Seems like most everything has changed this year. Here's a list of benefit changes that you may not be aware of:
1. New Networks & Directors - HMOs have made a huge comeback due to the maximum out-of-pocket being capped for a single at $6,350 and $12,700 per family plan per year. This also means no out of network coverage is available on most plans. Primary Care Physicians are the service directors and are already in short supply, so make sure you have one if you don't already.
2. One deductible per family plan - Most plans have a copay for Doctor and Prescription only after the deductible has been met.
3. Generic Prescriptions Required.
4. No Prescriptions Allowed for Over the Counter Medicines - EG Ibuprofen, Prilosec, and the like were sometimes cheaper with prescription. This also means the cost of these won't go towards your deductible.
5. Pediatric Dental and Vision are typically covered only after deductible so don't rush in thinking you have free benefits to use.
6. Clinical Trials - Not all are covered, just specific ones related to life extension with already proven results.
7. Platinum Plans not available on the Marketplace. If you'd like to have a $750 deductible and an out of pocket maximum of $1,500 you'll have to pay the full premium. Carriers on the Marketplace were afraid of adverse selection, so they decided not to offer this plan.
8. Off the Marketplace Carriers and Plans - Talk with an agent to see what additional plans are available in your area. Sometimes there's no substitution for an experienced agent. Navigators have little experience and have occasionally & inadvertently given inaccurate advice.
9. To avoid a penalty, you must enroll by Valentine's Day. This is because the penalty is for not having insurance more than 9 months of the year. If you don't enroll until March 15 for April 1st effective date, you've missed the cut off for the minimum coverage period to avoid the penalty. The IRS may change this, but it's a technicality which may cost you $95.
10. You won't be able to buy health insurance after April 1st unless you lost it elsewhere. Yes, it's true; the next open enrollment period will begin in October for coverage to start 1/1/15. If you find yourself without coverage and needing insurance this summer, you'll need to buy a short term plan which doesn't cover pre-existing conditions, get married to join your spouse's plan, get poor to join Medicaid, or get a job with group insurance.
1. New Networks & Directors - HMOs have made a huge comeback due to the maximum out-of-pocket being capped for a single at $6,350 and $12,700 per family plan per year. This also means no out of network coverage is available on most plans. Primary Care Physicians are the service directors and are already in short supply, so make sure you have one if you don't already.
2. One deductible per family plan - Most plans have a copay for Doctor and Prescription only after the deductible has been met.
3. Generic Prescriptions Required.
4. No Prescriptions Allowed for Over the Counter Medicines - EG Ibuprofen, Prilosec, and the like were sometimes cheaper with prescription. This also means the cost of these won't go towards your deductible.
5. Pediatric Dental and Vision are typically covered only after deductible so don't rush in thinking you have free benefits to use.
6. Clinical Trials - Not all are covered, just specific ones related to life extension with already proven results.
7. Platinum Plans not available on the Marketplace. If you'd like to have a $750 deductible and an out of pocket maximum of $1,500 you'll have to pay the full premium. Carriers on the Marketplace were afraid of adverse selection, so they decided not to offer this plan.
8. Off the Marketplace Carriers and Plans - Talk with an agent to see what additional plans are available in your area. Sometimes there's no substitution for an experienced agent. Navigators have little experience and have occasionally & inadvertently given inaccurate advice.
9. To avoid a penalty, you must enroll by Valentine's Day. This is because the penalty is for not having insurance more than 9 months of the year. If you don't enroll until March 15 for April 1st effective date, you've missed the cut off for the minimum coverage period to avoid the penalty. The IRS may change this, but it's a technicality which may cost you $95.
10. You won't be able to buy health insurance after April 1st unless you lost it elsewhere. Yes, it's true; the next open enrollment period will begin in October for coverage to start 1/1/15. If you find yourself without coverage and needing insurance this summer, you'll need to buy a short term plan which doesn't cover pre-existing conditions, get married to join your spouse's plan, get poor to join Medicaid, or get a job with group insurance.
Jeanine Kinzie is a Licensed Health Insurance Agent, Licensed Life Insurance Agent and a Federally Facilitated Marketplace Enroller from Grand Rapids, Michigan.
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