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The official 2024 Open Enrollment Information + FAQs

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Completely satisfied Open Enrollment 2024! 🎉 We could also be a few of the solely individuals who deal with Open Enrollment as a significant 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 will help you navigate Open Enrollment. If that is your first time shopping for particular person medical health insurance, this text can be your finest good friend.

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

This 2024 Open Enrollment Information is for workers who’ve been supplied an HRA by their employer and are in search of steering as they store for particular person medical health 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 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 many sources, together with this information, that will help you.

As you study matters like Open Enrollment, particular person insurance coverage, and HRAs, please keep in mind that our platform will stroll you thru the whole course of and assist you to select a plan that won’t solely give you the results you want however one which can even work together with your HRA.

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

Our platform will stroll you thru the whole course of and assist you to select a plan that won’t solely give you the results you want however one which can 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 possibly can enroll in a medical health insurance plan. For 2023, it is from November 1st to January fifteenth in most locations, though there’s just a few exceptions. Some states are completely prolonged by way of January thirty first, like California, Nevada, New Jersey, New York, Rhode Island and Washington D.C. Massachusetts has completely prolonged by way of January twenty third. 

For protection starting on January 1st, nonetheless, the deadline to enroll is December fifteenth nationally, no matter when open enrollment ends.

For those who enroll after December fifteenth, however earlier than the January fifteenth deadline, your protection will start February 1st in most states.

For those who’re over 65 and enrolled in Medicare, you get a head begin from October fifteenth by way of December seventh to evaluation and make any adjustments 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 stop hostile choice.  Hostile 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 stability 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 “trade.” These plans are known as  “on-exchange” plans. Most states use the federal trade, Healthcare.gov. Some states, like California, New York, Pennsylvania, and some different states, have their very own state-run exchanges and enrollment programs. 

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 trade.” For those who 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 start out buying as a result of you possibly can take a look at ALL of the out there plans aspect by aspect (together with “off-exchange” plans) to check – and see which plans are “Simple-Enroll”. True to the identify, Simple Enroll plans have simple, quick enrollment (Take Command takes care of it!) and our group can help you with the Provider! Search for the Simple Enroll tag for added peace-of-mind.

For those who’re prepared to start out buying, you possibly can view all your choices aspect by aspect on our platform.

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

The Reasonably priced Care Act created a medical health insurance trade, or on-line market, the place people can store for particular person medical health 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 trade.

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 essential to notice that you’re going to must enroll by December fifteenth, 2023 for protection that begins January 1st, 2024. Open enrollment continues by way of January fifteenth for February 1st begin dates. As talked about above, the dates might differ barely in some states.

Open Enrollment is the time when you should buy a compliant plan that’s certified to your HRA (both a certified well being plan for ICHRA or a Minimal Important Protection plan for QSEHRA). For those who’re a shopper already utilizing our platform, there can be a to do checklist in your dashboard. If you’re new right here, we’ll 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 possibly can observe this hyperlink to create a log in, sign up and get began searching for particular person medical health insurance.

Part 2: How To Purchase Particular person Insurance coverage

How do you purchase particular person insurance coverage?

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

It is good to assume these items by way of, as a result of what actually drives prices–and due to this fact your plan alternative–are the issues you realize about: prescriptions, physician visits, remedy, medical gear, and many others. For those who’re wholesome, possibly you propose on none of these items–which is simply as essential to know. Unpredictable prices, like catching a chilly, spraining an ankle, or a hospitalization, should not affect your plan alternative. 

Our buying portal permits you to enter a supplier’s identify to see which plans present them as in-network and see if particular prescriptions are coated in a plan’s drug formulary.

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 most effective worth to your plan?

Here is some excellent news for simplicity: any given plan bought throughout Open Enrollment can be priced precisely the identical regardless of the place you discover it. For those who discover a plan you want, say a Blue Cross Blue Defend silver plan on Healthcare.gov, it’ll 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 health insurance buying portal will present you the most effective costs for all your well being plan choices. 

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

Collect spherical, mates. It is a actually essential query. Why? As a result of not all plans combine with HRAs, that means that not all plans can 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. 

Here is a straightforward, fast checklist to get began:

ICHRA-compliant plans:

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. For those who 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 can be tax-free.
  • Pupil insurance coverage
  • Your partner’s plan (varies by QSEHRA plan): For those who’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! Nonetheless, the IRS doesn’t need you to “double dip” and likewise get a pre-tax QSEHRA reimbursement, so your QSEHRA declare to your premium could also be paid on a taxable foundation (plan relying). For those who can confirm that your premium is paid post-tax by your partner (very uncommon), then you possibly can nonetheless be reimbursed tax-free by way of QSEHRA!
  • Authorities plans: Medicare, Medicaid, CHIP (kids’s medical health insurance packages), TRICARE, and VA Care are all eligible healthcare plans and qualify as Minimal Important Protection. If you’re on considered one of these plans and pay a month-to-month premium out of pocket, these may 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 may be reimbursed tax-free by way of QSEHRA. When you’ve got 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 to your dental and insurance policy pre-tax, you possibly can solely be reimbursed for these premiums on a taxable foundation. 
  • Restricted Profit Plans: Restricted Profit Plans are normally 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 every other 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 way of 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 just buy on the Change can be compliant together with your HRA. Main medical off-exchange plans which might 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, test for a metallic tier (silver, platinum, bronze) within the identify or description of the plan. That is a very good signal. 

What if I am on Medicare with my HRA?

Nice information! Medicare is reimbursable together with your HRA. Bear in mind, it’s essential 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 may assist you to discover the best Medicare Benefit and Medicare Supplemental plans which might be designed to assist cowl the prices of assorted deductibles, co-payments and coinsurance prices that Medicare alone doesn’t embrace.

All you may should do is select a protection possibility from main insurance coverage corporations 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.

Be taught 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 adjustments to your Medicare protection.

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

To start with, 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 health insurance (like formulary!). Understanding medical health insurance jargon will preserve you out of hassle and cut back these stress ranges. 

One other factor to pay attention to is that in case you are buying outdoors of an trade, 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. 

READ MORE >>>  Coverage Specialists Focus on Methods to Maintain Employer-Sponsored Well being Insurance coverage Afloat

Additionally essential: For those who’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 overall value of protection; 100% of the price of your earlier plan plus a 2% administrative charge! 

 

How do I renew/preserve my similar particular person plan?

For those who’re comfortable together with your particular person plan and the insurance coverage firm is providing it once more in 2024, you possibly can renew your plan most often.

For those who had an “Simple Enroll” plan with Take Command in 2023, you might even see the choice to resume your plan whenever you log in to buy. In some circumstances chances are you’ll not see this feature. If your organization has an ICHRA with AutoPay, you possibly can store and select the identical plan for 2024. For those who’ve had adjustments that have an effect on your premium quantity like including/eradicating dependents or shifting, you’ll probably want to buy so as to select the identical plan. 

Earlier than retaining the identical plan, take a while to think about your loved ones’s well being wants for 2024, which docs it is advisable preserve in-network, and what prescription protection is essential. If the identical plan from final 12 months nonetheless meets your wants, then merely renew or select it once more! 

Bear in mind, it by no means hurts to browse different plans to ensure your present plan remains to be your most well-liked plan.

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

 

Do I must cancel my outdated well being plan?

Sure!

For those who’re altering insurance coverage corporations 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 precise 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 most effective time to cancel a 2023 plan.

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

 

Part 3: What are Premium Tax Credit?

What are Premium Tax Credit?

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

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

Our particular person medical health insurance buying portal will assist you to calculate your premium tax credit in the event you qualify. 

How are you aware in the event you qualify for Premium Tax Credit?

Typically talking, tax credit are tied to measurement and earnings. Additionally they differ throughout zip codes. It’s possible you’ll qualify for premium tax credit in the event 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 health insurance protection by way of {the marketplace} or trade.
  • Aren’t capable of get reasonably priced protection by way of an eligible employer-sponsored group plan that gives MEC.
  • Aren’t eligible for protection by way of 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 health insurance buying portal. 

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

It is a difficult one. The way in which HRAs and PTCs work together is determined by what kind of HRA you may have. 

For QSEHRA: We are going to begin by explaining how QSEHRAs and Premium Tax Credit work collectively. Scroll all the way down to skip forward when you have an ICHRA. 

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

Mainly the worker can be exchanging the tax profit from the federal government with the tax profit from the employer. The worker should 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 provides a $400 QSEHRA allowance, your PTC can be lowered to $100 ($500-$400). 

It’s very essential that workers 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: When you’ve got an ICHRA, here is what you must 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 particular person protection HRA is that as an worker, you may 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 permit workers to opt-out. 

For those who settle for the Particular person Protection HRA, you can’t declare any premium tax credit for the 12 months for both your self or any relations. For those who 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 supplied is deemed reasonably priced or unaffordable for you. In circumstances the place an worker has opted out of ICHRA and the HRA is taken into account unaffordable the worker is allowed to say premium tax credit for themselves and dependents. In circumstances the place the worker has opted out of ICHRA and the protection is deemed reasonably priced the worker might 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 contains protection by way of the Particular person Protection HRA. Workers can be required to provide discover to the Change of their ICHRA providing. 

In the course of the onboarding course of with Take Command, we’ll assist you 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, take a look at your plan paperwork in your portal. The worker discover, particularly, may have nice info on what to do about your PTCs that is tailor-made to you and your precise plan. Additionally try the next sources:

Part 4: Different Open Enrollment FAQs

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

An on-exchange, or market plan, is a medical health insurance plan that is bought on the ACA market or federal trade (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 supplied by main medical suppliers and bought immediately by way of them as an alternative of from the trade. 

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

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

Basically, there are different plans outdoors of the ACA plans and the off-exchange plans talked about above. However bear in mind, it is advisable have a plan that qualifies for reimbursement by way of your employer’s HRA. For QSEHRA, there are some different 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 accomplice we belief. 

For those who’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 not often get sick or want medical companies, other than an annual checkup and possibly a medicine or two.
  • You’re 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.  
  • Anticipate 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 remedy and specialist visits, however nothing needing shut monitoring or frequent care.
  • Your loved ones members are able-bodied and beneath 70.
  • Any youngsters are elementary age or older and wholesome, and play few or no sports activities that usually trigger harm.
  • Anticipate to pay 30% out of pocket, 70% paid by your plan

Gold:

  • You or a member of the family has a power situation, sees docs regularly or wants costly remedy that might be unimaginable to afford out of pocket.
  • Your kids are preschool age or youthful, needing frequent pediatrician visits.
  • It’s possible you’ll be older or at the next threat for colds and flu than most individuals.
  • Anticipate 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 medicines.
  • You search pressing or emergency care greater than as soon as per 12 months on common, regularly want exams to handle a situation or see docs greater than as soon as per 30 days.
  • You’re older or at very excessive threat for colds, flu, or accidents.
  • Anticipate to pay 10% out of pocket, 90% paid by your plan

Take a look at our useful 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 to your medical health 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 health insurance begins to cowl the prices. When you’ve got 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 reasonably priced, however least versatile community kind. Right here just a few key ideas of a HMO:

  • You’re required to pick a main care doctor (or the insurance coverage firm can assign one for you) who’s your first-stop for well being wants. You will want a referral out of your main care doctor to see a specialist.
  • For those who select to see a physician outdoors of the community or and not using a referral, you’ll usually should pay all prices out-of-pocket except it’s a true medical emergency or you haven’t any different choices.
  • The doctor community is native.

A PPO (or “most well-liked supplier group”) is usually essentially the most versatile, but most costly community kind. Right here just a few key ideas of a PPO:

  • You don’t want to pick a main care doctor and you do not want referrals to see a specialist.
  • For those who see an in-network supplier, you’ll solely be accountable for paying a portion of the invoice (based mostly in your plan’s protection construction).
  • For those who select to see a physician who’s outdoors the popular community, you’ll usually should 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 might be thought of in-network.

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

  • EPOs are extra versatile than an HMO, and are sometimes inexpensive than a PPO.
  • Like a PPO, you do not want a referral to get care from a specialist.
  • Like an HMO, you might be accountable for paying out-of-pocket in the event you search care from a physician outdoors your plan’s community.

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

  • POS plans are extra versatile than an HMO, and are sometimes inexpensive than a PPO.
  • Like an HMO, you will want 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 health insurance plans in the midst of the 12 months?

You’ll be able to solely change plans and purchase on-exchange plans throughout Open Enrollment (from November 1st by way of January fifteenth) except 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 adjustments.

If you’re supplied 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 suggest you benefit from Open Enrollment to enroll in a plan. You may 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 typically are included in well being plans bought on the Market or state-based exchanges. Whenever you examine plans on our window buying software and even on Healthcare.gov, you can see which of them embrace dental protection. In these circumstances, 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, chances are you’ll to buy a separate dental insurance coverage plan. Simply bear in mind, in the event you decide a separate dental plan, you’ll pay a separate premium. That is along with the premium you pay to your particular person medical health insurance plan. Generally, whenever you’re buying on the Change, you may see an possibility so as to add a dental plan. This may present additional choices for you. For our shoppers, now we have researched high quality particular person medical health insurance plans by way of 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. When you’ve got every other 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 satisfied Open Enrollment, all people! 🎉



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