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Open Enrollment

By Terry Savage on November 07, 2019

Now is the time to select your health insurance for 2020. It’s open enrollment season, and no matter what your income or job situation, you must make some important – and expensive – choices about your insurance for the year ahead.
There are basically six ways most Americans can get health insurance coverage.

Health insurance from work. More than 156 million Americans (49 percent of the population) get their healthcare from their job through group health insurance. Another 15 million are covered by union plans. Even if your job hasn’t changed, the options and pricing of your company insurance likely require you to make decisions in the next few weeks.

A company may offer several plans, including a PPO that basically gives you a choice of physicians and hospitals, or a more restrictive, but less expensive HMO plan. Many companies now offer high-deductible health insurance plans, combined with health savings accounts. The company may make or match your pre-tax contribution to your HSA, building money that can grow tax-free to pay for uncovered future medical expenses.

Private Health Insurance If you’re not covered at work, use an online service such as eHealthInsurance.com to compare private insurance policies offered in your state. Most comparison sites also offer toll-free numbers with representatives to help you make your decision. Because of the Affordable Care Act, you or your family cannot be denied coverage because of a pre-existing condition. But those policies may be very expensive, with high deductibles and high co-payments. Some restrict access to only certain hospitals and physicians.

Here’s what you need to compare:
• Monthly premium cost
• Deductible
• Out-of-pocket maximum you might have to pay
• Lists of participating hospitals and physicians
• Coverage costs for family members.

Those expensive policies may be out of your budget, unless you receive a government premium subsidy based on your income.

Obamacare or Affordable Care Act Insurance. You can search for ACA policies offered in your state at www.HealthCare.gov. You have until December 15, to sign up for one the policies offered in your state. (There is no longer a Federal penalty for failure to have health insurance.

The critical element in choosing one of these policies is understanding how much of a monthly premium subsidy you qualify for, based on your expected earnings next year. For 2020 coverage, that upper income cap is $49,960 for a single person to receive a subsidy, and $103,000 for a family of four. As income reaches those levels, the subsidy diminishes.

Search for these ACA policies at HealthCare.gov. You’ll be asked to input your zip code, your age, the number of people in your family, and your expected income, to compare coverage and prices, including your subsidy. There are three levels of coverage – gold, silver, and bronze. Gold is the most expensive,but offers the least exposure to costs. And you can actually apply directly from the Healthcare.gov website – or any ACA “Marketplace” agent, at no additional cost.

Medicaid. If you can’t afford the premiums, even with an ACA subsidy, you likely qualify for your state’s Medicaid program. Though the Federal government contributes to these costs, each state sets its own criteria for Medicaid. And each state has a separate CHIP program for child health insurance. Check out those programs if you cannot afford even the subsidized ACA coverage.

Small Business Health Insurance. You can still set up a group plan during the special enrollment period (SEP) for small businesses that have at least two employees. Even if only one employee takes the plan, the group cannot be denied the best coverage offered by private insurers in the state. Read details in my recent column.

If you fail to obtain some form of coverage during the current open enrollment period, you could be left without health insurance next year, exposing your salary and all your assets if you have an accident or illness. (Some “qualifying events” do let you sign up during the year.) Or you could apply for a short-term health plan (maximum one year), which not cover all conditions, and may deny coverage for pre-existing condition.

Of course, for the more than 53 million Americans who qualify for Medicare, there is another set of instructions, which you’ll find in next week’s column. And that’s The Savage Truth.

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