Healthcare Open Enrollment for 2023

With kids back to school, football on TV, and the weather cooling down, it means open enrollment is upon us. It’s time to review your options for 2023. Here are the highlights of what’s going on in each sector.                    

Medicare

Medicare has deductibles, co-insurance, and limitations. If you simply had Medicare as designed by the federal government in 1965, you would have approximately 80% coverage and no prescription drug coverage. Most people get one of two options once they go on Medicare.                    

Option 1: Medicare Supplement and Part D Rx: This picks up where Medicare leaves off. Nearly 100% coverage of all medical bills approved by Medicare except co-pays for Rx. The cost is around $150/mo. for a 65-year-old. Rates increase as you get older. You can see any provider that accepts Medicare.

Pluses: see any Medicare provider and nearly 100% coverage.

Minuses: Ongoing monthly premiums that increase with age with fewer physicians accepting new Medicare patients as Medicare only pays providers about 25% of what private insurance companies pay.                    

All the supplement plans were standardized around 30 years ago. If you have a supplement plan, there’s generally no need to switch as the plan any other insurance company offers is identical to yours. Only the rates might be different, but the plan is not.    

It is best to shop your part D Rx plan. Rates and drug formularies change each year, and you can save thousands if you take expensive drugs. In addition to the Part D plan, most people also use GoodRx to compare prices and find they can save on prescriptions. You can enter all of your prescriptions into Medicare.gov and view all the Part D plans available for 2023 to see which ones cover your prescriptions.                    

Option 2: Medicare Advantage Plan: Instead of Medicare paying providers, you can choose an advantage plan from an insurance company and they pay providers. Typically, $0 premiums and you get extras that Medicare does not offer such as dental, vision, hearing aids, a quarterly allowance for over-the-counter items, and a monthly allowance for groceries at Kroger. Some even have kickbacks that pay you to sign up for their plan. While you don’t pay a monthly premium, you do pay co-pays for services such as $0-15 for a primary care visit or $20-50 for a specialist, and $300-$400 for a day in the hospital.                    

You must go to an in-network provider to get lower co-pays. I recommend PPO plans which allow you to see any provider.

Pluses: Network may have providers that don’t take Medicare, but take the Advantage plan. Extras such as dental, vision, hearing aids, and nurses are on call to help you with care. You can switch plans each year during open enrollment.                    

Minus: must use in-network providers to get the best value.                    

The annual enrollment period is October 15 through December 7 and you can switch or enroll for the first time into a Medicare Advantage plan during this time. In addition, you can make a one-time switch during the first quarter of each year if you already have a Medicare Advantage plan and want to switch to another one.                    

Individual/Family Marketplace

If you are under age 65 and thinking of retiring or becoming self-employed, health insurance is a big concern. However, premium subsidies have been greatly expanded with the passage of the Inflation Reduction Act ensuring that health insurance is an obstacle you can overcome. Many of our clients are surprised that they now qualify for lower rates and better benefits and their doctors are in network. For example, a 60-year-old couple living in Atlanta who estimates they will make $100,000 qualify for $1,015 per month in federal help. At $200,000 they still qualify for $306/mo. Before the Inflation Reduction Act was passed, that same couple would not qualify for a subsidy if their estimated income was above $70,000.  

In the metro Atlanta area, there are more choices than ever, and there are eleven private companies to choose from for 2023. Companies will release their rates and benefits for next year on November 1, 2022. Open Enrollment is from November 1 through December 15, 2022, with a January 1, 2023, start date. You can also enroll after December 15th through January 15th for a February 1, 2023, start date.                    

Group Health for Small Companies

Since the passage of the Affordable Care Act, group health is in a constant state of flux. If your company has less than 50 employees, there are two ways for getting group plan quotes - fully insured plans and underwritten or level-funded plans. Fully insured plans are typically more expensive with less robust plans. Whether your group plan is fully insured or level-funded, group plans offer many different plan options with national or local networks, whereas individual coverage generally only offers a local network.                    

Underwritten (level-funded) plans have these advantages:                                                                        

• Employers and employees are able to keep their costs down.                                                                          
• Wide variety of plans to choose from.                                                                            
• Renewal increases may be lower.                                                                            
• Only paying for real claims made by your own employees versus community rates that may be higher than your employee group’s risk.                                                                            
• Stop loss insurance pays for any claims that exceed your claims fund. You will not be responsible for any deficits.
• If you have a surplus in your claims fund at the end of the year, you will be refunded 50% of it.
• As the employer, you will have access to data that allows you to see what the costs and claims are at a company level on a monthly basis.                            

Level-funded plans may ask medical questions of each employee and if your company has relatively healthy employees, the rates can be as much as 50% less than the fully insured rates and with better benefits.                            

The Affordable Care Act added many new regulations that companies with over 50 employees must comply with or face stiff fines. Companies must also be sure they are compliant with all ERISA, IRS, and Department of Labor regulations.                            

If you want to review your options, you can schedule a call with Ted Officer by clicking HERE. If you have a company and want Sally McPherson to audit your current benefits for possible savings and improvements, you can schedule a call with her HERE.              

USA Health Insurance in Woodstock, Georgia has been in business for over 25 years and is managed by, Ted Officer, CFP, and his wife, Sally McPherson, CPA. They have a very knowledgeable staff and offer all types of coverage including individual/family plans, Medicare, and group health plans. USA Healthcare is a free resource and provides guidance on which type of coverage and plan best suits your needs, then help you enroll accordingly. They provide continued service after you are enrolled with any issues you may have with claims, billing, or questions about your benefits. You can call or email their office to get personalized service rather than wait on hold with a call center. They offer the same plans with the same benefits and the same rates as the plans you can get through any website, agent, healthcare.gov, or by calling an insurance company.