09-25-2024 Primetime - Flipbook - Page 24
24 A Special Advertising Section of Baltimore Sun Media Group | Wednesday, September 25, 2024
OPEN ENROLLMENT
November
Open enrollment
A guide to choosing the
right health plan for you
2024
Sun Mon Tue Wed Thu Fri Sat
By Linda L. Esterson, Contributing Writer
A
s the calendar page turns to November, preparations are being made for
the winter holidays. But even more important for some is the beginning of
the health insurance open enrollment period.
Open enrollment is the one time each
year that individuals can make changes
to an existing health insurance plan or
enroll in a new health plan. This applies
to individuals who are not part of an
employer group plan, which mandates
its own open enrollment period at a
designated time of year. Additionally,
individuals who have what is called a
qualifying event – like job loss, marriage,
divorce or the addition of a new family member – can make changes when
these events occur outside of the open
enrollment period.
“It’s basically the one time a year
when anyone can sign up, change or
cancel their health insurance without having a qualifying event,” says
Ari Gross, president of The Columbia
Group, a full-service insurance brokerage in Baltimore. Open enrollment for
individual coverage occurs at the end of
every year and all changes and enroll-
ments are effective January 1 of the
following year.
A systematic approach
The Affordable Care Act of 2010
prioritized the availability for affordable
health plans for American families by
2014. The federal government created
a website – healthcare.gov – to assist
individuals with finding health care coverage.
Maryland state government officials took this a step further, creating
Maryland Health Connection and its
own website, marylandhealthconnection.gov, to simplify the process for
those who live in the state. Individuals
enter demographic information including family size and ages of family members, geographic location and household income, and that information is
used to find health plans for the family
and also determine if the family qualifies
for financial assistance. A sliding scale
of household size to income ratio calculates the tax credits available as well
as the amount of subsidy funding the
government would contribute toward
insurance coverage.
The website provides a tool that
yields a cost estimate in addition to the
subsidy amount. But there are other factors to consider.
Out-of-pocket costs
“People need to look out for more
than just the monthly cost of insurance,”
Gross explains. “You also want to take a
look at what you could expect to spend
out-of-pocket, depending on the health
plan you’re looking at.”
The term out-of-pocket refers to the
costs incurred above the monthly insurance premium. If an individual ends up
hospitalized, for instance, there could be
significant costs to the patient. The plan
could have a high deductible attached
to it. The deductible is the cumulative
amount of money a person pays above
the monthly fee before the insurance
covers the costs of care. Patients can
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incur high deductible and high copayments – the payment per visit beyond
coverage – for hospitalizations based on
the plan’s stipulations.
“We definitely encourage people to
not just price shop, but really look
behind what they’re buying,” Gross
adds. “That way, they’re making sure
that if they do end up with some medical
events, they’re not going to be severely
hamstrung with medical expenses.”
Gross often advises those investigating options to spend a little bit more
money for the plan itself to avoid being
put in a “precarious financial situation.”
There’s no way to predict future medical needs, but Gross and his team suggest those looking for insurance to “take
inventory of your medical life.” Track
how often primary care physician and
specialist visits occur in a year, if there
are often procedures needed for their
medical conditions and what types of
maintenance prescriptions are needed.
“You can gauge what you could
expect to spend just looking at what
Open enrollment,
continued on page 30
