Time Is Running Out to Make Changes to Your Coverage
by REBEKAH PIERCE
The end of the year means holidays and open enrollment.
The clock is ticking if you need to sign up for Affordable Care Act health insurance through the marketplace.
In 2022-2023, Florida led the charge with a record-breaking number of marketplace enrollees — with more than 3.2 million residents signing up for plans, according to the Centers for Medicare and Medicaid Services. A fifth of all marketplace enrollees in the country live in Florida.
Before you start stressing, know that open enrollment isn’t as complicated as it seems.
What Is Open Enrollment?
Open enrollment refers to the designated period of time each year when individuals and families can sign up for health insurance or make changes to their existing coverage. This period provides a critical opportunity to secure health insurance that best suits your needs.
Florida uses the federal Health Insurance Marketplace, available at HealthCare.gov. Plans on the exchange are available for those who are self-employed, people who are retiring early and need coverage until they are eligible for Medicare coverage, and people employed by small businesses without health benefits.
To be eligible for any kind of financial assistance via the Marketplace (including subsidies on your premium and certain cost-sharing reductions), you must meet income eligibility guidelines and not be eligible for Medicaid, premium-free Medicare Part A, or CHIP. You must not be employed by a business that offers affordable sponsored health coverage, either.
Open enrollment for ACA in most states (including Florida) runs from Nov. 1 until Jan. 16, but in order to have coverage on Jan. 1, you need to enroll by Dec. 15. There are also Special Enrollment Periods for people moving to the area, losing their coverage, or getting turned down for Medicaid.
It’s important that you pay close attention to the deadlines. If you miss it, you may not be able to sign up until the next open enrollment period (though you can often still qualify if you experience a significant life change during the year, like a marriage or the birth of a child).
So how much will it cost you? It costs nothing to explore your options, but the amount you’ll be expected to pay for your insurance coverage will vary.
Under the ACA, all health insurance plans must meet minimum standards to be considered “qualified health plans,” which means that they must cover essential health benefits such as prescription drugs, hospitalization, and preventative services.
Key Changes to Open Enrollment for 2024
As you gear up for the 2024 health insurance enrollment period, there are some important changes to keep in mind.
First, the deductible cap. For 2024, the federal government has capped what enrollees will spend out of pocket (co-payments and co-insurance) at $9,450. That means that, once you’ve spent that number within a year, the insurance company must pay the rest of the bills. That number’s up from $9,100 in 2023.
Enrollees who qualify for a tax subsidy based on their income can choose to have their monthly premiums lowered immediately or to receive a tax credit when they file.
The Marketplace also has updated the automatic re-enrollment process to allow enrolled to take advantage of certain cost savings.
For example, if you were already enrolled with certain income-based cost-sharing reduction eligibility under a Bronze plan, you will automatically be re-enrolled in a Silver Plan (but only if you do not make an active plan selection before the deadline). This will allow for better cost-sharing opportunities and allow enrollees to receive a better plan for the same or lower monthly premium.
If you are someone who might be eligible for this re-enrollment, you’ll receive a notice from the Marketplace.
Medicare Open Enrollment
It’s important to know that we’re also in the middle of Medicare Open Enrollment, and the process and rules vary from the ACA period of the same name.
According to Don Burrell of Burrell Insurance, “As you know, we are in the midst of the Medicare Annual Enrollment Period, AEP, where anyone with Medicare can switch, drop or join a Medicare Advantage or Medicare Prescription Drug Plan of their choosing. You can also enroll in original Medicare. Your plan selection becomes effective Jan. 1 of the following year. You may have noticed, every other commercial on TV is a Medicare commercial.”
For Medicare, there are also Special Enrollment Periods.
If you’re planning on enrolling in a Medicare plan, according to Burrell, “there are numerous Medicare companies with an assortment of plan options. Plans are county specific so if you move out of your plan area, you may have to change your plan, and Medicare realizes people move.” Because of this, the Special Enrollment period may apply. If you’re interested in learning more about how this works, be sure to contact a local Medicare agent.