Open Enrollment for Health Insurance and Medicare Is Happening Now

Guest post by Maria Pippidis, Extension Educator, University of Delaware Cooperative Extension

Are you spending too much on health insurance? It’s time to do a health insurance check up! 

Open enrollment for the Health Insurance Marketplace (November 1, 2022, through January 15, 2023) for those under age 65 and Medicare (October 15 through December 7) for those over 65 is happening now. Even if you have health insurance already, comparison shopping can help you save money and get better coverage. It is important to compare not only the premium costs but also other out of pocket costs like deductibles, copayments and coinsurance in relation to how often you use health care services. There are also options for dental insurance. Think back about how you have used health care services in the past to help you do an estimate of how much these other out of pocket costs might affect the choice of plans you consider.

Remember, for health insurance marketplace plans, prevention services like annual check ups with your primary care provider or gynecologist are covered at no charge.

For those under age 65, use the healthcare.gov website to see options for you and your family or for covering employees if you are a small business. Depending on your income and the state you live in you will have a variety of health insurance policy options and tax credits or tax subsidies. Here are some examples for a family of 4 with 2 children under 18 years of age in Delaware:

  • If your income is below $38,295/year you may qualify for the Children’s Health Insurance Program (CHIP) or Medicaid. 
  • An income range between $38,295 and $69,375/year will provide coverage with tax credits on premiums and reduced deductibles, copayments, and coinsurance.
  • An income range between $69375 and $111,000 will provide coverage with reduced premiums.

This is just an example and the income ranges will be based on your family size and your state. By going to the website and adding your specific information, you’ll get a better sense of the costs and coverage. I personally have seen farm operators save thousands of dollars by exploring the marketplace for health insurance options. Even if you have off farm employment covering your whole family, it might be worth exploring the healthcare marketplace options for those not working off farm and your children.

You can explore options online or you can get help by talking to a health insurance navigator. The healthcare marketplace website in your state will provide information about who are certified providers that can assist you in better understanding your options. These individuals have been trained to provide information about the plans. Note that some insurance brokers have been certified as well; these individuals can inform you about the marketplace plans and other plans for insurance organizations which they represent. There are also navigators/assistors who work with non-profit, government or health care organizations who are certified.

For those who are 65 and older, use the medicare.gov website to see which Medicare Advantage Plans or Medicare Supplemental (Medigap) plans are available in your area. You can comparison shop these plans very easily on the website. My advice is to ignore the TV commercials and the junk mail regarding Medicare plans. Rather use your State Health Insurance Assistance Program. You can find your local contact by visiting this website https://www.shiphelp.org/ and searching by your state. This program can assist you by setting up a free counseling session with a trained volunteer at a convenient site near you. Their goal is to empower people with Medicare to better understand their options and enable them to make the best health insurance decisions for themselves. The counselors can help you better understand your options to help you make the best decision for you related to Medicare, Medicaid, Medigap (Medicare supplement insurance), Medicare Part D, long-term care insurance and other types of health insurance. There is no charge for the service.  

Though it takes a bit of time, invest in yourself  because no matter what age you are, reviewing your health insurance coverage is one of the best ways to stay financially and physically healthy in the coming year.

Selecting an Insurance Plan

Open Enrollment for Marketplace Health Insurance plans is right around the corner. In fact, this year it runs from November 1, 2022 through January 15, 2023. For information about Marketplace plans visit Healthcare.gov. For this blog, I want to discuss items to consider when selecting a health insurance plan. The Smart Choice workbook provides guided steps to selecting an insurance plan.

One of the first items to consider when selecting a health insurance plan is how you are currently using your health insurance. Do you have a primary care provider? Are there specialists that you work with? Sometimes we are connected to the medical professionals we currently visit. If that is the case, when selecting a new plan you want to know if those providers are in the new plan’s network.

You should also consider how you plan to use the insurance in the coming year. For instance, are you planning a surgery or considering expanding your family (having a baby)? If so, you want to review the Summary of Benefits document provided by the insurance company, which explains what, and how much is covered. This information can be found on the health insurance company’s website.

Another item to consider is the costs. Plans will have monthly costs (known as premiums), out of pocket costs, deductibles, and out of pocket maximums. Typically, lower monthly costs mean a higher deductible. Just make sure you pay attention to the overall costs, not just how much it will cost you monthly. Keep in mind that if you have the higher deductible, you need to have money set aside to cover it. I just shared a few items to consider and there is much more. The Smart Choice workbook can walk you through the process of selecting an insurance plan to meet your specific needs. The fillable workbook asks important questions that assist you in comparing insurance plans. It includes definitions of terms used with health insurance that can be confusing. The workbook is one of many tools offered by the Health Insurance Literacy Initiative (HILI). Additional resources are available on the HILI website. There will also be a fall series with workshops on choosing a health insurance plan, understanding your health insurance plan benefits, and healthcare options in your senior years.

Health Insurance and Undergraduate Students

This blog written by Mumtahina Tabassum, FCS senior intern, class of ’22

Low health insurance literacy rates are a prevalent issue among undergraduate university students. As an undergraduate student myself, it was not until I began my internship with University of Maryland Extension (UME) that I realized I did not have enough knowledge of how health insurance works. I had heard some basic health insurance terms such as “deductible” or “co-pay” here and there but I did not know about the different types of health insurance or how to choose a plan that works for me.

After conversing with a few of my peers about this subject, I learned that many were also in the dark about health insurance knowledge and planning. Furthermore, many of my peers are and have been living without any health insurance. Health insurance is not always seen as a necessity by many students, although it is required by the University of Maryland. Many purchase the health insurance offered by the school, though students may find that another insurance plan would work better for them. After graduation, it is likely that most former students will have to choose a health insurance plan for themselves but, in order to make these types of choices, individuals will need to learn how to navigate through this information.

In the past few months, I have been learning about the basics of health insurance and how to make choices that work for me through the Smart Choice, Smart Use program offered by University of Maryland Extension. The Smart Choice, Smart Use program series offers multiple workshops to small groups in order to spread information on health insurance and how individuals can navigate complex but essential material.

These types of programs are important for undergraduate students to participate in, to help us prepare for the choices we will have to make after graduating. The workshops were offered via Zoom, which made it extremely accessible and easy to attend between or after my classes. Students would have the opportunity to ask questions and talk through items to reach a better understanding of the choices that they can make today.

If you’re an undergraduate student in any institution wanting to learn more about health insurance and your options, I recommend keeping up with UME’s resources and future workshops. These resources can be found on the website linked here.

How UME Helped Me Navigate my Health Insurance! 

One of the things we love to do here at Breathing Room is show people how University of Maryland Extension (UME) can help them with day-to-day challenges. We have tons of classes and resources all focused on helping people make positive changes in their lives. Today, I thought I would share the story of how one of those resources helped me navigate a particularly confusing situation with my health insurance. 

I don’t think it’s a secret that health insurance can be really confusing. When I started working for UME, I didn’t know much at all about how my insurance worked. But, I actually wasn’t too concerned about it. I had always been on my mother’s insurance and she had always helped me with it. Then, I got certified to teach our Smart Choice, Smart Use program and learned so much about the ins and outs of insurance! Now, I often get to teach people (including my own friends and family) about how health insurance works. I didn’t even realize how much my own confidence had increased until I ran into a problem with my insurance. 

It all started with my going to the doctor for a regular checkup. I wasn’t concerned, until a few weeks later I got a bill for $400 and a letter saying my visit wasn’t covered. Because of all I had learned, I knew my visit should have been considered preventive care and I knew my doctor was in-network for my plan. So, the visit should have been covered and I shouldn’t have had any out-of-pocket costs. 

I called the insurance company to get an explanation and they let me know they would look into it and get back to me. After not hearing back for a few weeks, I called again. The issue appeared to be that the health insurance company was confused about whether I was still covered under my mother’s insurance after getting married. We spent so long going back and forth, that I actually started getting calls from a debt collection company. I still refused to pay because I knew the visit should have been covered! 

Finally, the health insurance company resolved the problem and paid for the visit. After receiving confirmation the bill was paid, I wrote a letter to the debt collection company asking them to verify the debt, which basically means the debt collection company has to go back and make sure the original debt is still valid (I also learned about this from UME, we have great classes about credit and debt!) Finally, the company stopped contacting me and everything was resolved. 

Recently, I was thinking about how differently this whole situation could have gone for me! Without the knowledge and confidence I had gained with UME, I don’t think I would have known I could file a dispute with the health insurance company and get things figured out. Having had this personal experience, it’s so important to me to spread the word about our resources so that people can get the knowledge and skills they need to avoid situations like this. 

So, if you have ever been confused by health insurance, check out these resources!

  1. Smart Choice, Smart Use – these are workshops focused on different health insurance topics. We have workshops available now and you can register here: https://go.umd.edu/hili_spring_2022
  2. Need to resolve your own health insurance dispute? Check out this resource, it spells out the whole process: https://extension.umd.edu/resource/health-insurance-claim-problem-how-navigate-health-insurance-claims-process
  3. For many other resources, check out https://extension.umd.edu/resource/health-insurance-claim-problem-how-navigate-health-insurance-claims-process

Protecting the Health of Your Children

The Children’s Health Insurance Program provides children with health insurance coverage. It was signed into law in 1997 by way of the Balanced Budget Act. It was created for children in families with incomes too high for Medicaid but do not receive private health insurance coverage. The creation stemmed from the millions of children that were without health insurance in 1997. With CHIP installed in every state, all families could seek coverage for their children.

Eligibility varies depending on the state. Determination for eligibility is done by assessing the Modified Adjusted Gross Income (MAGI). This income assessment determines the family’s financial eligibility for CHIP. In some states, pregnant women are eligible. 2018 Medicaid statistics report that over 9.6 million children have been enrolled in CHIP.

According to the Medicaid website, the following list determines eligibility:

  • Under 19 years of age
  • Uninsured
  • A citizen or meets immigration requirements
  • A resident of the state and,
  • Eligible within the states CHIP income range, based on family income, and any other state specified rules in the CHIP state plan

Benefits can vary by state. For the state of Maryland, the benefits included are:

  • Doctors’ visits
  • Dental care
  • Vision care
  • Prescription medicine
  • Immunization
  • Hospital Care
  • Lab work and test
  • Mental health wellness
  • Transportation to appointments
  • Substance abuse treatment

To apply for coverage, you can call 1-800-318-2596 or fill out an application Health Insurance Market Place on healthcare.gov.  

This blog written by Family and Consumer Sciences student intern Ashante Scott.

Open Enrollment for Health Insurance

If you are one of the individuals that purchase health insurance through the marketplace, you have some important deadlines approaching. If you want your coverage to begin on January 1, 2022 and you are enrolled in a plan through Healthcare.gov then you needed to enroll by December 15th.

If you live in Maryland, you have until December 31, 2021. Each year, you need to review, update, or enroll in marketplace plans. If you don’t meet these deadlines, you have until January 15, 2022 with the health insurance plan beginning February 1, 2022.

In case you are thinking, “Why do I need health insurance?” let me share a couple of reasons. To begin, there is peace of mind. Having health insurance provides us with the resources we need to address health issues when they arise.

It also protects your financial resources from unexpected medical bills. Over 20% of Americans struggle to pay medical bills and 3 in 5 bankruptcies are due to medical bills. Health insurance provides you with wellness services and programs to help you stay healthy.  When you have and use your health insurance, you have better health outcomes. When you are sick and use your health insurance you get well faster and miss less work or school.

Now you’re thinking, what is my next step? That’s simple, visit Healthcare.gov. If you live in Maryland, you can go directly to Maryland Health Connection. There are navigators and assistors ready to help. If you are not sure how to select a policy, use our workbook. It will walk you through step by step process of comparing health insurance policies. 

Do I Need a Different Insurance Plan?

Health insurance can be confusing. We are often asked in a short period of time to commit to a plan for an entire year. We are confused with terms such as premium, deductible, and co-pay and plan types such as a PPO (Preferred Provider Organization) and HMO (Health Maintenance Organization). In most cases you only have once a year, during open enrollment, to change plans. It helps to start thinking about your current plan and future needs early to be prepared to make those changes during the open enrollment window. 

I will share a few reasons why you may consider changing plans. 

Health Care Providers/Doctors – Depending on the type of plan you have, health insurance companies enter into agreements with health care providers and doctors, which involves pre-determined prices for services. Health care providers/doctors in this agreement are referred to as “in-network.” If you see a provider that is not in-network, or “out-of-network,” you often pay higher prices. In some cases, you may have a provider that you like to use which is not in your network. If that is the case, you may decide to change plans during the next open enrollment.

Premiums/Deductibles – Some people choose a plan based on how much it costs them on a monthly basis. Those monthly payments are referred to as premiums. Deductibles are how much you need to pay before the insurance plan begins to pay. Deductibles vary in amount depending on the plan type. Typically, lower premium plans have a higher deductible, and higher premium plans have lower deductibles. Individuals that don’t use their plans often choose a low premium/high deductible plan. You may change a plan based on how you used the plan in the previous year or how you anticipate using a plan in the coming year.

Plan Type – There are four different plan types which offer various levels of flexibility in the healthcare providers you use. Information about the types of plans can be found here.  Some require that you stay within the plans network while others provide more flexibility. Some plans require a referral to see a specialist and others may not. The level of flexibility you want in your health insurance will determine which type of plan you select.

Change In Use – We typically select plans based on the information we have at the time. Over the course of a year, the reasons you chose that plan may change. Changes in your health or in needs for life like planning for a family, may affect when and how often you use your insurance plan. You may anticipate using the plan more often than the previous year and decide you want a plan with a lower deductible as a result. You may want to see a doctor that is not in-network and decide to change plans to ensure you visit your preferred doctors.  

It is not uncommon for someone to change plans. Just make sure you select a plan that best meets your needs. The Health Insurance Literacy Initiative at University of Maryland Extension developed resources to guide you through the process.