Topics:Buying health insurance health care Open Enrollment health insurance guides Health and wellness Medicare research
May 7th, 2021
May 7th, 2021
2020 has affected our daily lives in profound ways. Job loss affected access to health insurance and health care in the middle of a pandemic. Health insurance changes may also be on the horizon because the Supreme Court starts hearing a case on the Affordable Care Act in November. A decision is anticipated in 2021. COVID-19 and potential changes to health insurance laws make this year's Open Enrollment period more important than ever. Employers are also feeling pressure from COVID-19's fallout, which may affect the health insurance options they offer employees. Whether you're buying health insurance on your own or through your employer, shopping for and enrolling in health insurance for 2021 has more significance than past years. A recent study from Unum found that 64 percent of workers plan to pay more attention and spend more time reviewing their benefits and 36 percent plan to enroll in different benefits. While there is no data on these questions to compare with previous years, these numbers do show that workers are making adjustments and planning to increase time understanding their workplace benefits. As we enter the Open Enrollment period, here's what you should know as you select health insurance plans. COVID-19 pandemic We're all too familiar with stories of COVID-19 patients needing care in the ICU, and that level of medical care can add up quickly. The U.S. legislative responses to COVID-19 provided resources to cover COVID-19 care for uninsured individuals. Although those resources make a difference, buying health insurance can offer valuable financial protection, peace of mind, and help you access medical care when you need it. Fortunately, there's good news if you're buying your own insurance. "Because the marketplaces are strong and healthy, we’ve seen an increase in the number of insurers participating and an increase in the number of options being offered. Regardless of the pandemic, high-quality, affordable and comprehensive coverage remains available," says Joshua Peck, cofounder of Get America Covered. The risks of going without health insurance are starker this year than they were last year. Insurance premiums aren't cheap, but it's worth making adjustments to your budget and exploring subsidies available to fit it in. Peck continues, "It’s always risky to be without coverage. No one knows when they’ll have an emergency or develop a serious health problem. Last Open Enrollment, no one deciding whether to get covered or not could’ve anticipated this pandemic. It’s abundantly clear that this pandemic is not temporary. It’s not going away any time soon, and no one understands the long-term health implications of even mild cases of COVID-19. Everyone deserves to enjoy the peace of mind offered by health coverage — especially amidst this potentially devastating illness." If you receive insurance through an employer group plan, you may see some changes. These will vary by employer, so it's difficult to make generalizations at this point. Peter Nieves, Chief Commercial Officer and benefits management expert with WINFertility, provides wise insight for employees who want to maximize their benefits: "Employers may shift costs to employees through higher deductibles and coinsurance or only offer a high deductible plan. Employees should consider optimal use of FSA, HSA or HRA accounts and, if not enrolled in an HDHP, consider the lower monthly cost of the offer. If an Employee will have a greater cost share burden in 2021 for care, then be sure to not delay treatment, surgery or testing and take thoughtful action in 2020." Although changes are possible, Lesa Votovich, Vice President of Health and Benefits at Cowden Associates, Inc., notes that employers are working to avoid making changes: "In the group marketplace, it has been my experience thus far that employers are trying to make as few changes as necessary, recognizing the impact that the pandemic has had on their employees this year. They definitely are not looking to add more insult to injury wherever possible." Supreme Court case The Supreme Court will start hearing arguments for California vs. Texas in November. This case calls the Affordable Care Act's (ACA) "individual mandate," requiring everyone to purchase health insurance, into question. The Court's ruling could upend the health insurance landscape we've become accustomed to if the ACA is overturned. The ACA protected people with pre-existing conditions from being denied coverage or charged higher premiums on policies. It allowed children to stay on their parents' health plan until age 26. It expanded Medicaid and instituted income-based subsidies on Marketplace monthly premiums that made buying a good health insurance plan more affordable. Insurers used to have annual and lifetime benefit maximums that shifted excess costs on policyholders and limited the benefits available to people with chronic conditions. "It’s difficult to predict how the Supreme Court will rule and thus hard to predict how it will impact people enrolled in health plans. But no decision is likely until June of 2021, so anyone who needs coverage now should check out their options, enroll, and know that their coverage is secure," advises Peck. Although there is uncertainty, it's important to consider the potential fallout if the ACA is overturned by the Supreme Court. Votovich paints a bleak picture of the effects that ruling could have: "Should the Supreme Court decide to strike down the ACA, more than 20 million people will lose their health care coverage. These are individuals who obtain their health care policy through a federal marketplace plan. Those covered by employer-sponsored health care coverage will likely still remain covered by that plan. Currently, as we are in the midst of the pandemic, continued racial disparities in coverage and the heightened likelihood of a potential financial crisis, the impact of individuals losing coverage would be devastating." Anticipate how the Supreme Court ruling to uphold or overturn the ACA would affect you. Make sure you get the coverage you need for 2021 during Open Enrollment. Votovich shares this advice: "Understand the coverage that you are purchasing. If you are uncertain and have questions about the options available to you, seek out an agent who can assist you in navigating the plans. Assess the typical services that you receive in a year and disclose them to the agent you may work with so that they can provide you with options that may best meet your needs. Most importantly, don’t let your coverage lapse. If the Supreme Court does strike down the ACA, you want to make sure that you have continuous health coverage so that you may avoid being limited by pre-existing condition policy limitations in the future. If history holds true, if one does have coverage for a continuous period without a 60-day lapse, then pre-existing conditions will not likely apply." We have time before the Supreme Court issues a ruling. If the Court overturns the ACA, some of the changes will be immediate. Others will take more time. "Once the ruling is made there will likely be a noted transition period. For example, if the Court rules next June there may be a period of six months to a year for insurers to decide how they will react to the ruling and formulate what their individual market will look like on a go forward basis," says Votovich. Managing through uncertainty One of the challenges of 2020 has been confronting uncertainty and dealing with the unexpected. We've confronted realities in new ways and adapted to new circumstances. Enrolling in a health plan during Open Enrollment can help you be prepared for uncertainty in 2021, whether it's unexpected medical expenses or transitioning to an unfamiliar health insurance landscape. Use the checklist below to help you navigate this year's Open Enrollment period.
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 Shobin Uralil No employee or employer could have predicted the wide-reaching impact of the COVID-19 pandemic when preparing for open enrollment last fall. Now, to help alleviate benefits costs in 2020, the IRS has taken an unprecedented step with IRS Notice 2020-29 to allow qualifying employees to make mid-year health plan election changes. This opportunity creates much-needed flexibility in a time of uncertainty. But health care needs are unfortunately even more unpredictable than a normal plan year. We will walk you through what your options are and how to think about health plan selection for the rest of this year. What happened? Specifically, the mid-year changes apply to employer-sponsored health coverage and spending accounts (Health Savings Accounts and Flexible Spending Accounts). This applies to all plans that are regulated by a 125 cafeteria plan. Section 125 is part of the IRS Code that allows employees to convert a taxable cash benefit (i.e., salary) into non-taxable benefits. Under a Section 125 Cafeteria Plan, you can elect to pay for qualified benefit premiums before any taxes are deducted from your paychecks for health care premiums, FSAs, and HSAs. Under the new IRS regulations, in 2020, employees are allowed to: Make a new health plan election. Cancel or change an existing health plan election. Continue using previously allocated FSA funds for qualified expenses until December 31, 2020, even if changes are made. This is only relevant if your employer selected the grace period option as part of their FSA plan design. Check with your HR or benefits administrator to confirm. What can you expect? Many of you get a chance to re-evaluate your health care needs and, most importantly, your out-of-pocket costs for the rest of this year. If you or a family member have had a change in your employment type, income, health expenses, or want to review your health care benefits, keep reading. Mid-year plan changes don’t mean that you can expect new health plan offerings at your current company. Instead, it’s an opportunity to change to another plan or pre-tax saving options that you previously did not select during open enrollment. There is one important caveat: employers are allowed to ‘determine the extent to which such election changes are permitted and applied, provided that any permitted election changes are applied on a prospective basis only, and the changes to the plan’s election requirements do not result in failure to comply with the nondiscrimination rules applicable to § 125 cafeteria plans.’ Essentially, these changes are not mandatory. This means that your employer can decide the extent to which plan changes are available. Check with your HR or benefits administrator to determine what changes are eligible at your company and when this special period takes place at your company. What should you do now? Even though this is a ‘mid-year’ open enrollment, it still follows the same key open enrollment parameters. You should select the most cost-effective and personalized health plan option that meets your and your family’s needs. Review your current health plan offering and your ongoing monthly costs. This includes the following: Monthly premiums Out-of-network care Out-of-pocket maximums Deductible amounts (before insurance kicks in) Co-pays and co-insurance Note: All of these costs (or cost scenarios) have one thing in common, they are paid directly by you, not your insurance provider. What is that monthly amount? Did COVID-19 impact your expected monthly costs or your ability to pay for those costs? Compare your current health plan elections to the full offering of your employer’s health care options. Here is a Health Plan Comparison Calculator to help you get started. Take a hard look at the costs outlined above, review receipts if you have any, and do your best to forecast your health care expenses and financial situation for the rest of the year. Change or keep your current health plan elections based on your findings. Select the best health, at the best cost, based on the coverage you need. Don’t overpay for coverage you don’t need! It might be time to consider what your health costs are going toward. If you haven’t considered adding a tax-advantaged savings account, like an FSA or HSA, you are overpaying for health care costs. Use this new review period to reconsider your health care and savings strategy. Take some time to think about what you missed. Health insurance is a direct intersection of your well-being and your personal finance. Many employees unintentionally overpay for bells and whistle coverage they don’t end up using. The right plan is the one that provides the most personalized and affordable health care coverage for you and your family. You get a do-over this year; make the most of it. The catch As with all good things, there is always a catch. In this case, it's related to the 2020 FSA and HSA contribution limits. Normally this would not be a concern unless you change jobs or had a qualifying life event. But with this mid-year change, there are some nuances to consider. If you previously contributed to an FSA in 2020 but decide to now switch to an HSA-eligible health plan, like a High Deductible Health Plan (HDHP), you would expect to be eligible to also contribute to an HSA. However, since you already contributed to an FSA, this disqualifies you from contributing to an HSA in 2020. It will be tough to find guidance around this and other nuanced rules, so check with a financial or tax professional to ensure you remain IRS-compliant. Looking ahead Without knowing what ‘next’ looks like, it is hard to prepare for the future. But with health care, what we do now know is that saving for the long-term, and the unexpected, is more critical than ever. Health care plans expire every year, but marrying an eligible high-deductible health care plan with a pre-tax savings account creates the only long-term health savings and planning option available today. Whether you are looking for short-term savings with an FSA or planning for a long-term safety net with an HSA, you can have savings ready for every ‘just in case’ scenario, at least for health care costs. Shobin Uralil is the co-founder and COO of Lively, a top-rated health savings account provider.
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.
Updated September 10, 2021. Guest Post by Elissa Suh Open Enrollment for health insurance is soon to be underway — the federal open enrollment is from November 1 to December 15, 2021. However, more than 88 percent of Americans could not correctly identify these dates, according to the third annual Policygenius Health Insurance Literacy Survey. The survey also found that many people — more than one in four — avoided getting treatment because they didn’t understand their health insurance coverage. Health insurance can be daunting and challenging to navigate, but starting with the basics is a good place to help you prepare to make the best choices for your health and finances. Survey respondents also had trouble with basic health insurance terms like copay, deductible, and premium. Fewer than a third of people correctly defined all three terms. To help you get ready to choose your health insurance plan for 2021, here are seven terms to know: Premium Copay Deductible Coinsurance Out-of-pocket maximum Essential health benefits Short term plans 1. Premium A premium is the amount you pay for health insurance every month, whether you pay it directly or it’s automatically deducted from your paycheck if you have insurance through your employer. It’s the first cost you encounter when you have health insurance, and yet only a little over half (55.9 percent) of survey respondents could correctly identify the term. There are five plan categories — Bronze, Silver, Gold, Platinum, and Catastrophic — and each has a different way you and your insurer share costs for your care. You will have to pay a higher premium for Platinum plans, but will pay less out of pocket before insurance starts to cover the bills, or you can opt for a Bronze plan, which means you’ll have lower premiums but pay more out of pocket before insurance starts to cover medical bills. 2. Copay Copay, short for copayment, is a fixed amount you pay for a covered medical expense. Your copay amount will vary, based on your health plan and the type of service you receive (like a specialist physician, primary care physician, urgent care visit). Generally, copays are around $30 and do not count toward your deductible. Out of the health care terms asked about in the survey, “copay” caused the greatest confusion — only 40 percent of people could define it. 3. Deductible A deductible — the amount of money you pay out of pocket before insurance coverage kicks in — was a term that approximately half (49.6 percent) of survey respondents could correctly identify. For example, if your plan has a $1,000 deductible and you need to undergo a $3,000 surgery, you would have to pay $1,000 on your own, before the insurance company could start helping with the costs. And, because you’ve met the deductible, the next time you have a covered medical expense in the calendar year, insurance will pick up the bill in its entirety. Knowing how the health insurance deductible works can help you understand other types of insurance, too, like homeowners or auto insurance, as the concept remains the same. 4. Coinsurance Coinsurance is the percentage of health care costs you have to pay after you’ve met your deductible (until you meet your out-of-pocket maximum). Coinsurance is represented as a percentage or split, like 20 percent or 80/20. This means you pay for 20 percent of the costs for a covered medical expense, and the insurance company pays for the remaining 80 percent. 5. Out-of-pocket maximum The out-of-pocket maximum is the most you’ll have to pay for covered health care services in a given year. After you spend enough money on medical expenses to reach the out-of-pocket maximum, your insurance provider will cover 100 percent of your care. The out-of-pocket maximum limit depends on your health plan and resets annually. The government also sets an overall limit: For 2021 plans, the limits are $8,550 for individuals and $17,100 for families. 6. Essential health benefits Did you know that under the Affordable Care Act, all health insurance plans are required to cover the same 10 essential health benefits? The 2019 Policygenius survey asked about these benefits and found that nearly 87 percent of people didn't know what services were required. The 10 essential health benefits are ambulatory services (outpatient care), emergency services, hospitalization (inpatient care), laboratory services, mental health coverage, pregnancy/maternity/newborn care, rehabilitative services, pediatric care, prescription drugs, and preventative care. 7. Short-term health plan Short-term health plans were established as a way to help fill temporary gaps in insurance coverage, not to act as a comprehensive health plan. They’re not substitutes for traditional health insurance plans and do not have to adhere to standards in place by the Affordable Care Act, so they aren’t required to offer any of the essential health benefits mentioned above. This type of health insurance may cost less than a marketplace plan, but it also includes less coverage. Short-term plans are increasing in popularity, but not many people know how they work. According to the Policygenius survey, only 9.9 percent of people knew how long a short term plan could last — they’re typically limited to under a year, but can be renewed for up to a total of 36 months. Elissa Suh is a personal finance and insurance expert at Policygenius in New York City. She has previously worked in television research and written about film for IndieWire, MUBI, and Paste Magazine.
"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
Updated September 10, 2021. Medicare Open Enrollment for 2022 coverage runs October 15, 2021 to December 7, 2021. It's a good opportunity for people with Original Medicare to evaluate if a Medicare Advantage plan might be better and vice versa. It's also important to double-check your Part D prescription drug coverage for 2022. To make the most of Medicare Annual Enrollment, it’s a good idea to research and prepare. You should also be aware of pitfalls to avoid during the once-per-year enrollment period. Here are five pitfalls that Medicare experts identified: Not looking for changes Not considering other plans Not enrolling in Part D Following ill-advised recommendations Procrastinating Not looking for changes The saying “The more things change, the more things stay the same” does not apply to Medicare plans. When a Medicare plan is changed, the coverage is not the same. Insurance companies make changes to the coverage and costs each of their plans have. Double-checking to make sure your prescriptions are covered is important to do each year. John Hill, Gateway Retirement President“The biggest pitfall is assuming things are the same. Medicare seems to be always changing. The next pitfall is timing, you have from October 15 until December 7 to make your selections for your drug plan or Medicare Advantage plan. If you assume your Medicare Advantage plan or drug coverage is the same, you may be disappointed.” Adam Hyers, Hyers and Associates, Inc“Oftentimes, Part D plans will change their premiums and copays while also moving certain drugs into different (more expensive) tiers or out of formulary altogether. By the time someone might realize this in January, it can be too late to do anything about it. Part D plans are required to send out an ANOC (Annual Notice of Changes) form for all Part D and Medicare Advantage plans, but sometimes they are lost or ignored. Consumers should never assume their drug plan will stay the same year over year. They should contact their agent to make sure or double check their prescriptions using the Plan Finder tool at Medicare.gov. Enrolling the most suitable plan can save people hundreds of dollars or more for the next year.” Danielle R. Plummer, PharmD Consultant Pharmacist“Insurance companies are constantly changing their formularies, so just because a medication was on the lowest tier formulary this year, it may not be the next. If you are not comfortable using the internet, ask for help through local library, insurance brokers, and pharmacies. If a chain pharmacy does not have time to work with you, check with your local independent pharmacies. Insurance contracts also change which pharmacy is their preferred provider year to year, so don't assume that the pharmacy you've been using will still have the lowest copays for your plan. Call your plan to ask which pharmacy is preferred. Also ask about copays at independent pharmacies and mail order options.” Not considering other plans As Medicare health plans change and your health situation changes, it’s important not to assume that your current plan will always be best for you. By considering all your plan options for Medicare Advantage and Part D, you’ll make sure that you’ve got a plan that meets your health and budgetary needs. Kathryn Casna, Eligibility.com“Many plans change each year, so look for your plan's Annual Notice of Change (ANOC) in the mail in October, and make sure the plan still meets your needs. On the flip side, it never hurts to call an agent or run your info through the plan finder at Medicare.gov each year to see if you can get a better plan or a lower price elsewhere.” Not enrolling in Part D Medications and prescriptions are important, especially if you rely on a daily medication. If you don’t currently take medications, it may not make sense to enroll in prescription drug coverage. But, if you eventually do need medication and have not had prescription drug coverage, your costs may be higher down the road. Alex Enabnit, Eligibility.com“If you don’t have drug coverage but anticipate needing it at some point in the future, find a Part D plan during AEP. If you know you’ll never want drug coverage, that’s fine. But if at some point you will, you need to know that Medicare enforces a penalty charge for every month you went without drug coverage. This penalty remains in force, monthly, for the rest of your life. Yes, you read that right. Avoid this pitfall!” Following ill-advised recommendations Lots of people get advice from family members and friends for some major life decisions. While it’s nice to have a good support network, it’s important to realize that everyone’s health and financial situation is different. A plan that worked well for your friend may not be great for you. Kathryn Casna, Eligibility.com“Medicare beneficiaries will get tons of recommendations this season, but unless those recommendations are closely matched to your individual situation, you could be enrolling in the wrong plan. Both of these pitfalls can be side-stepped with a bit of research into the plans that fit your individual needs.” Procrastinating Don’t underestimate how long the underwriting and approval process can take when enrolling in a new Medicare plan. You’ll want to know if your application has been declined with plenty of time to apply for another. Danielle K. Roberts, Boomer Benefits“It’s important to start early. Don’t procrastinate until the end of the enrollment period because both insurance companies and Medicare get swamped with applications. There are longer hold times if you call in with a question. You also need adequate time to research your options so that you are not rushing to choose a plan. Another pitfall can occur if you are wanting to disenroll from a Medicare Advantage plan and return to Original Medicare and add a Medigap plan. In most cases you must answer health questions on the application for Medigap and the insurance company needs to time to decide whether they will accept for decline you. So it’s important that you apply for the Medigap plan first and well in advance of the December 7th deadline. Don’t cancel your Medicare Advantage plan until you have received approval from the Medigap carrier that they are granting you a policy.” Avoiding pitfalls Avoiding these Medicare Annual Enrollment pitfalls will help you find an affordable plan that meets your coverage needs. Reviewing any changes, double-checking prescription coverage and costs, and applying early in the enrollment period will help you decide if it's best to stick to your current plan or make a change.
Updated Septeber 10, 2021. Medicare Open Enrollment is a valuable opportunity to re-evaluate your Medicare plan, review Medicare options, and even find a better plan. The Annual Enrollment Period for coverage during 2022 runs October 15th through December 7th. Preparing for Annual Enrollment can help you take full advantage of this opportunity to make sure that your Medicare plans meet your needs. Here are three things you can do to be ready for this year’s Annual Enrollment Period: Analyze this year’s health costs Do your research Set an appointment with an agent Analyze this year’s health costs “People should prepare for Medicare Annual Enrollment by reviewing their health care utilization this past year and thinking about anticipated utilization and needs for the coming year,” advises Gayle Byck, PhD, Board Certified Patient Advocate, Certified Senior Advisor®, and founder of InTune Health Advocates, LLC. Understanding what you spent on health care this year can help you project costs for next year. As you think about how much your health plan costs, be sure to include the monthly premiums and all out-of-pocket expenses. Out-of-pocket expenses are the costs you paid for prescriptions, doctor visits, and treatment. While you’re evaluating this year’s costs, it’s important to consider how well your current plan met your coverage needs. While it can be less work to stay on the same plan, it’s not worth staying if there are cheaper options that offer better coverage. Byck recommends considering this question as you evaluate your current plan: Does your current plan (A, B, Supplement, and D, or Medicare Advantage) continue to meet your needs and make the most financial sense? As you evaluate the total cost of your plan and other health plans you are considering, include the monthly premiums and all out-of-pocket expenses. It’s important to do this in-depth analysis, especially if you’re considering switching between Original Medicare and a Medicare Advantage plan. While this kind of evaluation can be tedious and time-consuming, it’s worth it. If you’re living on retirement savings, you only have a certain amount that you can spend. It’s important to find the most cost-effective plan with the coverage you need to make your retirement savings last as long as possible. Do your research Medicare Advantage and Medicare Part D (Prescription Drug Plans) change every year. Additionally, companies offer new plans. There are a couple of important things to research about your current plan and for any new plan you consider: Changes New plans Coverage Cost saving resources Changes Make sure you know how your plans are changing by doing your own research. There are several great resources to help you understand how your current plans are changing, like Medicare.gov and Annual Notice of Change (ANOC) letters. Medicare.gov Troy Baccus, Medicare Life Group owner, suggests using Medicare.gov reports to check for changes in your Prescrption Drug Plan (PDP): “The best thing you can do to prepare for AEP is run a new prescription drug plan report on Medicare.gov. You'll want to wait until at least October 1 to run the report and make sure you are running the report for the year 2022 (it may default to the current 2021). Running a prescription drug plan report will help you confirm your current plan is still your best option for 2022. If not, you can usually enroll in the another plan directly from the Medicare.gov website.” Annual Notice Of Change Danielle K. Roberts, Boomer Benefits founder, suggests reading the Annual Notice of Change letter:“Review your Annual Notice of Change letter from your current Part D or Medicare Advantage carrier. You will receive this by mail in September. Look for what is changing that might affect you. Is the premium going up? Have your copays substantially increased? Are they dropping any of your important medications? If you find something you don’t like, then you have an opportunity to make a change during the upcoming OEP that begins on October 15th. Make a list of all your current medications, including dosage and frequency. You can enter these into the Plan Finder Tool on Medicare.gov website beginning in October. This will help you to search for plans that you know will cover your necessary medications.” New plans Because Medicare Advantage plans are privately operated by companies, companies can release new plans every year that can be a better option than your current plan. “New Medicare Advantage plans may be available in 2022 that provide superior coverage to your current plan. The easiest approach to review your Medicare Advantage plan is speaking with an independent agent. Just make sure they've got your best interest in mind and aren't looking to make a quick sale (we recommend checking out their Google reviews, if possible),” suggests Baccus. Coverage Coverage and access to your doctors are some of the most important things you need to double-check for your Medicare plans. To be clear, you can always see any doctor you like, but the cost-sharing available from your plan based on what plans your doctor accepts will affect how high your health care expenses are. “Reviewing your plan every AEP is important. Not only will you want to make sure your current plan will remain your best option for prescription coverage in 2022, but you'll also want to confirm your doctor will remain in network,” says Baccus. When checking your coverage, it’s a good idea to do your own research instead of relying on third-party information. “Please do not take a salesperson’s word for your network coverage, call your providers and ask – “will you be taking this specific plan next year?” Why specific? Because some companies have multiple plans, and your provider may not take them all. Going to medicare.gov is a safe recourse to get the facts,” recommends John Hill, President of Gateway Retirement. Cost saving resources Each state has federally funded programs to help people pay their Medicare premiums, typically for Original Medicare. If you qualify and apply, you may be eligible to participate in some of these Medicare Savings Programs. “During enrollment, be sure to look into the various savings programs available that can help pay for premiums, out-of-pocket costs, prescription costs and more. There are a number of services available and utilizing them can help you save money,” suggests Michael Stahl, HealthMarkets Executive Vice President and Chief Marketing Officer. Set an appointment with an agent If you’re new to Medicare or want help evaluating plans, meeting with an independent agent can be a smart move. “I always stress the importance of sitting down with a licensed, non-biased insurance agent who can provide information on Medicare, what is or is not covered, and pricing so you can be informed when it comes time to make decisions during enrollment and choosing your Medicare provider(s),” says Stahl. While experienced and knowledgeable agents can offer valuable insight and assistance with Medicare plans, it’s important to find a trustworthy one. “Seniors should find a solid broker with a consistent track record of providing value in the senior community and giving unbiased advice,” says Christopher Westfall, Sr, Senior Savings Network founder. Looking at client reviews and taking recommendations from friends can help you find a reliable agent. Beyond considering reviews, Medicare has rules regarding what insurance agents selling Medicare can and can't do when working with clients. Understanding these can help you identify good agents. Knowing that you’re getting good advice can be difficult to determine, especially if you’re not familiar with Medicare. If you want to be an informed decision-maker, it’s worthwhile to do your own research. “Do your own research rather than only relying on information from insurance agents. There are quality rating systems online and free resources from your state’s Senior Health Insurance Program,” advises Byck. Preparing for Medicare Annual Enrollment Understanding your health care expenses and coverage levels from this year will help you forecast costs for next year. It will also help you determine if it’s best to stick to your current plan or if another Medicare plan would be better. It’s also essential to be aware of any changes to current plans for next year. Knowing these changes will also help ensure that you enroll in the coverage you need in 2022. Working with a good agent can also help you understand your options and make an informed choice. Even working with an agent, do your own research so that you can ask these important questions and get the information you need to make the best choice for your health plan.
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