Completely happy Open Enrollment 2024! 🎉 We could also be a few of the solely individuals who deal with Open Enrollment as a serious vacation. We won’t assist it. We love this time of 12 months! However we perceive that not everybody shares our enthusiasm, so we produced this quick information that will help you navigate Open Enrollment. If that is your first time shopping for particular person medical insurance, this text might be your finest good friend.

Up to date October 13, 2023 in anticipation of Open Enrollment 2024! 

Yearly, we hear lots of the similar questions from people similar to you who’re having to navigate the well being care system outdoors of a standard group plan. Don’t be concerned! We’ve got many sources, together with this information, that will help you.

As you find out about subjects like Open Enrollment, particular person insurance coverage, and HRAs, please keep in mind that our platform will stroll you thru your entire course of and show you how to select a plan that won’t solely give you the results you want however one which may even work along with your HRA.

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

Our platform will stroll you thru your entire course of and show you how to select a plan that won’t solely give you the results you want however one which may even work along with your HRA.

In the event you’re over 65 and enrolled in Medicare, you get a head begin from October fifteenth by December seventh to evaluate and make any modifications to your Medicare protection, which can go into impact January 1st .

Why is Open Enrollment restricted to particular dates?

Well being insurers restrict the open enrollment interval to forestall opposed choice.  Antagonistic choice occurs when sick individuals join a well being plan, however wholesome individuals don’t, which throws the quantity of threat 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 coverage can be found from main medical insurance coverage firms to buy from “{the marketplace}” or “alternate.” These plans are known as  “on-exchange” plans. Most states use the federal alternate, Healthcare.gov. Some states, like California, New York, Pennsylvania, and some different states, have their very own state-run exchanges and enrollment methods. 

Whenever you store at Healthcare.gov, you’re solely seeing “on-exchange” plans. Nevertheless, insurance coverage firms solely make a fraction of their plans out there “on alternate.” In the event you go on to an insurance coverage firm’s web site, you’ll see their “off-exchange” plans.

The Take Command platform is a good place to begin procuring as a result of you may have a look at ALL of the out there plans facet by facet (together with “off-exchange” plans) to check – and see which plans are “Straightforward-Enroll”. True to the identify, Straightforward Enroll plans have simple, quick enrollment (Take Command takes care of it!) and our crew can help you with the Provider! Search for the Straightforward Enroll tag for added peace-of-mind.

In the event you’re prepared to begin procuring, you may view your whole choices facet by facet on our platform.

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 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, 2024. It is necessary to notice that you’re going to have to enroll by December fifteenth, 2023 for protection that begins January 1st, 2024. Open enrollment continues by January fifteenth for February 1st begin dates. As talked about above, the dates could range barely in some states.

Open Enrollment is the time when you should buy a compliant plan that’s certified in your HRA (both a certified well being plan for ICHRA or a Minimal Important Protection plan for QSEHRA). In the event you’re a consumer already utilizing our platform, there might be a to do checklist in your dashboard. If you’re new right here, we are going to stroll you thru onboarding which can embrace searching for a plan. After Open Enrollment begins in November, you may recieve an e mail to login or you may observe this hyperlink to create a log in, check in and get began searching for particular person medical insurance.

The costs on our particular person medical insurance procuring portal will present you the perfect costs for your whole well being plan choices. 

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

Collect spherical, pals. This can be a actually necessary query. Why? As a result of not all plans combine with HRAs, which means that not all plans might be reimbursed by 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. 

Here is a straightforward, fast checklist to get began:

ICHRA-compliant plans:

Plans that do not work with ICHRA embrace sharing ministries, TRICARE, quick 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. In the event you bought your plan by Healthcare.gov or your state’s public market, your plan is a Main Medical plan, and your reimbursement by QSEHRA might be tax-free.
• Pupil insurance coverage
• Your partner’s plan (varies by QSEHRA plan): In the event you’re coated by your partner’s group insurance coverage plan there are some nuances to know relating to 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! Nevertheless, the IRS doesn’t need you to “double dip” and likewise get a pre-tax QSEHRA reimbursement, so your QSEHRA declare in your premium could also be paid on a taxable foundation (plan relying). In the event you can confirm that your premium is paid post-tax by your partner (very uncommon), then you may nonetheless be reimbursed tax-free by QSEHRA!
• Authorities plans: Medicare, Medicaid, CHIP (kids’s medical insurance applications), TRICARE, and VA Care are all eligible healthcare plans and qualify as Minimal Important Protection. If you’re on one among these plans and pay a month-to-month premium out of pocket, these may be reimbursed by QSEHRA tax-free.
• Dental Insurance coverage & Imaginative and prescient Insurance coverage Plans: Month-to-month premiums paid for particular person and dental insurance coverage may be reimbursed tax-free by QSEHRA. You probably have dental and imaginative and prescient advantages by 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 in your dental and insurance coverage pre-tax, you may 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, fastened 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 may be reimbursed tax-free by QSEHRA. 

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

Confused?

Here is the excellent news: Any plan that you simply buy on the Alternate might be compliant along with your HRA. Main medical off-exchange plans which might be out there throughout Open Enrollment will qualify as effectively.

And here is extra excellent news: our platform will maintain your hand by this whole course of. 

Professional-tip: To see if a plan integrates along 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 if I am on Medicare with my HRA?

Nice information! Medicare is reimbursable along with your HRA. Bear in mind, you need to have protection of Half A and Half B collectively or Half C.  Half B by itself does not qualify.

To make this simpler, we have partnered with Chapter to make the Medicare enrollment course of a breeze. Chapter is a white glove service that can show you how to discover the precise Medicare Benefit and Medicare Supplemental plans which might be designed to assist cowl the prices of assorted deductibles, co-payments and coinsurance fees that Medicare alone doesn’t embrace.

All you may need to do is select a protection possibility from main insurance coverage firms based mostly on the place you reside and your particular person wants, then submit proof of protection to Take Command, together with receipts for eligible care, and get reimbursed tax-free.

Study extra on our Medicare partnership with Chapter right here.

Necessary: Medicare Open Enrollment runs October fifteenth to December seventh. That is the time to guage present Medicare protection and your probability to make modifications to your Medicare protection.

What are some issues you must 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 fundamental definitions of key phrases you may have to 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 concentrate on is that in case you are procuring outdoors of an alternate, for instance by a dealer, be careful for plans that say indemnity or quick 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 necessary: In the event you’re leaving an organization and COBRA is an possibility, 99% of the time, COBRA is a foul deal. Don’t simply settle for it as a result of it’s simple. You may be billed for as much as 102% of the full value of protection; 100% of the price of your earlier plan plus a 2% administrative charge! 

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

Do I have to cancel my outdated well being plan?

Sure!

In the event you’re altering insurance coverage firms for 2024, be sure you name and cancel your outdated plan from 2023 earlier than they auto-renew – and cost you for a January 2024 premium!

Even when you should have the identical insurance coverage firm in 2024 as in 2023, however are altering the particular plan itself, we suggest calling and confirming that they solely have your new plan on file for 2023. You don’t wish to pay for 2 plans! Word that some carriers course of funds in the midst of the month, so early December is the perfect time to cancel a 2023 plan.

Bear in mind that you’re maintaining your 2023 plan efficient by the tip of December as your new 2024 plan will develop into efficient January 1, 2024.

Our particular person medical insurance procuring portal will show you how to calculate your premium tax credit should you qualify. 

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

Typically talking, tax credit are tied to measurement and earnings. In addition they range throughout zip codes. Chances are you’ll qualify for premium tax credit should you: 

• Fall inside a sure earnings 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 {the marketplace} or alternate.
• Usually are not in a position to get inexpensive protection by an eligible employer-sponsored group plan that gives MEC.
• Usually are not eligible for protection by a authorities program, like Medicaid, Medicare, CHIP or TRICARE.
• Pay the share of premiums not coated by advance credit score funds.

Take Command Well being may help you determine how a lot you might be eligible for on our particular person medical insurance procuring portal. 

How will your HRA have an effect on your Premium Tax Credit?

This can be a difficult one. The way in which HRAs and PTCs work together is determined by what kind of HRA you’ve got. 

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

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

Mainly the worker might 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, in case you are eligible for a $500 tax credit score and your employer affords a $400 QSEHRA allowance, your PTC might be diminished to $100 ($500-$400). 

It’s very necessary that workers buying a plan by {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 end in having to pay again the tax credit to the IRS throughout tax time.

FOR ICHRA: You probably have an ICHRA, here is what you must find out about PTCs and ICHRA.

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

A pleasant characteristic of the particular person protection HRA is that as an worker, you’ve got the choice to take part in your employer’s ICHRA or opt-out yearly by the opt-out provision. That is completely different then ICHRA’s predecessor, QSEHRA, which doesn’t permit workers to opt-out. 

In the event 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. In the event you opt-out of the Particular person Protection HRA for the 12 months, you might be able to declare premium tax credit.

The Alternate will then decide if the ICHRA supplied is deemed inexpensive 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 inexpensive the worker could not declare any premium tax credit for themselves or dependents. 

When people enroll in an Alternate plan, the Alternate will ask if the person is obtainable any protection by their employer. This consists of protection by the Particular person Protection HRA. Staff might be required to present discover to the Alternate of their ICHRA providing. 

Through the onboarding course of with Take Command, we are going to show you how to perceive these nuances and decide what’s finest for you.

How will you 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 actual plan. Additionally try the next sources:

Our particular person medical insurance procuring portal exhibits each on- and off-exchange choices. 

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

Generally, there are different plans outdoors of the ACA plans and the off-exchange plans talked about above. However bear in mind, it’s worthwhile to have a plan that qualifies for reimbursement by your employer’s HRA. For QSEHRA, there are some various insurance coverage that qualify if sure circumstances are met. We are able to information you thru the method of weighing your choices and join you with a companion we belief. 

In the event you’re enrolled in an ICHRA, nonetheless, you may want a person medical plan. We suggest 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.

Here is the gist:

Bronze:

• You hardly ever get sick or want medical providers, other than an annual checkup and perhaps a drugs or two.
• You might be very wholesome and never aged.
• If shopping for a household plan, your kids 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 delicate circumstances that require some medicine and specialist visits, however nothing needing shut monitoring or frequent care.
• Your loved ones members are able-bodied and beneath 70.
• Any children are elementary age or older and wholesome, and play few or no sports activities that usually trigger damage.
• Count on to pay 30% out of pocket, 70% paid by your plan

Gold:

• You or a member of the family has a continual situation, sees medical doctors incessantly or wants costly medicine that may be inconceivable to afford out of pocket.
• Your kids are preschool age or youthful, needing frequent pediatrician visits.
• Chances are you’ll be older or at the next threat 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 continual situation and takes a number of medicines.
• You search pressing or emergency care greater than as soon as per 12 months on common, incessantly want exams to handle a situation or see medical doctors greater than as soon as per thirty days.
• You might be older or at very excessive threat for colds, flu, or accidents.
• Count on to pay 10% out of pocket, 90% paid by your plan

Take a look at 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 in your medical insurance. The premium is what your month-to-month allowance for an HRA will cowl.

A deductible is the quantity of coated healthcare prices you pay earlier than your medical insurance begins to cowl the prices. You probably 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 varieties (HMO, PPO, EPO)?

An HMO (or “well being upkeep group”) is usually essentially the most inexpensive, however least versatile community kind. Right here a number of key ideas of a HMO:

• You might be required to pick out a main care doctor (or the insurance coverage firm can assign one for you) who’s your first-stop for well being wants. You have to a referral out of your main care doctor to see a specialist.
• In the event you select to see a physician outdoors of the community or with no referral, you’ll typically need to 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 popular supplier group”) is usually essentially the most versatile, but most costly community kind. Right here a number of key ideas of a PPO:

• You do not want to pick out a main care doctor and you don’t want referrals to see a specialist.
• In the event you see an in-network supplier, you’ll solely be chargeable for paying a portion of the invoice (based mostly in your plan’s protection construction).
• In the event you select to see a physician who’s outdoors the popular community, you’ll typically need to pay a bigger portion of the invoice than you’d for an in-network supplier.
• You’ll have entry to out-of-state suppliers which might be thought-about in-network.

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

• EPOs are extra versatile than an HMO, and are usually inexpensive than a PPO.
• Like a PPO, you don’t want a referral to get care from a specialist.
• Like an HMO, you might be chargeable for paying out-of-pocket should you search care from a physician outdoors your plan’s community.

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

• POS plans are extra versatile than an HMO, and are usually inexpensive than a PPO.
• Like an HMO, you will have a referral out of your main care doctor so as to see a specialist.
• Like a PPO plan, you should have entry to out-of-network suppliers (at an elevated value).

Can I alter medical insurance plans in the midst of the 12 months?

You possibly can solely change plans and purchase on-exchange plans throughout Open Enrollment (from November 1st by January 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, large life modifications.

If you’re supplied an HRA for the primary time out of your employer, that qualifies you for a Particular Enrollment Interval as effectively, the place you may have 60 days to enroll in a well being plan that meets your HRA necessities. 

Professional-tip: We suggest you reap the benefits of Open Enrollment to enroll in a plan. You will have extra choices.

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

What about dental insurance coverage? 

There are two methods to enroll in dental insurance coverage.

1. The Market: Dental plans generally are included in well being plans bought on the Market or state-based exchanges. Whenever you examine plans on our window procuring instrument and even on Healthcare.gov, you’ll see which of them embrace dental protection. In these instances, your premium would cowl each well being and dental protection. 
2. Separate dental plans: In case your well being plan doesn’t embrace dental protection, it’s possible you’ll to buy a separate dental insurance coverage plan. Simply bear in mind, should you decide a separate dental plan, you’ll pay a separate premium. That is along with the premium you pay in your particular person medical insurance plan. Generally, if you’re procuring on the Alternate, you may see an possibility so as to add a dental plan. This may present additional choices for you. For our purchasers, we now have researched high quality particular person medical insurance plans by Renaissance and AmFirst that we suggest to make use of with an HRA. 

Here is a useful put up for extra details about our dental partnerships.

Subsequent Steps

That is an thrilling time, and we’re honored to part of this course of with you. You probably have another questions as you start the method, please attain out. We’re right here that will help 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 happy Open Enrollment, all people! 🎉