With open enrollment on government-run health insurance exchanges starting on … and going through …, it’s time to start thinking about whether you will stay in your plan or look for another one.
Fortunately, there is one year left to take advantage of generous government subsidies under the Affordable Care Act that have brought the cost of coverage down significantly for the majority of people, with the lowest earners paying a few bucks or nothing at all for good coverage with low or no deductibles. These subsides are on a sliding scale, with higher-income earners receiving fewer subsidies.
If you are unemployed, self-employed or work for an employer that doesn’t offer health coverage, now is the time to get off the fence and take advantage of this government assistance.
Here’s what you’ll need to know about open enrollment and your choices.
Important dates
Nov. 1: The first day to enroll, renew or change plans.
Dec. 15: The last day to enroll or change plans for coverage starting on Jan. 1, 2025.
Jan. 15: The last day to enroll or change plans for 2025 with coverage starting on Feb.1, 2025.
Plan categories
The plans being sold over the exchanges come in four tiers: Bronze, Silver, Gold and Platinum.
Bronze plans usually have the lowest premium, but have higher out-of-pocket costs and deductibles. Conversely, Platinum plans have the highest rates, but the most generous benefits with the lowest out-of-pocket expenses.
According to the Centers for Medicare & Medicaid Services:
- Bronze plans typically pay about 60% of medical costs, while the rest is covered by the policyholder.
- Silver plans typically cover about 70% of medical costs. There are some Silver plans that will pay more, between 73-96%.
- Gold plans typically cover about 80% of medical costs.
- Platinum plans typically cover about 90% of medical costs.
When you work with us to purchase marketplace coverage, here’s what you should consider:
Health care spending — Based on what you spend on health care this year, estimate how much you will spend next year, including premium.
We can help you review plans in different categories to see how the plan’s share of costs can adjust the estimate for your total yearly costs.
Silver plan “extra savings” — Enrol in a Silver plan if you qualify for extra savings. You’ll find out if you qualify for these savings when you apply for a marketplace plan. You only get the extra savings if you enroll in a Silver plan.
The premium tax credit — We can help you find out if you qualify for a premium tax credit. If you qualify, you can get lower premium costs in any metal plan category, thanks to generous federal government subsidies (these expire at the end of 2025 unless Congress acts).
Coverage — All marketplace plans in every plan category must cover the same 10 essential health benefits, including preventive services, with no cost-sharing. Many plans also offer programs that help manage chronic diseases and health conditions before you meet your deductible.
Quality of care — We can help you compare each plan’s quality with its quality rating, which ranges from one to five stars, from worst to best.
Other considerations
Health maintenance organizations and preferred provider organizations generate significant premium savings by restricting choices to their network. Out-of-network non-emergency care may cost much more out of pocket or may not be covered at all.
If premium savings are very important to you, HMOs and PPOs can be excellent options. However, there are some PPOs and HMOs that have very high deductibles on the marketplace. These can leave you significantly out of pocket in case of a sudden illness or injury.
If you want to be able to select any doctor, and your preferred doctor is not in the network, then you may want to consider other options, such as indemnity plans.
If you regularly use health care services and have substantial expenses, it may be worth buying a higher-tier plan because you know you’ll get the benefit of a lower deductible and a better coinsurance rate.
If you are reasonably healthy and rarely use health care services, and have no particular reason to think you will in the next year, it may make sense to opt for a lower tier.
Open enrollment
During open enrollment, we can help you find a plan that best works with your health circumstances and your budget. The key to finding a plan is to look for:
- Affordability (on the front end and back end in the form of out-of-pocket expenses).
- A doctor network that includes your preferred doctor.
- Your preferred pharmaceuticals on the plan’s drug formulary, to make sure they are covered.
Give us a call.
