So, What is Open Enrollment, Anyway?
What is Open Enrollment?
Open Enrollment is the official time of year where you can look at the health insurance plans available to you through the Marketplace, (AKA: ObamaCare, or ACA). It is very important you take advantage of this time to carefully choose the best plan for your situation and complete enrollment before the deadline. If you miss out, then coverage within the ACA will not be available to you until next year. In addition, if you choose a plan you later decide isn’t right for you, you’re unable to change until the next open enrollment.
When is Open Enrollment?
Open Enrollment officially begins this year on November 1, 2024. You are able to research plans that will begin at the start of 2025. It is important to note, if you need your plan to begin on January 1, 2025, then you will need to enroll in the plan you choose by December 15, 2024. Enrollment will still be open until January 15, 2025. All plans enrolled between December 15, 2024 and January 15, 2025 will begin on February 1, 2025. As stated above, if you do not choose a plan by January 15, 2025, then coverage through the ACA will not be an option for you for calendar year 2025, unless you have a qualifying life event. You can browse the Marketplace plans offered to you and enroll at https://www.HealthCare.gov
Do I Have to Enroll in ObamaCare?
No. The Marketplace is an option, but not the only option. Other options you may explore are group plans, (if you or your spouse work for a company that provides coverage options), private health insurance or short-term plans. Chances are, if group coverage through an employer is an option, then you’re probably already enrolled, and truthfully, should probably stay put (although, exploring all options is always advised). Private health insurance is a fantastic option for healthy people who have an income that places you above the subsidy receiving threshold – more about this to come. Short-term plans are always an option, but should be cautiously considered if you’re planning to be on them for, well, more than a short time.
Why Should I Choose a Marketplace Plan?
Two of the biggest reasons a Marketplace plan, or ObamaCare would be the right option for you are: your financial situation and/ or your health conditions. First, let’s look at the financial aspect. ObamaCare is set up to allow lower income individuals and families be able to afford health insurance on a monthly basis. The premium amount is set based on the household size and income. The government provides a subsidy to lower income people to help pay for the health coverage premiums. This allows individuals and families to obtain health coverage sometimes at no cost to them! That sounds great, right?! You should always be sure to read through all the plan documents to make sure the plan you choose is right for you. Plans are not all created equal and it will be important for you to understand your out of pocket costs you’ll be responsible for, as well as making sure your prescriptions, doctors and preferred hospitals are in network and covered. Secondly, taking your pre-existing conditions into consideration is important. ObamaCare does not decline anyone for coverage. Meaning, even if you have cancer or are in renal failure, etc. you can still obtain health coverage. If you have a pre-existing condition that would limit private health care coverage options, then ObamaCare is the right place for you to be.
Does My Whole Family Have to be on the Same Plan?
Great question! The answer, is No. Sometimes, it’s best for the one family member with pre-existing conditions to be on the Marketplace while the rest of the family is on a private plan. Why, you ask? Well, there a a couple reasons. First, if your family doesn’t qualify for a subsidy, then Marketplace plans are often more expensive than a private plan option. So, splitting the family can save money when it comes to the monthly premiums. Second, if more than one person is on a Marketplace plan, then you have to reach that family deductible instead of the individual deductible. By moving the rest of the family to a different plan, this significantly lowers the out-of-pocket costs to the person needing more health benefits – again, saving a substantial amount of money.
Where Do I Find Private Plan Options?
There are options outside the marketplace that may be a better fit for you. Private health coverage is more affordable monthly and offers stronger, more flexible benefits. There is only one private plan option out there that offers long term, guarantee-renewable coverage. That means, you’ll never be kicked off the plan if you’re diagnosed with a major illness. You do not have to go through anymore enrollment periods. As long as you’re paying your monthly premium you will continue to have coverage. You may be subject to medical underwriting. Typically, this coverage is about 40% lower cost than the marketplace. So individuals or families who do not qualify for subsidies save thousands on their premiums every year. Additionally, deductible options are much lower, ranging from about $2,500 – $10,000. This plan offers you a PPO network – which means you can use it in any geographic location – even across state lines, which makes it great for travelers too! Having a PPO network also allows you to see any specialist without needing a referral from your PCP. You even have the Mayo Clinics and MD Anderson in Texas in your network so you have the best treatment centers for big diagnoses. In addition, a PPO network gives you a discount on all services received, before it’s sent to claims, saving you even more money. Cash benefits for critical illness diagnoses are typically included, as well as options for accident coverage, short-term disability, term life coverage, vision and dental. These are all benefits not given to adults in the marketplace world. You do need an advisor to navigate this option, as it is not obtainable on your own. If this is an option you’d like to explore, I’d be happy to help you and my services are free. Feel free to set up a time for us to connect, here
How Do I Know if a Short-Term Plan Would be Right for Me?
Any plan on the internet that you find, that is outside the Affordable Care Act, is a short-term plan. This is very important for you to understand, because they are not always advertised as a short-term plan and you need to understand why that would be important to you. Short-term plans are a great option for people that have left one job and coverage at their new job does not start right away. This can offer them a “bridge” to get to new coverage at their new job. It would also be a good option if you plan to enroll in marketplace coverage, but it’s not that time yet. In my experience, short-term plans are not usually suitable for self-employed people who plan to stay on the coverage long-term. Why? Because short-term plans are exactly that. Short term. They only cover you for a set amount of time – ranging from a couple months to 1 year. This means that once your term is up, you have to re-enroll. So, any new conditions that have developed during this time will now NOT be covered on the new term – even if it’s the exact same plan you had last term. This can be a terrible situation for someone diagnosed with cancer or any other expensive, long term condition or illness. Now you have this pre existing condition and your only option will be the marketplace. Even worse, if your short term plan ends at the beginning or the middle of the year, you cannot obtain ObamaCare coverage until that enrollment period and it won’t be effective until January of the next year. Going without coverage when you have an expensive illness – well, you get the idea. A lot of people are enticed by short-term plans because the monthly premium is typically much lower than the marketplace or the private long term coverage. This should be a red flag for you. Health insurance is not “cheap” and if you find a plan you consider “cheap”, then there are probably risks you’re taking. Additionally, it’s also important to know that many short term plans are indemnity plans. An indemnity policy is one where the health insurance company agrees to pay a set amount for the facility, physician, prescriptions, etc. After the insurance company pays that amount then you are responsible for all remaining medical expenses, no matter the cost. Not having an out-of-pocket max can be very risky and could cost you tens of thousands of dollars.
I Read all This and I’m Still Confused
No worries. Health Insurance coverage options can be confusing. You got the idea that choosing the right plan is very important, so it is totally ok that you’re nervous about making the right choice. I’m happy to help you navigate your options to help you find the most suitable plan for you and your family. Again, my services are free and you can set a time convenient to you here.
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