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Getting the right health insurance coverage during open enrollment is one of the most important decisions Americans make to protect their health and finances.
But people usually have a lot of questions during open enrollment, which, for many, runs through November – for Medicare, open enrollment goes from October 15 to December 7.
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We asked two Aetna executives, Kyu Rhee, MD, Masters of Public Policy, chief medical officer, and Anand Shukla, senior vice president of individual and family plans, five often asked questions about open enrollment and health coverage. Their answers, slightly edited for space, follow.
What should consumers be aware of during this year’s open enrollment?
- The open enrollment period is November 1, 2022, through January 15, 2023 (some states extend open enrollment through January 31).
- Consider the “’five Ds’”: the doctors, the drugs, the diagnostics, the deductibles and dollars (cost and affordability)” before deciding on coverage. Leverage the public health exchanges to look affordable, high-quality plans aligned with providers in your area.
- Understand your total cost of care — premiums, out-of-pocket costs and deductibles.
- Be sure to research and ask about subsidies you may be eligible for. These subsidies reduce your cost for health care coverage. Enhanced subsidies through American Rescue Plan established for 2021 and 2022 gives consumers more purchasing power through healthcare cost subsidies. The Inflation Reduction Act extended these subsidies through 2025.
- There are many knowledgeable resources who can provide guidance and support: brokers, health insurance plans, healthcare.gov call center, and local resources such as navigators and enrollment assisters, who help people get coverage.
What should consumers be looking for when searching for health insurance?
- There are many factors to consider when individuals and families shop for health insurance on the exchanges – your budget, your health situation, deductibles and out-of-pocket costs. As you evaluate insurance options, make sure to choose an individual and family plan that supports you and your family’s preventive care, clinical conditions and acute health needs.
- Coverage plan prices on the exchange vary, depending on family income, the number of people insured and the coverage selected.
- Depending on your income, you could qualify for premium tax credits and cost-sharing reductions to your out-of-pocket expenses. Work with a broker to determine your best option.
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With rising healthcare costs, should consumers consider alternative healthcare options, such as short-term coverage?
- Short-term coverage is not a comprehensive insurance product. The risks of coverage denial, policy cancellations and limited access to care must be considered before purchasing this product.
- It’s very important to note that the plans offered on the Individual Exchange offer a wide variety of coverage options to fit most budgets. The four levels of exchange plans – Platinum, Gold, Silver, Bronze – all offer great benefits with different costs structures.
- For the majority of people shopping for insurance, Silver plans provide the best value with robust coverage at an affordable price.
- And don’t forget, you may qualify for subsidies that can lower your costs. For questions, contact licensed, trained agents can help you choose the right plan for you and your family.
What is the bare minimum coverage people should get and why?
Every ACA plan covers 10 essential benefits:
- Pediatric services, including oral and vision care
- Ambulatory patient services (outpatient services)
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services (those that help patients acquire, maintain or improve skills necessary for daily functioning) and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
What are your key recommendations for consumers to get the best coverage during open enrollment?
- There are many options and many carriers in most markets. Do your research and use resources such as www.healthcare.gov to assist you in choosing a plan and with the enrollment process.
- As you evaluate insurance options, make sure to choose an individual and family plan that supports you and your family’s preventive care, clinical conditions and acute health needs.
- Consider what is most important to you in terms of cost. Some consumers want lower monthly premiums, while others are more concerned about deductibles and out-of-pocket costs. There is no right answer, just the one that best fits your needs and gives you peace of mind.
Anything else to add?
Yes. Don’t go without health insurance. Use the open enrollment period to find the coverage that is right for you and your family. The exchanges offer accessible, quality care for any budget.
Those who are uninsured experience worse health outcomes, are more likely to not seek care and more likely to be diagnosed in the later stages of disease.
