Open Enrollment 2022 Information and FAQs

Completely satisfied Open Enrollment 2021! ? We could also be a few of the solely individuals who deal with Open Enrollment as a serious vacation. We will not assist it. We love this time of 12 months! However we perceive that not everybody shares our enthusiasm, so we produced this brief information that can assist you navigate Open Enrollment. If that is your first time shopping for particular person medical insurance, this text will probably be your finest good friend.

This Open Enrollment 2021 Information is for workers who’ve been provided an HRA by their employer and are on the lookout for steering as they store for particular person medical insurance that may be reimbursed with an HRA just like the Certified Small Employer HRA (QSEHRA) and the Particular person Protection HRA (ICHRA).

Yearly, we hear most of the similar questions from people similar to you who’re having to navigate the well being care system exterior of a standard group plan. Final 12 months, we created a video sequence to handle these questions and despatched it out through e mail. We have included it beneath as a useful resource. As you find out about matters like Open Enrollment, particular person insurance coverage, and HRAs, please keep in mind that our platform will stroll you thru your complete course of and make it easier to select a plan that won’t solely give you the results you want however one which may even work together with your HRA.

Listed below are a couple of of the high-level questions, in addition to a number of related questions, this information addresses intimately: 

• What’s Open Enrollment?
• How do you purchase particular person insurance coverage?
• What are Premium Tax Credit?
• + Further FAQs

Our platform will stroll you thru your complete course of and make it easier to select a plan that won’t solely give you the results you want however one which may even work together with your HRA.

Part 1: What’s Open Enrollment?

What’s Open Enrollment?

Open enrollment is the annual interval when people like you’ll be able to enroll in a medical insurance plan. This 12 months, it is from November 1st to December fifteenth in most locations, though there’s a couple of exceptions the place there is a bit extra time this 12 months (like California, Colorado, Massachusetts, Minnesota, Nevada, New Jersey, New York, Pennsylvania, Rhode Island, and Washington D.C.). Should you’re over 65 and enrolling in Medicare, you get a head begin on October fifteenth.

Why is Open Enrollment restricted to particular dates?

Well being insurers restrict open enrollment to the 6-week open enrollment interval to forestall adversarial choice.  Hostile choice occurs when sick individuals join a well being plan, however wholesome individuals don’t, which throws the quantity of danger a well being plan takes on out of steadiness when insuring somebody.

The place can you purchase particular person insurance coverage?

Throughout open enrollment, insurance policy can be found from main medical insurance coverage corporations to buy from “{the marketplace}” or “alternate.” These plans are known as  “on-exchange” plans. Most states use the federal alternate, Healthcare.gov (38 states, in truth). Twelve states, like California and New York, in addition to Washington D.C., have their very own state-run exchanges and enrollment programs. Pennsylvania and New Jersey will probably be working their very own state-run exchanges this 12 months for the first time, which means should you reside in these states, your course of will probably be new this 12 months. 

Observe that 5 of the states that use HealthCare.gov are thought of state-based exchanges, however truly use the federal platform for enrollment (Arkansas, Kentucky, New Jersey, Pennsylvania, Oregon, and New Mexico).

Whenever you store at Healthcare.gov, you’re solely seeing “on-exchange” plans. Nonetheless, insurance coverage corporations solely make a fraction of their plans out there “on alternate.” Should you go on to an insurance coverage firm’s web site, you’ll see their “off-exchange” plans, or you’ll be able to have a look at all your plans aspect by aspect (together with off-exchange choices) on our buying portal. 

Should you’re prepared to start out buying, you’ll be able to view all your choices aspect by aspect on our portal.

What’s “{the marketplace}” or “alternate”? 

The Reasonably priced Care Act created a medical insurance alternate, or on-line market, the place people can store for particular person medical insurance plans and examine their well being plan choices. That is identified to most as Healthcare.gov. People are solely eligible to obtain premium subsidies and cost-sharing reductions in the event that they buy their protection by way of the alternate.

Why is Open Enrollment important for me?

As a result of your employer is providing you a well being reimbursement association, now’s the time to buy your plan for protection beginning on January 1st, 2021. Open enrollment is the time when you should buy a compliant plan that’s certified on your HRA (both a certified well being plan for ICHRA or a Minimal Important Protection plan for QSEHRA). Should you’re a shopper already utilizing our platform, there will probably be a to do in your dashboard. In case you are new right here, we’ll stroll you thru onboarding which is able to embrace searching for a plan. Simply observe this hyperlink to create a log in, check in and get began searching for particular person medical insurance. 

Part 2: How To Purchase Particular person Insurance coverage

How do you purchase particular person insurance coverage?

It may be a bit overwhelming! Earlier than you store, begin by desirous about what’s vital for you and what well being wants you anticipate for the 12 months. Good inquiries to ask your self embrace, Is it extra vital to have a low premium or a low deductible? Do you usually see a specialist that should keep in-network? Do you will have a whole lot of prescriptions that you’re going to want lined? Are you anticipating any medical wants this 12 months (i.e., ongoing bodily remedy, surgical procedure, or being pregnant?)

It is good to suppose these items by way of, as a result of what actually drives prices–and due to this fact your plan selection–are the issues you realize about: prescriptions, physician visits, remedy, medical tools, and so on. Should you’re wholesome, perhaps you propose on none of these items–which is simply as vital to know. Unpredictable prices, like catching a chilly, spraining an ankle, or a hospitalization, should not affect your plan selection. 

Greater than 75% of your healthcare prices within the subsequent 12 months are predictable based mostly in your wants.

How are you aware you are getting the very best worth on your plan?

This is some excellent news for simplicity: any given plan bought throughout open enrollment will probably be priced precisely the identical regardless of the place you discover it. Should you discover a plan you want, say a Blue Cross Blue Protect silver plan on Healthcare.gov, it should legally be priced the identical whether or not you buy it on the Change, or from a dealer good friend. 

The costs on our particular person medical insurance buying portal will present you the very best costs for all your well being plan choices. 

How are you aware if the plan you wish to purchase qualifies on your firm’s HRA?

Collect spherical, buddies. This can be a actually vital query. Why? As a result of not all plans combine with HRAs, which means that not all plans will probably be reimbursed by way of an HRA and never all plans will qualify you to take part in your organization’s HRA. Finest to get this proper the primary time. 

This is a straightforward, fast listing to get began:

ICHRA-compliant plans:

• Main medical plans bought on the alternate (Bronze, Silver, and Gold) 
• Medicare (Half A+B, or Half C)
• Catastrophic Plans (restricted to these underneath age 30 or should qualify for hardship exemption)
• Pupil Well being Insurance coverage

Plans that do not work with ICHRA embrace sharing ministries, TRICARE, brief time period and indemnity plans, and different employer sponsored group plans (both from partner, COBRA, or retirement plan). 

QSEHRA-compliant plans:

• Main medical plans: Main Medical plans are these compliant with the Reasonably priced Care Act (ACA) and qualify as Minimal Important Protection. Should you bought your plan by way of Healthcare.gov or your state’s public market, your plan is a Main Medical plan, and your reimbursement by way of QSEHRA will probably be tax-free.  
• Pupil insurance coverage
• Your partner’s plan (varies by QSEHRA plan): Should you’re lined by your partner’s group insurance coverage plan there are some nuances to know concerning premium reimbursement. First, solely the portion of the group premium that’s  not paid for by your partner’s firm is eligible for reimbursement. Second, most group plans are already paid on a pre-tax foundation out of your partner’s paycheck. That is nice! Nonetheless, the IRS doesn’t need you to “double dip” and in addition get a pre-tax QSEHRA reimbursement, so your QSEHRA declare on your premium could also be paid on a taxable foundation (plan relying). Should you can confirm that your premium is paid post-tax by your partner (very uncommon), then you’ll be able to nonetheless be reimbursed tax-free by way of QSEHRA! 
• Authorities plans: Medicare, Medicaid, CHIP (youngsters’s medical insurance packages), Tricare, and VA Care are all eligible healthcare plans and qualify as Minimal Important Protection. In case you are on one in all these plans and pay a month-to-month premium out of pocket, these will be reimbursed by way of QSEHRA tax-free.
• Dental Insurance coverage & Imaginative and prescient Insurance coverage Plans: Month-to-month premiums paid for particular person and dental insurance policy will be reimbursed tax-free by way of QSEHRA. If in case you have dental and imaginative and prescient advantages by way of your partner’s employer, solely the portion of the group premium that’s  not paid  for  by your partner’s firm is eligible for reimbursement. As well as, in case your partner pays the premiums on your dental and insurance policy pre-tax, you’ll be able to solely be reimbursed for these premiums on a taxable foundation. 
• Restricted Profit Plans: Restricted Profit Plans are often considerably cheaper than Main Medical plans however solely present a set quantity of advantages (vs. limitless advantages). These plans embrace short-term plans, mounted indemnity plans, accident plans, and another plan that pays a medical profit. So long as you even have a Minimal Important Protection well being plan, and the restricted profit plan pays a medical profit to the supplier (not a money profit to you), the premiums on these plans will be reimbursed tax-free by way of QSEHRA. 

Here’s a put up on plans that combine with QSEHRA and plans that combine with ICHRA that can assist you weigh your choices. 

Confused? This is the excellent news: Any plan that you just buy on the Change will probably be compliant together with your HRA. Main medical off-exchange plans which can be out there throughout open enrollment will qualify as nicely. And here is extra excellent news: our platform will maintain your hand by way of this whole course of. 

Professional-tip: To see if a plan integrates together with your HRA, examine for a metallic tier (silver, platinum, bronze) within the identify or description of the plan. That is a great signal. 

What are some issues you need to keep away from whereas searching for a plan?

Initially, be an knowledgeable shopper. Obtain our PDF on “Well being Insurance coverage 101,” the place you may discover the essential definitions of key phrases you may must know whereas searching for medical insurance (like formulary!). Understanding medical insurance jargon will maintain you out of bother and cut back these stress ranges. 

One other factor to pay attention to is that if you’re buying exterior of an alternate, for instance by way of a dealer, be careful for plans that say indemnity or brief time period as they do not qualify for QSEHRA or ICHRA. For QSEHRA, some plans like this may be supplemented to qualify however they won’t work for ICHRA. 

Additionally vital: Should you’re leaving an organization and COBRA is an possibility, 99% of the time, COBRA is a nasty deal. Don’t simply settle for it as a result of it’s simple. You will be billed for as much as 102% of the entire value of protection; 100% of the price of your earlier plan plus a 2% administrative payment! 

Do I want to buy a brand new plan if I had one this 12 months? (Do it is advisable renew?)

We advocate by no means letting your plan auto-renew as a result of 80% of plans could have a major change annually that you could be not concentrate on. 

It’s tempting to wish to follow one plan out of comfort, and the considered attempting one thing new will be intimidating. Sadly, medical insurance isn’t one thing that must be placed on auto-pilot. Plans, physician networks, prescription protection and your loved ones’s well being wants are altering yearly. To not point out, the market is altering considerably as a consequence of a number of rising traits: narrowing supplier networks, modifications in premiums, insurers leaving the alternate and providing off-exchange solely plans, premium tax credit altering.  

What was nice one 12 months could also be horrible the following, and insurance coverage corporations are often shifting issues round to maximise their earnings—not essentially your well being. 

To get began searching for a plan, head on over to our particular person medical insurance buying web page to match plans aspect by aspect and discover one that can give you the results you want and your HRA.

Part 3: What are Premium Tax Credit?

What are Premium Tax Credit?

Premium tax credit, often known as PTCs, are refundable credit (or subsidies) that helps eligible people and households cowl the prices of premiums for his or her medical insurance bought by way of the ACA Market, or Change. To obtain a premium tax credit score, you have to meet sure necessities.

One technique to pay an excessive amount of for medical insurance is to depart cash on the desk. We see many people assume they don’t seem to be eligible for tax credit after they truly are. Relying on the place you reside, a household of three or 4 that makes $90,000 a 12 months will seemingly qualify for a tax credit score.   

Our particular person medical insurance buying portal will make it easier to calculate your premium tax credit should you qualify. 

How are you aware should you qualify for Premium Tax Credit?

Usually talking, tax credit are tied to measurement and revenue. Additionally they range throughout zip codes. You could qualify for premium tax credit should you: 

• Fall inside a sure revenue vary
• Can’t be claimed as a dependent 
• Don’t file a tax return utilizing the submitting standing of Married Submitting Individually
• Have medical insurance protection by way of {the marketplace} or alternate.
• Are usually not in a position to get reasonably priced protection by way of an eligible employer-sponsored group plan that gives MEC.
• Are usually not eligible for protection by way of a authorities program, like Medicaid, Medicare, CHIP or TRICARE.
• Pay the share of premiums not lined by advance credit score funds.

Take Command Well being may help you determine how a lot you’re eligible for on our particular person medical insurance buying portal. 

 

How will your HRA impact your Premium Tax Credit?

This can be a tough one. The way in which HRAs and PTCs work together is determined by what sort of HRA you will have. 

For QSEHRA: We’ll begin by explaining how QSEHRAs and Premium Tax Credit work collectively. Scroll right down to skip forward when you have an ICHRA. 

Basically, QSEHRA allowance will cut back premium tax credit greenback for greenback.

Mainly the worker will probably be exchanging the tax profit from the federal government with the tax profit from the employer. The worker should still entry their tax credit if the profit is lower than the premium tax credit score out there to them. 

For instance, if you’re eligible for a $500 tax credit score and your employer gives a $400 QSEHRA allowance, your PTC will probably be diminished to $100 ($500-$400). 

It’s very vital that staff buying a plan by way of {the marketplace} and receiving a premium tax credit score notify their insurance coverage supplier instantly about their small enterprise HRA profit.  The insurance coverage supplier will recalculate the worker tax credit score with the QSEHRA profit. Failure to report the QSEHRA to your insurer will lead to having to pay again the tax credit to the IRS throughout tax time.

FOR ICHRA: If in case you have an ICHRA, here is what you need to find out about PTCs and ICHRA.

Workers can select to take part in ICHRA or obtain a PTC. You can’t have each.

A pleasant function of the person protection HRA is that as an worker, you will have the choice to take part in your employer’s ICHRA or opt-out yearly by way of the opt-out provision. That is completely different then ICHRA’s predecessor, QSEHRA, which doesn’t enable staff to opt-out. 

Should you settle for the Particular person Protection HRA, you can not declare any premium tax credit for the 12 months for both your self or any members of the family. Should you opt-out of the Particular person Protection HRA for the 12 months, you might be able to declare premium tax credit.

The Change will then decide if the ICHRA provided is deemed reasonably priced or unaffordable for you. In instances the place an worker has opted out of ICHRA and the HRA is taken into account unaffordable the worker is allowed to assert premium tax credit for themselves and dependents. In instances the place the worker has opted out of ICHRA and the protection is deemed reasonably priced the worker could not declare any premium tax credit for themselves or dependents. 

When people enroll in an Change plan, the Change will ask if the person is obtainable any protection by way of their employer. This consists of protection by way of the Particular person Protection HRA. Workers will probably be required to offer discover to the Change of their ICHRA providing. 

In the course of the onboarding course of with Take Command Well being, we’ll make it easier to perceive these nuances and decide what’s finest for you.

How are you going to get extra details about Premium Tax Credit?

First cease, have a look at your plan paperwork in your portal. The worker discover, particularly, could have nice info on what to do about your PTCs that is tailor-made to you and your precise plan. Additionally try the next assets:

• Extra on QSEHRA & Premium Tax Credit
• Extra on ICHRA & Premium Tax Credit
• Premium Tax Credit score calculator (a.ok.a. Subsidy Calculator)
• Affordability calculator (for workers)
• Affordability calculator (for employers)

Part 4: Different Open Enrollment FAQs

What’s an “on-exchange” or “market” plan?

An on-exchange, or market plan, is a medical insurance plan that is bought on the ACA market or federal alternate (a.ok.a. Healthcare.gov.) or, in some states, state-run exchanges. Any of those are thought of market plans and are eligible for premium tax credit.

 

What’s an “off-exchange” plan?

Off-exchange plans are provided by main medical suppliers and bought immediately by way of them as a substitute of from the alternate. 

Our particular person medical insurance buying portal reveals each on- and off-exchange choices. 

Can I purchase a plan that is not bought on the alternate? Are there different choices moreover Obamacare (ACA)?

Basically, there are different plans exterior of the ACA plans and the off-exchange plans talked about above. However keep in mind, it is advisable have a plan that qualifies for reimbursement by way of your employer’s HRA. For QSEHRA, there are some various insurance policy that qualify if sure circumstances are met. We will information you thru the method of weighing your choices and join you with a companion we belief. 

Should you’re enrolled in an ICHRA, nevertheless, you may want a person medical plan. We advocate you make the most of open enrollment to buy an on- or off-exchange main medical plan that integrates with ICHRA. 

 

What do the metallic tiers imply? (Bronze, Silver, Gold, Platinum)

What the metallic tiers are telling you is how a lot the plan covers and the way a lot it prices.

This is the gist:

Bronze:

• You not often get sick or want medical companies, other than an annual checkup and perhaps a drugs or two.
• You’re very wholesome and never aged.
• If shopping for a household plan, your youngsters are grown and wholesome and don’t take part in dangerous actions.  
• Count on to pay 40% out of pocket, 60% paid by your plan

Silver:

• Your loved ones members have one or two gentle circumstances that require some medicine and specialist visits, however nothing needing shut monitoring or frequent care.
• Your loved ones members are able-bodied and underneath 70.
• Any youngsters are elementary age or older and wholesome, and play few or no sports activities that always trigger harm.
• Count on to pay 30% out of pocket, 70% paid by your plan

Gold:

• You or a member of the family has a power situation, sees medical doctors often or wants costly medicine that will be inconceivable to afford out of pocket.
• Your youngsters are preschool age or youthful, needing frequent pediatrician visits.
• You could be older or at a better danger for colds and flu than most individuals.
• Count on to pay 20% out of pocket, 80% paid by your plan

Platinum:

• You or a member of the family has an costly power situation and takes a number of drugs.
• You search pressing or emergency care greater than as soon as per 12 months on common, often want exams to handle a situation or see medical doctors greater than as soon as per 30 days.
• You’re older or at very excessive danger for colds, flu, or accidents.
• Count on to pay 10% out of pocket, 90% paid by your plan

Try our helpful weblog put up on what the metallic tiers imply for extra info. 

What are insurance coverage “premiums” and “deductibles”?

A premium is the month-to-month value on your medical insurance. The premium is what your month-to-month allowance for an HRA will cowl.

A deductible is the quantity of lined healthcare prices you pay earlier than your medical insurance begins to cowl the prices. If in case you have a $2,000 deductible, you may be paying $2,000 out of pocket earlier than insurance coverage kicks in. 

Professional-tip: Your month-to-month premium doesn’t rely towards your deductible. 

What are the variations between the community sorts (HMO, PPO, EPO)?

An HMO (or “well being upkeep group”) is usually probably the most reasonably priced, however least versatile community sort. Right here a couple of key ideas of a HMO:

• You’re required to pick a major care doctor (or the insurance coverage firm can assign one for you) who’s your first-stop for well being wants. You’ll need a referral out of your major care doctor to see a specialist.
• Should you select to see a physician exterior of the community or and not using a referral, you’ll usually must pay all prices out-of-pocket until it’s a true medical emergency or you don’t have any different choices.
• The doctor community is native.

A PPO (or “most well-liked supplier group”) is usually probably the most versatile, but costliest community sort. Right here a couple of key ideas of a PPO:

• You don’t want to pick a major care doctor and you don’t want referrals to see a specialist.
• Should you see an in-network supplier, you’ll solely be answerable for paying a portion of the invoice (based mostly in your plan’s protection construction).
• Should you select to see a physician who’s exterior the popular community, you’ll usually must pay a bigger portion of the invoice than you’d for an in-network supplier.
• You should have entry to out-of-state suppliers which can be thought of in-network.

An EPO (or “unique supplier community”) is a hybrid of a HMO and a PPO. Right here a couple of key ideas of an EPO:

• EPOs are extra versatile than an HMO, and are sometimes cheaper than a PPO.
• Like a PPO, you don’t want a referral to get care from a specialist.
• Like an HMO, you’re answerable for paying out-of-pocket should you search care from a physician exterior your plan’s community.

A POS (or “level of service”) can also be a hybrid of a HMO and a PPO. Listed below are a couple of key ideas of a POS:

• POS plans are extra versatile than an HMO, and are sometimes cheaper than a PPO.
• Like an HMO, you have to a referral out of your major care doctor with a purpose to see a specialist.
• Like a PPO plan, you’ll have entry to out-of-network suppliers (at an elevated value).

Can I modify medical insurance plans in the course of the 12 months?

You may solely change plans and purchase on-exchange plans throughout Open Enrollment (November 1st by way of December fifteenth) until you meet sure circumstances that qualify you for a Particular Enrollment Interval. These circumstances embrace having a child, getting married, getting divorced, or altering jobs. In different phrase, massive life modifications.

In case you are provided an HRA for the primary time out of your employer, that qualifies you for a Particular Enrollment Interval as nicely, the place you may have 60 days to enroll in a well being plan that meets your HRA necessities. 

Professional-tip: We advocate you make the most of Open Enrollment to enroll in a plan. You will have extra choices.

Learn our posts on Particular Enrollment Intervals for QSEHRA or Particular Enrollment Intervals for ICHRA for more information. 

Subsequent Steps

That is an thrilling time, and we’re honored to part of this course of with you. If in case you have another questions as you start the method, please attain out. We’re right here that can assist you! And for these of you who’re able to being, please login to our portal and we’ll stroll you thru the method.

Completely satisfied Open Enrollment, everyone! ?