OPEN ENROLLMENT for those who purchase health insurance on the Affordable Care Act exchange is drawing near. It’s your once-a-year opportunity to choose a plan that best fits your needs and your pocketbook. We can help you get started. While you can choose a plan on your own on the government’s website, we can guide you towards a plan you’re most suited for. Thanks to COVID-19 pandemic-era legislation, there are generous subsidies for health insurance, with many people paying less than $100 a month or nothing for Bronze level plans and some paying nothing at all. These subsides are set to expire at the end of 2025 (see page 1 for details).
Under current rules, if health insurance premiums would account for more than 8.5% of your houshold income, you may qualify for subsidies.
Your Choices
Plan options will vary depending on where you live. Some states only have a few insurers that participate in Affordable Care Act exchanges, others have many vying for business in the same city or county.
You’ll likely have more options in a larger metropolitan area versus a small town. You’ll be faced with choices of four types of plans named for four precious metals, which are ranked from lowest premium/more out-of-pocket costs to high premium/low or no outof-pocket costs, as in the box below.
The least expensive bronze plans may feature low premiums but high deductibles that may be as high as $9,000 a year for an individual plan.
Metal Plan Coverage
• Bronze plans (lowest premium) cover 60% of your medical costs.
• Silver plans cover 70%.
• Gold plans cover 80%.
• Platinum plans (highest premium) cover 90%.
What’s best for you?
When deciding what plan is best for you, think about your health and your family’s health and financial situation.
Do you see a doctor or other health care provider regularly to help you manage a chronic disease or condition? Do you take costly medications? You may want a health plan that has lower copays and deductibles if you’re a frequent user of services.
Here’s what you need to consider:
• Can you afford the premiums?
• Can you pay the out-of-pocket costs and deductibles if you need care?
• Are your doctors and hospitals in the plan’s network? • Do you mind getting a referral to see a specialist?
• Do you want the flexibility to see providers outside of your network?
Once you answer these questions, you can compare plans and see what’s best for you. Even if you already have a plan, it’s smart to check every year to see if your doctor or hospital is still in-network.
Likewise, if you need a specific medication for a chronic condition, you will want to make sure the plan you are considering covers it. You should also revisit your plan to see what next year’s premium is going to be. Some insurers will raise rates more or less than others, so it pays to stay on top of your plan.
If you want to understand more about available plans, schedule an appointment with Mark Williams. He can guide you through your options and help you make informed decisions about your healthcare coverage.