Do you hate studying the options and making your health insurance selections for next year? If so, you are not alone! It can be complicated and confusing, but simply maintaining this year’s coverage for next year may not be the best decision.
Whether you are a Medicare participant, an Affordable Care Act (ACA) Marketplace user, or have coverage through your employer, your open enrollment period is likely occurring now or is just around the corner. Regardless of where you get coverage, it is important to review the different options available and to be aware of helpful resources.
Open enrollment for Medicare users started on October 15 and continues through December 7. During this period, users can select a new Medicare Advantage Plan; switch to and from traditional Medicare (Part A and B) to a Medicare Advantage Plan; or join a different Medicare Part D (prescription drug coverage) plan.
Open enrollment for Medicare Advantage and Part D plans differs from the special enrollment period for first time Medicare enrollees. The special enrollment period begins three months before you turn age 65 and ends three months afterward, totaling seven months. Additionally, Medicare Advantage has another open enrollment period that begins on January 1 and ends March 31 of each year. During this period, Medicare Advantage enrollees can switch to a different Advantage plan or switch to traditional Medicare.
Medicare Advantage and Part D policy benefits and costs differ each year. It is important to review any changes to your plan and determine if it still fits your health care needs. Some plans are eliminated, and new plans with more affordable pricing may be available for next year.
Also, be aware that changing plans may require additional steps and medical underwriting, so it is best to work with a professional to navigate the transition.
Visit the Medicare Plan Finder on the Medicare.gov website for information on 2021 Medicare Advantage and Part D plans. If you need additional assistance, the State Health Insurance Assistance Program (SHIP) is a free and impartial counseling service exclusively for Medicare users. SHIP is not affiliated with an insurance company and does not sell insurance.
Health Insurance Marketplace
Those who don’t have health insurance coverage through an employer, Medicare, or Medicaid are generally eligible for coverage through the Health Insurance Marketplace. Marketplace open enrollment began on November 1 and continues through December 15.
If you are a current Marketplace user and you fail to update your application or enroll in a new plan, you will be automatically re-enrolled in a 2021 plan. If you are a new Marketplace user and miss the December 15 deadline, the only way to enroll is to qualify for a Special Enrollment Period. Life events that qualify include birth, adoption, marriage, loss of employer-sponsored coverage, or moving.
Updating your Marketplace application with expected income and household information for 2021 is the first step in the open enrollment process. Updates to your application should be made online, by phone, or in person. A checklist of information needed to enroll is available on the Healthcare.gov website.
Private insurance companies offer marketplace plans, which range in terms of benefits and prices. If you need assistance selecting a plan, the Healthcare.gov website includes a search feature for brokers and others that can assist in your geographical area.
Open enrollment for employer-sponsored health insurance coverage, commonly called “group coverage,” varies from employer to employer, but generally occurs during late fall and early winter. Any changes to coverage need to occur within the open enrollment window unless you qualify for a special enrollment period based on a qualifying life event.
Similar to Medicare and Marketplace plans, benefits and costs for group coverage change from year to year. This makes it important to evaluate your options annually, including any group health insurance available to your spouse or life partner. Generally, it is less expensive to obtain coverage under one plan versus being on separate plans.
Choosing the Right Plan
Choosing the right health insurance plan for you and your family might seem overwhelming, particularly if you have various options from which to choose. Finding a balance between premium costs and benefits received is crucial.
If you and/or your family are relatively healthy and are not frequent users of the health care system, you will likely save money opting for a higher deductible plan with lower premiums. If the opposite is true and you have frequent doctors’ visits or have expensive prescriptions, you may want to consider a lower deductible plan with higher premiums. Don’t forget to review the doctor and hospital networks available as well as prescription coverage when making your final selection.
Open enrollment doesn’t need to make you anxious! Set aside a little time; review all the options; and make your selection. Then, you can relax for another year!
Abby VanDerHeyden is a Wealth Advisor with Bedel Financial Consulting Inc., a wealth management firm located in Indianapolis. For more information, visit their website at www.bedelfinancial.com or email Abby at AVanDerHeyden@bedelfinancial.com.