With the open enrollment period deadline nearly a month away, local insurance agents are urging residents to choose a policy.
Those searching for a plan may notice a cost increase this year.
“Rates seem to go up this year, and I was not expecting that,” Andrew Bennett, Insurance That Fits agent, said. “All of the industry data that I keep track of actually said the claims were down. Actually because of COVID, a lot of people who say they were going to get a new knee or hip or whatever, those aren’t things you have to do so those are things they put off because claims were down. I’m assuming that some of the companies are feeling like those are going to boil over next year, so they went up pretty substantially.”
As a result of the Affordable Care Act, millions across the country are eligible for a premium tax credit to helps pay for coverage.
Credits can go directly to insurers to pay a share of the monthly premiums or can be claimed when taxes are filed.
“For people who are under the federal poverty level within 400% of it, they get a tax credit,” Bennett said. “If they’re within 250% of the federal poverty level, they also get cost sharing. That’s only at the silver level, so one of the problems that people need to avoid is people will stop looking at the bronze level and when they’re going through the bronze level first and see those prices and go, ‘Oh my gosh,’ and they quit looking, well, the cost sharing is only at the silver level. Instead of paying $0 or $20 a month, they pay $100 a month but now instead of having a $5,000 deductible, they have a $750 deductible.”
The open enrollment period is also important for retirees and veterans with Medicare. That deadline is Dec. 7.
“Every year, Medicare health and drug plans change their coverage, which medications are covered, how much you will pay for prescriptions and what pharmacies give you the best pricing with your insurance choice,” Heather Majka, Citizens Insurance Solutions agent, said. “Most people who investigate their options yearly save an average of $3,500 on prescriptions alone. If you are receiving retiree health benefits, you want to consult your plans benefit administrator.”
Due to the COVID-19 pandemic, many insurers are urging people to find a coverage plan that fits in the budget in the event of an unforeseen health crisis.
There is no longer a federal penalty against people without health coverage, Nick Weissfeld, Carriage Hill benefit specialist, said.
“With COVID-19 happening this year, income may have changed for your household,” he said. “Make sure to complete new financial data so that you get the full subsidy available to you. These income levels are at $51,040 for an individual and $104,800 for a family of four. You can only get the subsidy if your employer doesn’t offer medical insurance, though. We encourage everyone to be insured because something catastrophic can happen at any time to anyone.”
Finding a suitable network can also be a challenge, which is why Bennett encourages looking closely and comparing plans with other networks.
BlueCross BlueShield, Cigna and Farm Bureau are some of the most reliable networks on the market.
A cheaper alternative to the ACA marketplace is short-term medical insurance or telemedicine.
“The other thing is to look at the networks because there are companies, Bright Health specifically, that their whole business plan is built around what I call skinny networks,” Bennett said. “For Bright Health, it’s essentially the (University of Tennessee) system. In terms of access to doctors and facilities, Bright Health it’s just UT and that’s all. People will need to watch that, and Bright Health really expanded their policy offering ... but you’ve got to watch out for that. All the other companies have pretty established networks.”
Planning for the future is also important.
“People have to got to realize once you do your application, it’s not set in stone,” Bennett said. “If something changes in your life, you are required to go into the application and update it. If you get married, you get a job with benefits, you’re not going to be eligible for the tax credit. If you keep it, you’re going to end up paying back when you do your taxes — it’s not a set-it-and-forget-it scenario. You’ve got to have an awareness that this affects my findings and you need to have that in the back of your mind.”