The ACA Open Enrollment Period (OEP) starts tomorrow for Healthcare.gov and most of the state based marketplaces. Idaho allowed shopping earlier in October. During OEP you can switch plans for any reason. You can buy a plan for any reason.
Here are a few things to remember:
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- Health insurance is complicated and complex so go get help
- Navigators are government funded helpers who can’t make a specific recommendation but can help reduce complexity
- Agents and brokers can make specific recommendations but they work on commission/premium while they are only required to give good advice not optimal advice.
- Take your time
- Open Enrollment goes through at least December 15th for all markets and through January 15 for Healthcare.gov
- Be ready to accept good enough instead of perfect.
- Look around and actively choose
Looking around and actively choosing is the most important advice I can give every year. The ACA’s use of price linked subsidies combined with the non-stickiness of the marginal enrollees means that every year insurers aggressively compete to offer very low premium plans. This means that a plan in Year 1 that is a great deal may be a really bad deal in Year 2 for an individual who is mostly buying on price. Sometimes this happens even if the same insurer offers the cheapest plan in both years. Looking around and making an active choice minimizes price surprises.
It is particularly important this year as over 1 million people will be automatically re-enrolled into different insurers because Bright (nationally) and Friday (Texas) withdrew from the markets very late as regulators were suspicious about their ability to sustain losses and pay claims. These folks will be automatically re-enrolled into new plans but the odds that these plans are the plans that they would want are fairly low.
Finally, if you have purchased an “off-exchange” plan for 2022 where you are not eligible for subsidies, unless you are an arbitration eligible second basemen who can actually hit a curveball with authority and a good bat angle, you are likely leaving potential cost-savings on the table. See if you can convert your off-exchange plan into an on-Exchange plan that is eligible for ACA premium subsidies.
Good luck and remember — ask for help. This is complicated and messy.
Within the Margin of Effort – 25 Pairs of Boots On the Ground in AZ
WaterGirl
Thanks for this, Dave.
Sister Golden Bear
Thanks for the info.
I’ve got a question: I was laid off and opted for COBRA because comparable CoveredCA plans were about the same price, but had large deductibles. Hopefully I’ll be re-employed, and on a new employer’s health plan soon.
But worst case, what are the rules around switching from COBRA to ACA insurance? I.e. if I wanted to switch in January when the deductibles reset anyway, would I need to change by the Dec. 15 deadline?
David Anderson
@Sister Golden Bear: You can buy an ACA plan for any reason during the OEP period. You can buy an ACA plan even if you have other coverage.
I would consult with a navigator to look at your subsidy eligibility with COBRA as an option.
If you want January 1 coverage, you need to make your choice by December 15 (you might have a day of unnannounced wiggle room, but don’t count on it.)
raven
It’s odd timing but my bride terns 65 on December and we have started the process to get her the stipend from my work to pay for the Medicare Supplemental plan!
RaflW
So, here’s our issue we could use help with, if anyone has suggestions. My partner is finding that cyclosporine ophthalmic emulsion is helpful (dunno if it’s the fancy brand name one sees advertised, or the one recently approved generic), and started with the medicine several weeks ago. The first month appeared to be ‘covered’ by his insurance. But when he went to refill, the major chain wanted a hare over $500 for the next pak.
He called his ins. co because the first month had no co-pay. It’s a bit murky why there wasn’t, but the ins. co is saying the $500 is the ‘covered’ price, that it’d be >700 without ins.
Q: Is it possible for 2023 to shop plans at this level of formulary coverage? If so, how. And can the ins. co. change the formulary mid-year and screw him anyway? Is this something a navigator can help with? A broker? We’re in MN which in theory has ‘not for profit’ health ins on the individual market. FYI he’s on a cobra plan, and can stay on it thru Nov 30, 2023. But he can of course shop for a plan (I think he could qualify for some amount of subsidy, at least looking at his projected income for 2023, but he also took a big pay cut in 2022 hence the cobra).
Scout211
@Sister Golden Bear: @David Anderson:
I don’t know the answer to the COBRA vs. ACA question but here is the Covered California site.
It looks like CoveredCA open enrollment is November 1 through January 31.
William D
any thoughts on whether adding dental coverage makes financial sense?
David Anderson
@William D: If you strongly suspect that you’ll use a good amount of dental services next year (extraction, root canal etc) then dental insurance likely makes sense; otherwise, it is just a limited buyers club with decent per unit prices at best
RaflW
OK, so I looked around a little. The MN health ins site seems to let me search by both preferred doc + prescription name. But when I go to the specific insurer’s site, they say they can change the formulary with 90 days written notice.
If a $500/mo drug gets dropped from your formulary mid-year, is that a qualifying event to shop elsewhere? I hate this shit.
Scout211
@RaflW:
It looks like some insurance plans will approve Restasis if your doctor fills out a medical request form.
There is also a generic now and in the meantime, have you checked the discounters like GoodRx for coupons and discounts?
O. Felix Culpa
@Scout211:
Not directed at you, but isn’t it a shande that USians still need to cobble together f’ing coupons to afford necessary medications? I’m so glad we have the ACA, but WTF. Still more work to be done.
Sister Golden Bear
@David Anderson, @Scout211: Thanks to you both.
Scout211
@William D: @David Anderson:
We pay for a dental plan. The thing that helped us make the final decision for or against was more psychological than financial.
If you had to pay out of pocket for regular preventative check-ups, X-rays and cleanings, would you make a point to do that every 6 months?
We decided that we would likely put off that preventative care and likely end up with worse problems. The check-ups in our plan are no co-pay so we do schedule those twice a year.
We felt it was worth the monthly premiums and with my recent root canal and extraction, it helped keep our cost share down to a minimum.
Ohio Mom
@RaflW: I also have dry eyes and use horribly expensive prescription eye drops, mine are named Xiidra.
What I have learned to do is eke four drops out of each vial. After the first set of drops, I store the vial, opening facing up, in a cup until it’s time for the next dose. Since there is no preservative in the solution, I am very careful to keep the opening of the vial untouched. My ophthalmologist is fine with this.
The other thing that has helped my eyes is starting a medicine for my RA (still need the prescription drops but not dependent on OTC “tears” anymore). The way I figured that I needed to ask for an RA test was that I read a brochure on dry eyes in the ophthalmologist’s waiting room and it mentioned RA as a possible cause. I put that together with my sore finger joints.
The moral of this story is, I hope your partner has worked with his PCP to rule out other causes for his dry eyes.
BretH
Where does one go to get the help needed to navigate insurance selection, if not a broker?
Scout211
@BretH: You can start here: localhelp.healthcare.gov/