Dear Addy: Open Enrollment Options for 2022

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Dear Addy,

I know Open Enrollment for 2022 health insurance began on November 1, 2021. As a person with a bleeding disorder, what do I need to know, and how should I go about choosing my options?

Signed,

Anxious About Insurance

https://www.youtube.com/watch?v=tZ79sOLnLzI&feature=youtu.be

Dear Anxious,

You are right that Open Enrollment just started and is the period each year when health insurance plans or HMOs (health maintenance organizations) are required by law to accept applications from new plan enrollees regardless of their health history. This also is the time when you can choose to stay with your existing health plan for the coming year if it still meets your needs. Open Enrollment dates vary, depending on the state you live in and whether you get your coverage from your employer, an ACA Marketplace, or another source – but for many people, open enrollment takes place annually in the fall.

Timing

  • If you get insurance through your job, check with your human resources department to find out when your company’s open enrollment period begins and ends.
  • If you get your health insurance through the ACA Marketplace, please note that in most states the open enrollment period will run longer than in past years.
  • Enrollment in Medicaid, for those eligible, is open 365 days a year.

Costs

  • Don’t just focus on premium costs. Your out-of-pocket spending (deductibles, copays, coinsurance) can end up being substantially more than your premium. Make sure you understand and compare OOP amounts.
  • If shopping on healthcare.gov, don’t be put off by “list” prices. Most purchasers will qualify for tax credits that lower the cost of premiums. With tax credits factored in, many people qualify for insurance that costs $10/month. Depending on income, you may also be eligible for assistance with your OOP spending, so long as you purchase a silver-tier plan.

Scope of Coverage

Here are tips for reviewing potential health plans:

  • Read all plan provisions carefully.
  • Check that your providers are in-network.
  • Research whether your products are covered.
  • Beware of copay accumulator adjusters.

If you cannot answer these questions, seek help and clarification from:

  • Your company’s human resources department (for an employer-sponsored health plan),
  • Your HTC social worker or an ACA Marketplace navigator (for Marketplace plans).

Special considerations for 2022

As you approach Open Enrollment this year, carefully research your options.

  • A federal law enacted in March 2021 makes ACA insurance more affordable for those who buy their own coverage in 2022. Under the 2021 American Rescue Plan Act, premium subsidies for 2021 and 2022 are more generous and are available to more people (even those who previously earned too much to qualify!), reducing the cost of coverage for people who buy ACA insurance.
  • Beware of “skinny” plans and insurance look-alikes that don’t provide adequate coverage: short term plans, association health plans, fixed indemnity plans, and health care sharing ministries.

    • These types of plans do NOT provide adequate coverage for people with bleeding disorders. They do NOT have to cover all ACA-mandated benefits, and they do NOT have to meet ACA financial protection standards (leaving you at risk of huge out-of-pocket costs).
    • You CANNOT get subsidies to help pay your premium costs for non-ACA plans.
    • Make sure your plan meets ACA standards for coverage and financial protection and don’t be duped by misleading sales pitches or look-alike websites. To avoid pitfalls, start your search on healthcare.gov.

  • Avoid health plans that limit your ability to make use of manufacturer co-pay assistance programs. Health plans with “copay accumulator adjusters” do not credit manufacturer co-pay assistance toward your overall deductibles or out-of-pocket maximums, leaving patients on the hook for out-of-pocket costs up to their yearly maximum. Unfortunately, it can be hard to spot whether your plan contains an accumulator adjuster. Read your plan documents carefully and call plan administrators to ask specific questions. Learn more about accumulator adjusters from HFA’s 2020 Symposium.

Be an active participant as you consider your insurance options. And whether you choose to keep your current health insurance or to enroll in a new plan, READ YOUR POLICY. This is critical because the health insurance plan you choose will be yours for 12 months unless you have a qualifying life event that allows you to switch plans.

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