses on domestic health insurance. Kaiser Permanente Customer Reviews Learn more about Kaiser Permanente's offerings to see if it's a good fit for you. Learn More Back to Menu Kaiser Permanente vs. Cigna When it comes to ratings and reviews, Kaiser Permanente and Cigna are similarly rated on Best Company in the overall score and user ratings. If you're choosing between these companies and comparing similar plans, read the most recent reviews and complaints on their respective Best Company profile pages to make an informed choice. While Cigna could provide more general information about the plans it offers independent buyers, it also offers a nice variety of supplemental health insurance plans that are great for people seeking additional coverage for specific situations. Cigna is also a great choice for purchasing independent international health insurance. Kaiser Permanente stands out for its Medicaid, CHIP, and Charitable Health Insurance offerings. For consumers interested in this kind of health insurance, Kaiser Permanente is the clear choice. If you're considering Kaiser Permanente, keep in mind that their health plans only cover care received at its medical facilities by the care providers it employs. This is different from the distinct provider network structures that other companies like Cigna offer. If you're interested in a more traditional network structure, like a Preferred Provider Network (PPO) that offers both in- and out-of-network coverage, Cigna may be a better option. Both Cigna and Kaiser Permanente offer Medicare Advantage plans. The biggest differences between the two are the additional programs that are included with some plans. Cigna also offers Medigap insurance, which is great for consumers looking for additional cost-sharing help. Kaiser Permanente and Cigna both offer a nice selection of employer-provided health insurance plans. Employers who are choosing between the two should contact each company directly to compare pricing and coverage. Cigna also offers international insurance. Those seeking international insurance would need to work with Cigna when choosing between the two insurers. Kaiser Permanente Customer Reviews Learn more about Kaiser Permanente's offerings to see if it's a good fit for you. Learn More
Updated September 10, 2021. Enrolling in health insurance is an important financial decision. Health insurance can save you money on your health care, which offers good financial protection. This season, make sure you are making the best choice for your health and financial planning. Below are some pitfalls that you’ll definitely want to avoid: Not knowing open enrollment dates Open Enrollment for health insurance coverage for the calendar year 2022 is November 1, 2021 to December 15, 2021. Don’t miss it!“Unless you have special circumstances, you will not be able to purchase a new plan or switch out of your existing plan if you miss these important deadlines,” says Dr. Nicole Rochester, MD, private health advocate, and CEO of Your GPS Doc, LLC. Some employers have a different enrollment period. Your employer’s human resources department should be reaching out to share that information with you, if it hasn’t already.A Special Enrollment period allows you to enroll in health insurance at a time aside from Open Enrollment. These occur if you have a qualifying event, like getting married, having a baby, or moving to a new state. Lingo confusion Dr. Sam Kina, Senior Vice President of Economics and Data Science at Picwell, says, “Few people understand basic terms, like deductibles, coinsurance, copayments and out-of-pocket maximums. Learn these concepts before comparing your options.”Health insurance lingo can be confusing and intimidating, especially if it’s your first time purchasing health insurance. Make sure you know the terminology so that you can better understand health insurance plans and make a good choice.BestCompany’s health insurance guide has a vocabulary section that can help clarify health insurance terms. Misunderstanding the coverage Most health plans have rules about what health services they cover, especially when it comes to pre-existing conditions. Meghan Nechrebecki, MSPH, Founder and CEO of Health Care Transformation, says, “Make sure the services you know you will need are covered by the insurance plan. This can be found in the Evidence of Coverage document.”Reading the Evidence of Coverage document will help you understand what medical services are covered and help you determine if a health plan is right for you.Health insurance plans also have networks. Seeking health services from in-network providers is often cheaper than seeking them from out-of-network providers.Suzanne Garber, executive producer and director of PBS documentary “GAUZE: Unraveling Global Healthcare,” says, “It’s important for individuals to check the in-network status of all of their current/regular doctors (primary care, pediatrician, gynecologist) along with any that might be necessary in the year ahead (obstetrician, orthopedist, cardiologist, physical therapist, etc).”Some plans don’t offer out-of-network coverage. When you look at a health insurance policy, consider how much you travel in addition to whether your current doctors are covered.Good coverage doesn’t necessarily come with lower premiums. Adam Hyers of Hyers and Associates, Inc. says, “Consumers must be aware of discount plans sold today that are not actual insurance. The rates are attractive, but the coverage is very flimsy and generally won’t pay much for a serious health incident.” Misunderstanding the cost The real cost of health care and health insurance can be tricky to pin down. Suzanne Garber says, “The lack of transparency in U.S. health care makes an educated decision about selecting a health care plan very difficult and is one of the reasons we advocate for published pricing of every procedure by every health care practitioner — most other countries mandate this already.”The amount health insurance saves you can also be difficult to understand because it depends on the medical services received and the negotiated prices agreed upon by insurance companies and health care providers. These negotiated prices vary depending by insurance company and health care provider.Garber says, “Take the time to crunch the numbers and estimate what health care will really cost you based upon what your usage has been in the past and what risks or major events are likely to come up in the new year.” Understanding what you’ll need in 2022 and what that might cost will help you look at more than just the monthly premium.Rochester says, “If you don't read the information about the deductible, copays, and coinsurance, you may end up with huge medical bills that could have been avoided by paying a little more each month in premiums.”You should also consider what out-of-network services will cost. Garber says, “Don’t overlook the maximum out-of-pocket or not properly estimate any out-of-network provider charges (usually from specialist visits), which can add up quickly.”Taking time to understand the monthly premium, in-network and out-of-network costs, and out-of-pocket expenses, like copayments and deductibles can help you evaluate the value of a health insurance plan. Coinsurance The health plan you are considering may have coinsurance instead of copays. This means that you would have to pay a percentage of the bill instead of a fixed copayment amount.“Another pitfall that individuals fall prey to is the difference between a set contribution (whether co-pay or out-of-pocket) versus a percent contribution,” says Garber.Coinsurance is a two-edged sword in health insurance plans. In some instances it may be beneficial, in others it may be detrimental.Garber says, “For example, it may look that the better option for “Emergency Room” may be a co-pay of $500 instead of 20 percent, as ER visits can be quite costly. However, if an insurance company has a contracted rate with the hospital, they may receive a discount, which may then be passed on to you. An example of this is a recent ER visit, which cost ~$700. The insurance company had a 50 percent discount, which left the remainder $350, of which I owed $35—a much better deal than had I opted for the $500 co-pay option.”Nechrebecki disagrees. She says, “Avoid coinsurance! This means you have to pay a percentage of the bill instead of a defined amount. Medical bills these days can be massive and unexpected.”Understanding the difference between coinsurance and copayments will help you evaluate the cost of a health insurance plan. Health Savings Accounts vs. Flexible Spending Accounts Some health insurance advisers recommend Health Savings Accounts (HSAs) in addition to a health insurance plan. These funds are tax-deductible and can be used for medical expenses not covered by insurance. Shobin Uralil, Co-founder and COO of Lively, says, “Instead of picking the same health plan from last year, which will likely cost you more this year, consider switching to a High Deductible Health Plan (HDHP). HDHPs will likely lower your monthly premiums and get you exclusive access to a health savings account.”If you’re at a relatively healthy point in your life, choosing an HDHP to allow greater investment in an HSA could be a good option. Kina says, “Once you pay your premiums, you never get that money back, even if you don’t use any medical care. Instead, consider taking the premium savings from switching to a low deductible plan and putting it in an HSA.”Be sure to be strict with your budget and put the money you are saving by choosing a lower premium into your HSA. This can be a smart money move for paying future health care costs not covered by insurance.“HSAs are like a 401(k) for healthcare. Because HSA money is yours for life, next year, you will already have health savings to fall back on," adds Uralil.Flexible spending accounts (FSAs) are also a great option to consider along with purchasing a health insurance plan. The difference between an FSA and an HSA is that the funds in an FSA must be used within the year or the money is lost. The money in FSAs is also not tax-deductible.Knowing the dates and understanding health insurance terms, the cost of plans, and the coverage they provide will help you make sure you have coverage and choose the best health insurance policy for you. Looking for more advice? View our article "4 Ways to Prepare for Open Enrollment" and Important Things to Know section.
Updated September 10, 2021. Open Enrollment for 2022 health insurance coverage is just around the corner. It starts November 1, 2021 and continues through December 15, 2021. You won't want to miss it. If you do, you will be unable to enroll in health insurance for 2022 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. Do your research 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. Consider your health needs 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 2022.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. Know what’s affordable Gross recommends answering these questions as you review the cost of a health insurance policy: What is your current income and your monthly expenses? What health insurance subsidies are offered through your state? What are the copays and deductibles? How much is the premium? 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. Understand your options 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 (Medicaid, Medicare, CHIP, and others) On-exchange plans (sold on state-run marketplaces) Off-exchange plans Government-provided Health Insurance The government provides health insurance to certain qualifying groups: Veterans Children Elderly (65+) Low-income individuals and families 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. Open Enrollment for 2022 began October 15, 2021 and will continue until December 7, 2021.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 PlansOff-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: Pitfalls to Avoid During Open Enrollment 4 Things to Look for In a Health Plan
Open enrollment is upon us! From November 1 through December 15 people will have the opportunity to either sign up for health insurance, or make changes to their existing coverage. If you're on Medicare, the Open Enrollment Period started October 15 and ends December 7. Read these articles about Medicare Annual Enrollment and Medigap to learn more about Medicare and how to take advantage of the Annual Enrollment Period. Below are some important dates for Open Enrollment that you'll want to pay attention to as you make your decisions: November 1, 2021: Open Enrollment Starts December 15, 2021: Last Day to Enroll or Make Changes for Coverage starting January 1, 2022 Of course, if you've never signed up for health insurance before, there are some questions you'll need to ask yourself about your situation before you enroll. Health insurance in this country can be complicated, so before you can know what your options are, you need to understand how your circumstances influence your access to health insurance. Are you employed? While you don't need to be employed to have access to health insurance, it certainly helps. Many employers in the country offer some kind of health benefits to their full-time employees. Some also offer it to their part-time employees. Does your employer provide insurance? Of course, not every employer offers health insurance. As healthcare costs increase, fewer and fewer businesses can afford to provide health insurance benefits to their employees. If you're employer doesn't offer health insurance, you can see what insurance companies offer to individuals and families. You may even qualify for an income-based subsidy or another government health insurance program. Is your job-based insurance sufficient? By "sufficient" we mean, does the insurance coverage your employer provides able to meet all of your healthcare requirements? This question might be more difficult to answer than you think. How do you know if your employee benefits are enough or not? Unfortunately, the answer to this question depends on a lot of factors: your preexisting conditions, what benefits and packages are available, and whether you can afford necessary add-ons to your policy. First, it's important to do some research on the insurance provider your employer has partnered with. We've identified and reviewed some of the major health insurance companies in operation today. You should also talk to your company's human resources representative (if you have one) to discuss your specific needs, and whether your company's insurance will be able to address these needs with the packages available. If your employee benefits are enough If the insurance provided by your employer is enough to cover all your healthcare needs, then great! You're in good shape; however, it's still important to familiarize yourself with some crucial terms related to your health insurance policy. If your employee benefits aren't enough If your insurance policy does not quite cover all of your healthcare needs, that's okay! You can look at your options on your state's health insurance exchange. These Health Marketplace plans can give you access to group premium rates that may be cheaper than other options with comparable coverage. You can also consider other options through insurance companies, like off-exchange plans. Off-exchange plans do not cover all of the essential health benefits, so pay attention to what services are covered if you're looking at these plans. Is your income less than 138 percent of the Federal Poverty Level? The Federal Poverty Level is a standard against which you can determine whether you qualify for cost assistance when buying insurance through the Health Insurance Marketplaces. If you make less than 138 percent of the Federal Poverty Level, you may qualify for Medicaid or CHIP (Child Health Insurance Program), depending on whether your state has expanded Medicaid coverage (more on that later). If your income is greater than 138 percent of the Federal Poverty Level You'll still have a number of health insurance options available to you. The Health Insurance Marketplace offers a insurance packages on a sliding scale, meaning your income (along with other factors) can influence the number and variety of benefits you can potentially receive. If you fall into this group, you may also qualify for certain insurance subsidies, as follows: Premium Tax Credits Based on income, these premium tax credits can go towards paying for a portion of your health insurance costs by either lowering your premium, for factoring into your annual tax return. More specifically, if you make between 100 percent and 400 percent FPL, you may qualify for these credits. Out-of-Pocket Cost Assistance Out-of-pocket cost assistance (also known as cost sharing subsidies) will help lower the amount of money you yourself pay towards specific health insurance costs. These include deductibles, copayments, and coinsurance costs. In order to qualify for these subsidies, you must be making between 100% and 250% FPL. Has your state expanded Medicaid? Right now, one of the major issues affecting health insurance access is the expansion of Medicaid. Medicaid is a health care program (jointly funded by the federal government and the individual states) specifically designed for low-income people. It covers children, the elderly, the blind or otherwise disabled, and others who qualify for federally assisted income maintenance payments. Currently, Alabama, Georgia, Kansas, Florida, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, Wyoming are the only states that have not expanded their Medicaid programs. If your income is less than 138 percent of the Federal Poverty Level, and your state hasn't expanded Medicaid You should still apply for Medicaid coverage, as you still may qualify. However, if you still don't qualify for Medicaid and your state hasn't expanded this type of coverage, you may not be completely out of luck. In some areas, there are Federally Qualified Health Centers that offer primary care services in areas with underserved people. The Health Resources & Services Administration funds these centers through its Health Center Program. You can also buy a catastrophic health plan. These plans only offer coverage for emergency medical care and serious injuries. Because the coverage is so limited, the premiums tend to be much lower. If you're 30 or older, you have to file a hardship exemption form before you can purchase one of these plans. If your income is less than 138 percent of the Federal Poverty Level, and your state has expanded Medicaid You may qualify for Medicaid or CHIP. Rules for Medicaid will vary state to state, so it's important that you check state laws to see how Medicaid has been specifically expanded. As for CHIP, there are some important step, including visiting www.insurekidsnow.gov, selecting your state, then filling out a Marketplace application. Understanding your health insurance options In conclusion, the health insurance world doesn't need to be so intimidating. There are a lot of great resources available for first-time health insurance enrollees. Just be sure to closely examine your situation, the needs of your family, and never be afraid to ask those who have been there before. Health insurance is one of those things you'd rather have and not need, rather than need and not have. The clock on open enrollment is ticking, so sign up today!