Jill on Money: Applications Open for Healthcare in 2023

It’s that time of year when you’re faced with open enrollment packages for health coverage from your employer and, in some cases, the government.

Rising coverage costs, coupled with nearly four-decade high inflation, means this is the year you need to pay attention and take the time to sift through your options.

Employer-based coverage

According to a recent survey by Voya Financial, 70% of employed individuals plan to “spend more time reviewing their benefit selections during open enrollment to help make the most of their benefit dollars because of inflation.”

That’s good news because the combination of the pandemic and a tight job market has led many employers to expand their menu of health care options — both a blessing and a curse.

Before you throw in the towel and go back to what you chose last year, take the time to review your current plan and determine if there have been any changes.

For example, are your doctors and prescriptions still covered? If not, move on and start comparing replacement plans. You’ll need to determine what they cover and how much they cost, including copayments and deductibles. The various types of plans include:

  • health maintenance organization, which limits coverage to the care of physicians who work for or are contracted by the HMO. It usually does not cover out-of-network care, except in an emergency. An HMO may require you to live or work in its coverage area to qualify for coverage.
  • Preferred Provider Organization, which contracts with medical providers, such as hospitals and physicians, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use out-of-network doctors, hospitals, and providers at an additional cost.
  • service point plan, which usually costs less if you use doctors, hospitals, and other health care providers that are part of the plan’s network. POS plans require a referral from your primary care physician to see a specialist.
  • Exclusive provider organization plana managed care plan where services are covered only if you go to doctors, specialists or hospitals in the plan’s network (except in an emergency).
  • High deductible health plan, which has lower premiums in exchange for higher annual deductibles. These plans are combined with tax-advantaged health savings accounts, which can be an efficient way to save for current and future health expenses. For many, an HSA can serve as another retirement savings vehicle because the money in it can be used to offset health care costs after retirement.

Affordable Care Act

For those who have exited the corporate world and are self-employed, are experiencing a gap in coverage between jobs, or are waiting to turn 65, the open enrollment period for the ACA began November 1 and runs through January 15, 2023.

The main difference between the four plan types is that each has a different method for sharing costs. The government notes that “the plan’s categories have nothing to do with the quality of care.” Costs vary depending on the plan you choose and your state of residence.

Medicare coverage

If you’re over 65, Medicare open enrollment has started — and ends on Dec. 7. During this period, you can join, switch or cancel a plan.

Since insurers often change what they cover from year to year, it is up to policyholders to update coverage.

Using the same analysis mentioned earlier, go to medicare.gov to compare plans and select the one that’s right for you. If you need financial assistance to help pay for coverage, consider Medicare Savings programs, which are administered through state Medicaid agencies.

Jill on Money: Applications Open for Healthcare in 2023

Leave a Reply

Your email address will not be published.

Scroll to top