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Annual Open Enrollment for Individuals is Upon Us

Those who have individual coverage have an open enrollment period which begins November 1st for a coverage effective date of January 1st. This year in all the states served by healthcare.gov, open enrollment will extend through January 15th. If you enroll after December 15th, then you’ll have a February 1st effective date.

Those who live in states served by a state-based marketplace often have longer enrollment periods. If you don’t know whether you would be served by healthcare.gov (the federal marketplace) or a state-based marketplace, go to https://www.healthcare.gov/marketplace-in-your-state/ to see a list of state-based marketplaces.

If you have individual coverage, you should work to understand what might be changing that could affect you. As we reported last year, a plan in Connecticut began to offer a plan with a national network in 2022. We didn’t see that coming but it was a welcome option for many people.

This year we understand that CIGNA is entering a number of states after reducing its presence over the years. On a less positive note, we’ve already heard from several New York clients that their insurer will no longer offer their plan in 2023.

You must buy your coverage through the marketplace or exchange if you qualify for a subsidy or tax credit and want to take advantage of the premium tax credit. Those who don’t qualify for extra support can buy coverage directly from an insurer.

We recommend that those on COBRA have a plan for transitioning to the individual market if that is what they ultimately expect to do. You always have the option of staying on COBRA until it ends and many will choose to do that. To enroll in coverage outside the annual enrollment period, however, is more involved so that is a factor. One must have documentation that COBRA is ending, for example, or documentation of some other qualifying event.

Others will want to avoid having two deductibles to meet in a given year, one as a result of having COBRA for a portion of the year and a second deductible once individual coverage begins.

Healthcare coverage in our country is fragmented and complex. Many don’t make the effort to understand how fragmented and complex it is because they are in relatively good health. That’s understandable. Healthcare coverage is, however, a matter that you want to get right for you and your family and increasing your knowledge of healthcare coverage issues will always serve you well.

End of sermon. Thanks for reading and listening.

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