Richard Notter

Notter

While many receive coverage through an employer-sponsored health plan, those responsible for their own coverage can enroll in an individual or family plan through healthcare.gov during open enrollment.

This year, the period to renew, change or update health plans for 2022 runs Nov. 1 through Jan. 15, 2022. For Jan. 1 coverage, individuals must enroll by Dec. 15. There are plans to fit each person’s health care needs and budget.

Individuals who experienced life changes such as the birth of a child, marital status or adjustments to employment and income, especially considering the COVID-19 pandemic, may be eligible for additional assistance including subsidies or state-sponsored benefits.

Five questions to ask when considering changing health insurance plans:

  1. Are there changes in health status?If an individual has a newly diagnosed chronic condition or plans on a major medical procedure in 2022, they may want to change to a plan that covers the types of provider visits and prescription medications that will be needed in the next year. Reviewing the in-network providers is an additional step when considering a change.
  2. All marketplace plans provide treatment coverage for preexisting medical conditions and coverage cannot be terminated due to a change in health status, including diagnosis or treatment of COVID-19.
  3. Are there changes in income?Financial assistance may be available for individuals and families who experienced changes in income or employment. Health care subsidies can offset the costs. Because of the 2021 American Rescue Plan Act, health insurance subsidy eligibility expanded to those with income above four times the federal poverty level. Two types of subsidies:
  4. Advanced Premium Tax Credit: Tax credit taken in advance to lower monthly health insurance premiums. Those who qualify based on their estimated annual income can use any amount of credit in advance to lower their premium. This can be used toward bronze, silver, gold or platinum categories.
  5. Cost Sharing Reduction: Lowers the amount individuals pay for deductibles, copayments and coinsurance. In the health insurance marketplace, these are often called “extra savings.” However, those who qualify must enroll in a plan in the silver category to receive extra savings.
  6. Are there changes in the number of dependents?Subsidy eligibility is determined by multiple factors including income, number of dependents and filing status, so check frequently as status can change yearly.
  7. Is there a change in job status?During the pandemic, many people experienced financial hardships due to lost employment or reduced hours. Those who have may qualify for a special enrollment period if they lost health coverage through their employer or a family member in the past 60 days or expect to lose coverage in the next 60 days.
  8. Has an individual recently turned 65?These individuals are eligible for health coverage through the Medicare program. Individuals can enroll in Medicare three months before their 65th birthday, during their birthday month and three months after their birthday.

Medicare plans have their own annual election period: Oct. 15 to Dec. 7. Individuals enrolled in a Medicare plan may adjust their coverage to add Medicare Advantage or Part D coverage or change plans during this time. The changes take effect Jan. 1, 2022.

About the author: Richard Notter is vice president of Individual Business at Blue Cross Blue Shield of Michigan.

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