November marks the beginning of the holiday season, and the start of a busy time in health insurance: The Affordable Care Act’s open enrollment period.
Millions of people are eligible for insurance through the ACA marketplace, said Jeness Sherrell, an ACA navigator at Change Happens, a nonprofit in the Third Ward. This is the time Texans get the chance to check out the market and shop for new coverage if they’re unhappy with their plans.
Navigators like Sherrell, who help people pick new plans, say there’s been a jump in interest this year as the coronavirus-driven recession forces layoffs and sends newly unemployed individuals searching for affordable health insurance.
Here’s what you need to know about enrolling during the 2021 open enrollment season.
How do you enroll?
The website to enroll is healthcare.gov. Between Nov. 1 and Dec. 15, everyone can check the federal site to see if they qualify for a marketplace insurance plan and enroll online.
You can also find a plan through an insurance broker or designated ACA navigator. If you plan to work with a third party to pick your insurance, you can do it in-person or over the phone. Some navigators, such as Change Happens, may offer options to review plans through curbside assistance this year.
Be sure to have handy the name of your health care provider if you see a primary care doctor or specialists, along with prescriptions for medication, so a navigator can help you pick a plan that includes those providers and services in-network.
More Information
Glossary of terms
Premiums: The amount you pay for health insurance every month.
Deductibles: The amount of money that an insured person must pay before insurance companies begin to pay out claims.
Co-insurance: The share of medical costs patients pay after filling the deductible.
In-network: Insurance carriers have agreements with each hospital, clinic and/or doctor’s office to negotiate down prices. If your health care provider is in-network, you’ll see them at a discounted price.
Out-of-pocket costs: Deductibles come first. After you fill that, your insurer will start paying a percent of your medical bills. You’ll have to pay the other portion — a reduced cost from what you would’ve paid if you were still trying to fill your deductible. Some plans will have separate meters for your deductible and out-of-pocket costs. Once you’ve hit the cap on the latter, insurers will cover the full costs.
Open enrollment: The period of time from Nov. 1 and Dec. 15 to pick a health insurance plan for the next year.
Special enrollment period: When a person has a qualifying life change such as unemployment, the death of a spouse providing health insurance or moving, they can apply for insurance through the marketplace in the 60 days following the event.
“The navigators are able to explain terms that some consumers maybe don’t understand,” Sherrell said. “They may have heard of a premium before, but may not know the difference between cost-sharing and out-of-pocket expenses.”
MORE ‘HOW TO’: Here’s how to navigate Medicare open enrollment
Some people can also qualify during special enrollment periods, which are 60-day periods after major life events like the death of a spouse, moving or losing employer-sponsored insurance. That can happen any time during the year.
What plans are available?
Healthcare.gov has a directory of the plans. To preview the plans, type in your zip code. There are 32 bronze-level plans, 37 silver-level plans and 15 gold-level plans in Harris County. Surrounding counties like Fort Bend and Montgomery counties offer fewer plans.
This year, six carriers are offering insurance in Houston: Ambetter, Blue Cross Blue Shield of Texas, Community Health Choice, Friday Health Plans, Molina and Oscar. Friday Health Plans is the new insurer in town.
Gold plans have lower deductibles, meaning that they require patients to spend less of their own money on health care before insurance covers all the costs. Bronze plans have lower premiums, so customers pay less every month but higher deductibles when they need care. Most consumers prefer silver plans, an in-between.
Shoppers can add primary care doctors, specialists, frequented hospitals and medications to the filters on the plan directory pages to see whether each carrier includes them in their networks.
What are the most important things to consider in a plan?
Consumers should consider what their deductibles, co-pays and co-insurance (the share of the costs a patient is responsible for after fulfilling the deductible) will be on the plan. While premiums are important, said Stacey Thompson, an ACA navigator at Change Happens, there’s more to health care costs than what customers pay each month in premiums.
“You want them to explain how it’s broken down,” Thompson said. “When you go to the doctor or get medication, what co-pay will you have to pay when you go there?”
Patients need to know how much they’ll be expected to pay out-of-pocket before insurance covers the full costs.
How much can I expect to pay?
It depends. If you make less than 400 percent of the federal poverty line ($51,040 is the cap for an individual), you might qualify for a tax credit. The tax credit depends on your estimated income level and household size. You have the option to apply all or some of the tax credit toward your monthly insurance premium.
Individuals and non-smokers have lower rates. If you’re also looking for insurance for a spouse, dependents or you smoke, your premiums will be much, much higher. (Note: Some prices increase as you get older, but they’re limited by the Affordable Care Act.)
For example, a 26-year-old woman, who does not smoke and makes $38,000 per year, qualifies for just $4 in monthly tax credits. The cheapest plan, a bronze Friday Health Plan offer, has a $189.27 monthly premium and $8,550 deductible.
A family of four (two 35-year-old adults, neither of whom smoked, with a 10-year-old and 9-year-old and household income of $60,000 per year) qualify for a $860.27 monthly subsidy in the form of tax credits. The bronze Friday Health Plan would cost a $0 monthly premium (after tax credits) and $17,100 deductible, meaning they would have to pay $17,100 out of pocket during the year before their insurance would fully cover medical costs.
What if I just want to renew my current plan?
If you don’t log on to healthcare.gov and enroll by Dec. 15, you’ll likely be re-enrolled in your 2020 plan. Your insurer should have sent a letter earlier this fall with expected changes to your plan and information on whether you’ll be automatically re-enrolled.
Consumer advocates, however, say you should still log on and compare prices if you’re concerned about getting a good deal.
“You need to go back and shop every year because things change,” such as income level or household size, said Stacey Pogue, a senior policy analyst at Austin think tank Every Texan.
Texas Inc.: Get the best of business news sent directly to your inbox
The Affordable Care Act is going to the Supreme Court, right? How does this affect the plans?
On Nov. 10, the Supreme Court is expected to hear an hour of arguments in Texas v. California, the state’s challenge to the Affordable Care Act. The state’s attorney general, Ken Paxton, has challenged whether the Affordable Care Act is constitutional.
The earliest that a decision would be made in the case is June 2021.
As of the beginning of open enrollment, the Affordable Care Act is still a law. People can enroll in health plans and expect to keep their insurance for the year. Health insurance coverage for 2021 is not at stake with this hearing, Thompson said.
gwendolyn.wu@chron.com
twitter.com/gwendolynawu
"exchange" - Google News
October 30, 2020 at 06:00PM
https://ift.tt/37VIDew
How do you enroll on the 2021 Affordable Care Act exchange? - Houston Chronicle
"exchange" - Google News
https://ift.tt/3c55nbe
https://ift.tt/3b2gZKy
Exchange
Bagikan Berita Ini
0 Response to "How do you enroll on the 2021 Affordable Care Act exchange? - Houston Chronicle"
Post a Comment