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Your Guide to Health Insurance Open Enrollment 2023

November 1 – January 15th

During this time, individual policy holders can enroll in a health plan or make changes to their existing plan.  If you obtain health insurance from your employer, you are likely to have a different Open Enrollment period. 

What to Expect in 2023

  • Open Enrollment has been extended to January 15th!  Please note, changes made AFTER December 15th will take effect February 1st.

 

  • CARRIER CHANGES:
    • Aetna is offering plans this year
    • Bright Health will NOT offer plans in 2023
    • Blue Cross Blue Shield continues to be the only carrier offering a PPO network
    • Cigna will no longer offer the Northwestern network for those located in Cook County
    • We continue to struggle with network issues with Ambetter and United Healthcare.  Their provider finders are not accurate.  If you are considering one of these plans it is best to contact your doctor’s office to confirm they are accepting the plan.

 

  •  ALL carriers will now offer virtual visits.  While Blue Cross Blue Shield only offers this service with their PPO network, Aetna, Ambetter, Cigna, Oscar, and United Healthcare will offer the same service on all of their plans. Policy holders can call or chat online with a nurse practitioner to obtain a diagnosis and prescription for medication.

 

  • Out of pocket maximum will increase to $9,100 per person.  You can offset this by purchasing an accident or critical illness rider.  The rider starts at $25 per month and provides coverage to you in the event of an accident or diagnosis of a critical illness (heart attack, cancer, or stroke). 

 

  • Group plans are still an option for small employers. Blue Cross Blue Shield continues to offer relaxed guidelines during this time to allow for a 1-person group. The employer must have at least 2 full time employees that are not husband and wife.  The employees can be 1099’d.

 

  • Carriers are offering Visa gift cards for participating in their rewards program.  Some are offering up to $500!  Rewards are given for signing up for an account online, obtaining an annual physical, signing up for text message reminders, selecting a primary care physician, etc.

 

  • Cigna is offering plans tailored to those with asthma, COPD, and diabetes.  This means lower drug costs, $0 cost for labs, pulmonary rehab, and supplies (including certain brands of insulin pumps)

 

  • NO penalty continues! This means you will not receive a penalty for not having coverage or for obtaining a plan that does meet the minimum standards of the Affordable Care Act.

 

Understanding Health Insurance Claims Process

Health Insurance Explained

The number one complaint I receive about health insurance is how confusing it is.  Below are some tips to help explain the process.  I will start with a brief explanation of some of the key terms.

CO-INSURANCE is often confused with co-payment. A co-payment is typically a fixed dollar amount, while the co-insurance is a percentage that you pay after the deductible has been met. 

OUT OF POCKET MAXIMUM is the amount you pay before the carrier is responsible for 100% of your medical expenses.  The out-of-pocket maximum is a combination of your deductible, co-pays, and co-insurance.

DEDUCTIBLE is a fixed amount you are responsible for before the carrier begins to pay their share.  A higher deductible means lower health insurance premiums.

CO-PAYMENT is a fixed amount you are responsible for a particular service.  Typically, a visit with the primary care physician has a lower co-pay than a visit with a specialist. 

 

Tips to Filing a Claim

  1. Know Your Network. 

You should have an idea before needing to use the coverage of who is in network vs out of network.  While you can go out of network on a PPO plan, co-pays and deductibles are significantly higher for an out of network provider.  HMO plans do not allow coverage for out of network providers.  This means you are responsible for 100% of the charges.

You can keep this simple by sticking with the same medical group (i.e. Advocate, Duly Health, Northwestern Medicine, UIC, etc.).

*If treated for an emergency, ALL services are covered as in network regardless of the location*

 

  1. Know Your Plan Coverage Limits.  While I do not expect you to know everything, having a general idea of your co-pays and deductible is helpful.  This eliminates any surprises in the end and alleviates stress when something major occurs.

 

  1. Urgent Care vs Emergency Room. Pay attention to the location of the urgent care facilities in your area.  The wait is much shorter than the emergency room AND the cost is much less.  It is common to see a $1,000 copay for the emergency room vs a $40 copay for the urgent care.

 

  1. Wellness Visit vs Follow Up. While wellness visits are typically covered at no cost, if the doctor codes the visit as a follow-up, you will be responsible for the payment.  The service itself is typically shorter and less involved if it treated as a wellness visit.

 

  1. Additional Charges. As a reminder, each service renders a separate bill.  For example, if a service requires additional testing, it is common to receive a separate charge for each service (i.e. labs, x-rays, etc.).  This is the same for hospitalization or surgery.  You can expect to receive a bill for the location, the doctor’s time, and whatever additional testing was required at the time.

 

  1. Consult an agent with any questions or issues. Many assume we are alerted every time someone files a claim, but we are NOT.  Your agent can help set expectations, obtain answers, and fight if need be.  While we are not able to discuss your claim with the carrier (HIPAA requirement), we can help you through the process.

What’s Next??

*Healthcare: Open Enrollment has been extended until January 15th.  Current policy holders can submit changes to their existing plan or submit a NEW plan.  Once the 15th has passed, you will not be able to make any plan changes.  NEW policies submitted during this time will take effect February 1st.

*Medicare: Medicare Supplement policy holders ages 65-75 have the option to change to another Medicare Supplement plan without requiring underwriting approval.  To qualify for the Birthday Rule, you must enroll in a plan with the same or lesser benefits.  The change must be done within 45 days AFTER your birthday. 

*Medicare: Medicare Advantage policy holders are currently in a second Open Enrollment period until March 31st.  During this time, you can change to another Medicare Advantage Plan.

*Auto/Home Insurance: Many policies renew during the month of January.  When reviewing rates consider these tips:

+Always review the total package (i.e. home and auto).  Often, some carriers will have a better rate on the home as opposed to the auto however, the total calculation needs to be reviewed when determining the best scenario. 

+Make sure you are matching coverages.  Some carriers are notorious for removing full coverage to reduce the rate.  Sadly, some people do not realize that until they have an accident.  Full coverage means the carrier will fix your vehicle in the event of an at fault accident.  On the flip side, liability only means your vehicle is NOT getting fixed in the event of an at fault accident.

*Life Insurance: With the start of the New Year, many will review their financial goals for the year and discuss any gaps.  Many people will not buy Life Insurance because they overestimate the cost of a policy. Costs depend on a number of factors, including your health, age, tobacco use, and gender.  As one example, a healthy 35-year-old male can expect to pay about $20 per month for $250,000 on a 30-year term.

*Business Insurance: We’ve received LOTS of calls lately regarding employees injured on the job.  A workers compensation policy provides wage replacement and medical benefits to employees injured as a result of their job.  Premiums are based on the annual payroll and type of work performed.

Tips to Reducing your Medicare/Health Insurance Premium

REMINDER: Medicare Open Enrollment ends December 7th and Health Insurance Open Enrollment ends January 15th.

 

TIPS to Reducing your Medicare Premium…

*Consider a Medicare Advantage Plan.  If you are already in one, you may want to consider another carrier.  Be sure to pick a plan with a low maximum out of pocket and confirm that your doctors accept the plan before switching.

*Consider switching the type of Supplemental Plan you are in currently (i.e. Plan N is less expensive than a Plan G).  I will caution, that changing your plan may require you to pay for services that you have not paid for in the past. 

*Consider switching carriers for your Supplemental Plan.  Plan coverages are the same regardless of who the carrier is.   Please note, you may be medically underwritten which means the new carrier can charge a higher rate or deny you based on your medical history.

*Review your drug lists with other carriers.  Medicare.gov is a great source for reviewing rates with other carriers.  Simply plug in your drug information, select your pharmacy, and review the different plans available (based on the drugs you have been prescribed).

*Consider switching pharmacies.  First, make sure your pharmacy is still in the Preferred Network with your prescription drug plan.  Second, find out what the different pharmacies charge for your drugs.  You may see a difference that can save you some time in reaching the donut hole.

 

TIPS to Reducing your Health Insurance Premium…

*Be prepared to discuss your household, estimated adjusted gross income for 2022.  This will be used to determine if you qualify for assistance.   Thanks to the American Rescue Plan, the threshold has increased.  Some families making $250,000 per year can qualify for assistance!

*Those without pre-existing conditions should consider a short-term medical plan.  These plans do not provide coverage for pre-existing conditions, maternity, and limited wellness visits. However, these plans are a fraction of the cost of plans offered through the Marketplace and they have a PPO network.

*If you are going to opt to self-insure, protect yourself with an accident or critical illness plan.  The plan works separate from health insurance and pays you in the event of an accident (slip, fall, and break an ankle) as well as a diagnosis of a critical illness (cancer, heart attack, or stroke).  The purpose is to use the funds to pay towards the unexpected treatment.

Consider splitting your household.  If one of you need to be on a plan that covers pre-existing conditions the other can look into the short term medical plan.  You can also split plans through the Marketplace. 

 

 

Health Insurance Open Enrollment

During this time, individual policy holders can enroll in a health plan or make changes to their existing plan.

 

What to Expect in 2022

  • Open Enrollment has been extended to January 15th! Please note, changes made AFTER December 15th will take effect February 1st.

 

  • NEW CARRIERS: Molina Healthcare, Oscar Health Plan, and United Healthcare will offer plans for 2022.  Blue Cross Blue Shield continues to be the only carrier offering a PPO network.

 

  • OFF EXCHANGE Plans: While the network is the same on exchange or off exchange, Blue Cross Blue Shield, Bright Health, and Cigna will offer off exchange plans.  This means if you do not qualify for assistance you do not have to go through the Marketplace.  Blue Cross Blue Shield is the only carrier offering a PPO network.

 

  • NO penalty continues! This means you will not receive a penalty for not having coverage or for obtaining a plan that does meet the minimum standards of the Affordable Care Act.
     
     
  • Blue Cross Blue Shield, Bright Health, Cigna, and United Healthcare will offer virtual visits.  While Blue Cross Blue Shield only offers this service with their PPO network, Cigna, Bright Health, and United Healthcare will offer the same service on all of their plans. Policy holders can call or chat online with a nurse practitioner to obtain a diagnosis and prescription for medication.

 

  • Out of pocket maximum will increase to $8,700 per person.  You can offset this by purchasing an accident or critical illness rider.  The rider starts at $25 per month and provides coverage to you in the event of an accident or diagnosis of a critical illness (heart attack, cancer, or stroke). 

 

  • Group plans are still an option for small employers. Blue Cross Blue Shield continues to offer relaxed guidelines during this time to allow for a 1-person group. The employer must have at least 2 full time employees that are not husband and wife.  The employees can be 1099’d.

 

  • Carriers are offering Visa gift cards for participating in their rewards program.  Some are offering up to $500!  Rewards are given for signing up for an account online, obtaining an annual physical, signing up for text message reminders, selecting a primary care physician, etc.

 

  • Cigna is offering plans tailored to those with asthma, COPD, and diabetes.  This means lower drug costs, $0 cost for labs, pulmonary rehab, and supplies (including certain brands of insulin pumps)

 

I am now license in Florida!!  Insurance Counts can service plans in Illinois, Indiana, Wisconsin, Texas, and Florida.

Questions
Questions

Feel free to email or call me with any questions or comments about my services or if you have any insurance related inquires.

Contact
Contact

Phone: 708.444.0050
Email: kelly@kellyburkeinsurance.com

Availability
Availability

Monday - Friday: 10am - 5pm
Evening and weekends
available upon request