Job losses, resignations and early retirements triggered by the COVID-19 pandemic have put many people in the position of shopping for insurance from the individual marketplace, perhaps for the first time.
In Oklahoma, more than 480,000 adults younger than age 65 are uninsured, with about 39% of them qualifying for free or reduced-cost insurance premiums through marketplace coverage.
The Mobile Assistance Center team for Blue Cross and Blue Shield of Oklahoma (BCBSOK) is dedicated to educating consumers about their options during open enrollment. The team’s specialists recommend keeping some important factors in mind.
The open enrollment window is open
It’s time to start comparing plans. Consumers have until Jan. 15, 2022, to select coverage. Enrolling by Dec. 15 guarantees coverage will begin Jan. 1, 2022.
There’s a good chance you qualify for a subsidy
Nationally, an estimated 12 million uninsured people are eligible to buy coverage through the marketplace. With expanded subsidies under the 2021 American Rescue Act, most will qualify for free or reduced-cost monthly premiums, the Kaiser Family Foundation found.
At least 6 million uninsured people could get a $0 premium marketplace plan. And, according to the U.S. Department of Health and Human Services, 4 out of 5 people can find a plan costing no more than $10 a month.
Even people with incomes between 400% and 600% of the federal poverty level, who previously earned too much to qualify for subsidies, (up to $76,560 for a single person or $157,200 for a family of four) could save an average of $213 per month.
There’s more to health care costs than premiums
No matter how low the premiums, people may be tempted to underinsure themselves to reach $0 premiums, says Melissa Summar, a BCBSOK communications specialist.
“The lowest-premium plan may have a high deductible,” she says. “If you have high-utilization rate, then you could end up paying way more out of pocket over the year. Sometimes paying a little more premium may save you more in deductible, copays, coinsurance and out-of-pocket costs.
Although some retail customers now may qualify for Medicaid, they still may find better coverage through the marketplace, Summar says.
“A retail plan could be more comprehensive and include a larger network of providers that they could visit,” Summar says.
However, Medicaid-eligible consumers who buy marketplace coverage will not qualify for a premium tax credit.
Think about your provider network
There’s also more to a plan than its price tag. All plans don’t include the same doctors, clinics and hospitals. Do you like your doctors? Do you or your kids require ongoing medical care? Look for a plan that includes the doctors and hospitals you want in its provider network.
Accurately report your income
It makes sense people want to qualify for the lowest-possible premiums. But the Internal Revenue Service will expect them to make up the difference if they earn more than they claim when buying insurance.
People who get subsidies fill out special tax forms, and any income differences will be reflected in their tax payment or refund, Summar says.
Automatic re-enrollment isn’t always in your best interest
Current marketplace members should take a fresh look at their plans and options before automatically re-enrolling, Summar says. It’s important to check for changes in the provider network, drug coverage and premiums.
“Every year people make a decision and they don’t think about it again,” she says. “We have to help them understand what they purchased and how it may have changed.”
Ask for help
With the Dec. 7 deadline for Medicare quickly approaching, the team also can answer questions about Medicare supplement and Medicare Advantage plans. BCBSOK is offering Medicare Advantage plans in more counties and with more benefit choices in 2022.
“I really want people to look at us a resource,” Summar says.