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Making the Most of Open Enrollment

By: Richard Notter, vice president of Individual Business, Blue Cross Blue Shield of Michigan

Each year, the open enrollment period to renew, change or update marketplace health plans for the upcoming year runs from November 1 through December 15. There are a variety of plans offered to fit each person’s health care needs and budget, but it’s important to understand the options and resources available. Individuals who have experienced life changes such as the birth of a child, marital status or adjustments to employment and income, especially in light of the COVID-19 pandemic, may be eligible for additional assistance including subsidies or state-sponsored benefits.

Coverage Options

While many Americans receive coverage through an employer-sponsored health plan, those responsible for purchasing their own coverage can enroll in an individual or family plan through the health insurance marketplace at healthcare.gov during the annual open enrollment period. However, depending on age and income eligibility, health care coverage is also available through Medicaid and Medicare programs.

Subsidized Coverage

Financial assistance may be available for individuals and families who have experienced changes in income or employment throughout the year. Health care subsidies can help offset the cost of coverage for those who qualify. There are two types of subsidies:

  • Advanced Premium Tax Credit: A tax credit that’s taken in advance to lower monthly health insurance premiums. Those who qualify for a premium tax credit based on their estimated income for the year can use any amount of the credit in advance to lower their premium. This credit can be used toward a plan in any metal category – bronze, silver, gold or platinum.
  • Cost Sharing Reduction: A discount that lowers the amount individuals have to pay for deductibles, copayments and coinsurance. In the health insurance marketplace, cost-sharing reductions are often called “extra savings.” However, those who qualify must enroll in a plan in the Silver category to receive the extra savings.

Subsidy eligibility is determined by multiple factors including income, number of dependents and filing status, among others, so it is important to check frequently as each person’s status is likely to change year-over-year.

Effects of COVID-19

As a result of the pandemic, many people have experienced financial hardships due to the loss of employment or a significant reduction in hours. Outside of the open enrollment period, those who have may qualify for a special enrollment period if they lost health coverage through their employer or a family member in the past 60 days or expect to lose coverage in the next 60 days.

It’s also important to note that all marketplace plans provide treatment coverage for pre-existing medical conditions and coverage cannot be terminated due to a change in health status, including the diagnosis or treatment of COVID-19. For more information on how COVID-19 is affecting health care coverage, visit healthcare.gov/coronavirus.

Richard Notter is the vice president of Individual Business at Blue Cross Blue Shield of Michigan. For more information on open enrollment, visit mibluesperspectives.com.

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