As in prior years, Open Enrollment for the purchase of individual health insurance is Nov. 1 to Dec. 15. For those of you who buy your own health insurance through healthcare.gov or directly from insurance companies, this is likely the only opportunity for you to buy or change an Affordable Care Act (Obamacare) qualified health plan.
Special Enrollment Periods will still be around for people who lose coverage due to life changing events such as job loss or moving out of service area of the insurance carrier. Please note that you will not be able to enroll in a qualified insurance plan after open enrollment unless you first lose coverage and enroll within 60 days of the event.
Premium increases are generally less than 5% and one carrier’s average price is decreasing for 2021. Average premium changes from 2020 to 2021 for plans offered on the individual market range from -3.5% to 4.7%, excluding one carrier whose increase is just over 11%. You should also note that the increases are the carrier’s AVERAGE so some plans will have higher than the average increases. And, don’t be fooled – with premium reductions or low increases, plan benefits may be reduced, and you may be paying the about the same for less coverage.
- Many insurance carriers are now offering tele-medicine and express care options at low or no cost for the treatment of minor ailments. Be sure to review what your plan offers before you get sick or injured so you know when and how to seek tele-medicine and express care options.
- Stay in-network. Most individual plans offer in-network coverage only – except in the case of an emergency. If you go to an out-of-network provider in a non-emergency situation, you’ll likely pay the full cost of that service.
- Establish your primary care doctor before you get sick. Often it takes 6 weeks on longer to get an appointment with a new primary care doctor and if you need to see a provider quickly, you may need to seek treatment at the more expensive urgent care co-pay. Once you’re established with your primary care doctor, you can usually get an appointment more quickly, often within a couple of days.
- Review the benefits your plan offers. Many of the carriers offer discounts and benefits not included in the summaries you look at when you’re selecting your plan.
Short Term Medical (STM) Plans
STM plans work well for their intended purpose to bridge coverage gaps when changing insurance. Remember that STM plans do not cover pre-existing conditions. Use of a STM plan for an accident or illness may be cited as a pre-existing condition when you apply for another temporary policy – and that could result in denial of claims.
Even though short term medical (STM) plans are approved for up to 364 days Federally, the State of Oregon has opted to leave the term for STM plans at 30 to 90 days, including renewals.
Please be extra careful when dealing with a person you don’t know. It seems that difficult times bring out those trying to take advantage us. Feel free to reach out for a second opinion if you are unsure of the person you are dealing with or the product they are offering. I am local, I know the market and I’m happy to help you.
Remember, agents and brokers are available to you at no cost. As always, my goal is to help you stay healthy, wealthy, & wise, so please give me a call to schedule a time to review your health insurance options. I look forward to hearing from you.