November 1st kicks off open enrollment for the Health Insurance Marketplace — also known as Obamacare. Now’s the time to sign up for a low-cost insurance plan.
The Marketplace is a federally-operated exchange where consumers can sign up for insurance. Until the Affordable Care Act passed, there were limited and expensive ways for Americans to get health insurance. Most people got insurance through their jobs. But if your employer didn’t offer health benefits, or if you didn’t qualify for benefits because you weren’t a full-time employee, then you had to purchase health insurance on the private market. The only problem was that it was perfectly legal for health insurance companies to deny coverage or charge higher premiums to applicants who had a pre-existing condition. And that turned out to be a lot of people. In 2018, KFF reported that pre-ACA, more than a quarter of non-elderly adults “had declinable pre-existing conditions that would have made them uninsurable.” For those who could get private insurance, plan providers were also permitted to offer reduced coverage—for any reason.
Fortunately, the worst of the health insurance marketplace dark ages are behind us. Not that our nation’s health-insurance problems are solved. But they’re a lot better and seem to be improving. In March 2021, when the American Rescue Plan passed, health insurance costs through the marketplace dropped by an average of 40%.
If you’re interested in signing up for health insurance through the Healthcare.gov marketplace during open enrollment, here’s everything you need to know.
Your 8 Most Important Health Insurance Questions Answered
When can I sign up for health insurance through the Marketplace?
Open enrollment begins on November 1. If you sign up by December 15, coverage starts on January 1, 2022. Open enrollment ends on January 15.
How much can I expect to pay for health insurance in 2022?
A lot of factors go into estimating health care premium costs for families and individuals. But if you go to HealthCare.gov’s See Plans & Prices, simply answer a few questions and you will see your estimated 2022 costs and options.
If you’re already enrolled in an ACA plan, simply enter your plan ID number, answer a few questions, and get an estimate.
What is the difference between gold, silver, bronze and platinum plans?
There are five categories of health insurance plans. Here’s a pretty basic breakdown.
Monthly Premium: Highest
You pay: About 10% of your medical costs
Cost of deductibles: It depends on a variety of factors, but it can be $0
This a good plan for you if: You use your health insurance frequently and you can afford a high monthly premium.
This plan is the most comprehensive but costs the most. If you or someone in your family has a chronic illness or requires ongoing medical care and uses prescription medications, you may want to consider this tier.
Monthly Premium: High
You pay: About 80% of your medical costs
Cost of deductibles: Not as low as Platinum, but lower than Silver and Bronze
This a good plan for you if: You get a lot of medical care and you can afford high monthly premiums.
This is a good plan if you or a family member require more than the standard amount of medical care and have one or more ongoing medication prescriptions.
Monthly Premium: Moderate
You pay: About 30% of your medical costs
Cost of deductibles: Moderate. In 2021, the average cost of a deductible for this tier was under $5,000
This a good plan for you if: You see your medical provider more than once a year or you have one or more medical specialists.
If you’re healthy overall, but plan to see one or more specialists or if you think you’ll need treatment from an emergency department, a Silver plan will help offset expensive medical bills. This plan will also help cover the cost of one or more prescription medications.
Monthly Premium: Lowest
You pay: About 40% of your medical costs
Cost of deductibles: Highest
This a good plan for you if: You’re in good health and you don’t plan to see your doctor more than once a year for recommended preventive care. You don’t use any or only occasionally require prescription medication.
If you’re in very good health and not accident-prone, this is a good health insurance plan.
Monthly Premium: Very low
You pay: After deductible, $0
Cost of deductibles: Very high. The average cost in 2020 was $8,150
This a good plan for you if: You’re young and in very good health. You only see a medical provider for preventive care, you don’t see a medical specialist, and you don’t need prescription medication.
If you’re under 30, in extremely good health, and rarely need to see a doctor or specialist, you may want to consider a catastrophic healthcare plan.
You can get more information about metal category plans here.
I see my doctor once a year for checkups. Should I get an expensive healthcare plan?
The ACA requires health insurance companies to cover preventive health services. So if you only go to the doctor once a year for a checkup, then you don’t have to pay a lot of money for a health insurance plan. Well-woman visits, including a physical exam, are fully covered. Screenings for certain common diseases and infections are also covered, including mammograms and bone density tests. Blood pressure, cholesterol and diabetes screenings are covered for all patients as well. See more information about preventive care services here.
Can I sign up even if I have health insurance through my job?
Yes. But you need to know some things first. Employer-sponsored health insurance is either fully or partially paid for by your company. If you enroll in a Marketplace plan, your employer does not have to help you pay for it. And if you turn down job-based coverage, you may not qualify for the premium tax credit that would drastically lower your premium costs.
If the insurance offered at your job does not meet the minimum value standard (if it does not cover at least 60% of the total cost of medical services) then you probably want to consider a plan from the Marketplace. You can go to HealthCare.gov get more information about comparing your employer-based health care benefits to the Marketplace.
Will Covid make health insurance premiums for 2022 go up?
There’s been some chatter that Covid is making health care costs for 2022 skyrocket. However, in July, KFF released a report indicating that insurance costs are not expected to increase, but if they do, the increase is expected to be less than 1%. One thing keeping costs down this coming year is the public’s use of less expensive telehealth services in place of in-person doctor appointments.
My premiums may not go up that much, but I’ll still get expensive surprise bills, right?
You shouldn’t! In January, the No Surprises Act goes into effect. At that time, it will be illegal for providers to send patients a bill for services they did not choose or for services they don’t know about. Also, doctors and medical centers can’t bill for out-of-network services unless the patient specifically agrees to the service. It’s like that time you went to the ER for an x-ray and paid your co-pay on you’re way home, but then received another bill two months later because the radiologist was out-of-network.
Check out this Investopedia article for more details about the No Surprises Act.
So I’m really not going to get any surprise medical bills anymore?
Never say never, but not only shouldn’t you get surprise medical bills, but hospitals are supposed to post their prices online. Hospitals and health insurance companies negotiated the cost of services. Not only is that information kept on the down-low, it’s downright impossible for patients to access that information. As a result, patients have no way to anticipate how much they should expect to be charged for things like a pregnancy tests, common health screenings and elective surgeries.
A new rule is supposed to put a stop to those shenanigans. According to NPR.com, “[The law] requires hospitals to post a range of actual prices — everything from the rates they offer cash-paying customers to costs negotiated with insurers.” Unfortunately, it’s still really difficult for consumers to access health-care fee schedules, but third-party companies are currently developing ways to make it easier. So keep your eyes peels for those apps to hit Apple and Google Play stores.
I have insurance. What do I care what a test or procedure costs?
Fair question. It turns out that some hospital services are actually cheaper if you pay out of pocket! And hospitals and insurers really don’t want you to know that.
In August, the New York Times published an article about hospital transparency and what they discovered was incredible. A colonoscopy at a Mississippi hospital cost $2,144 with an Aetna insurance plan. For uninsured patients, the same procedure cost $782. The hospital doesn’t want you to know this because they want to bill the higher amount. And insurance companies don’t want this information out there. It would give consumers more power to compare health insurance companies and plans.
Read Decoding Health Insurance
To better understand health insurance and the U.S. health care system, check out Decoding Health Insurance and the Alternatives: Options, Issues, and Tips for Saving Money. You’ll find easy-to-read information, plus tips for buying health insurance and saving money on health care.
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