1. Open enrollment for health insurance: Every year, during the open enrollment period, tens of millions of Americans can enroll in a health insurance plan. Consumers can enroll for the first time or change their existing plan until Jan. 1, 2022.
  2. Health insurance exchanges vary by state: The ACA mandated the creation of exchanges in each state, but implementation varies widely. This year’s exchanges will include 15 state-run exchanges, 24 federally facilitated exchanges, and six state-partnership exchanges. The marketplace health insurance plans provide subsidies for some lower- and middle-class consumers.
  3. Employer-provided coverage: Environ 153 million Americans, or more than half of the non-elderly population, had employer-sponsored health insurance in 2019. Because of the COVID-19 pandemic, millions have lost their employer-sponsored health insurance. Many employers provide a two- to three-week enrollment period between October and November, according to Rebecca Madsen, chief consumer officer of UnitedHealthcare, a global health insurer. It serves individuals, businesses, and Medicare and Medicaid recipients.
  4. Which marketplace tier is right for you: Marketplace health plans are classified as Platinum, Gold, Silver, or Bronze. Xcenda, a strategic consulting and field reimbursement services firm that works with pharmaceutical and biotech markets, says the tiers are separated based on cost structure – specifically, how patients and their plans split the cost of health care. Bronze plans, for example, have the lowest monthly premiums but the highest out-of-pocket costs, according to Ford. “Platinum plan members pay the highest monthly premiums but the lowest out-of-pocket costs.”
  5. Key elements to consider: When comparing health insurance plans, keep in mind these six key points:
  • The plan’s provider network.
  • Monthly fees.
  • Deductibles
  • Formulary
  • Copayments
  • Coinsurance

Consumers should consider all of them. “Patients should confirm that their preferred doctors, hospitals, and pharmacies are in the plan’s network before purchasing. Otherwise, patients may be charged more for services at those locations.”

  1. Avoiding a tax penalty: Initially, the ACA imposed a fine for not having health insurance. While being uninsured is no longer a federal offense, Madsen says some states still do. Not having health insurance is a crime in New Jersey, Massachusetts, California, Rhode Island, and DC. Penalties vary by state and are either based on income or are fixed.
  2. Many plans now reward you financially for taking healthier actions like completing a health survey, exercising, or avoiding nicotine. Some plans include free gym memberships and wellness programs.