This open enrollment season, several carriers including Aetna, UnitedHealthcare and Humana, have exited from the Marketplace in some states, and these changes were estimated to have affected just under two million people. We’ve said before, even if your plan is still around for 2017, it’s a good idea to see what’s out there, because premiums and networks change, both of which can have a big impact on your coverage. But if your plan is gone completely from the marketplace, what steps should you take?
Make a list of your preferred doctors. Know the physicians that are most important to you. You’ll want to make sure they are in-network for any new plan you choose. With networks narrowing, you may need to divide your list into “must haves” and “nice to haves”.
Make sure you know the brand and generic versions of your prescriptions. Some plans may not offer high levels of coverage on brand-name drugs and will offer better coverage on generics. Make sure you’re aware of which prescriptions you need, as well as for which you and your doctor are comfortable in the generic form. (Note: According to the FDA, generic drugs are required to have the same active ingredient, strength, dosage form, and route of administration as the brand-name product.)
Compare metal tiers to determine how much coverage you need. Maybe you never get sick and health insurance gives you peace of mind; in that case, a bronze-level plan may be completely sufficient for your needs. These plans typically come with higher deductibles, coinsurance and copays, out-of-pocket maximums, and overall lower levels of coverage, but carry a lower monthly premium.
If you use your plan more and need to better control expenses, you’ll want to look at higher tiered plans, which generally have higher monthly premiums. It’s important to remember that a health insurance plan with a $100 monthly premium may look like the lowest cost plan, but after factoring in deductible, copays/coinsurance, and prescription costs, that same plan could end up costing more than one with a $200 monthly premium and higher levels of coverage.
Find out if you qualify for tax credits. Last year, 85 percent of people who enrolled in a health insurance plan on the Marketplace qualified for tax credits averaging $291.* Tax credits are determined by income and household size and can help to significantly reduce monthly premiums, saving you thousands of dollars each year. Since your income and circumstances can change from year to year, it’s always a good idea to check when re-enrolling to see if you qualify.
Don’t be afraid to ask for help. We’re here for you! Helping you find the best plan for your needs is what we do best. So, if you find yourself with questions or just needing some help, give us a call at (866) 602-8466.
*Centers for Medicare & Medicaid Services: March 31, 2016, Effectuated Enrollment Snapshot