The official 2024 Open Enrollment Information + FAQs

Glad Open Enrollment 2024! 🎉 We could also be a number of the solely individuals who deal with Open Enrollment as a serious vacation. We won’t assist it. We love this time of yr! 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 insurance, this text shall be your finest buddy.

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 searching for steering as they store for particular person medical 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 identical to you who’re having to navigate the well being care system outdoors of a standard group plan. Don’t fret! Now we have many sources, together with this information, that will help you.

As you find out about subjects like Open Enrollment, particular person insurance coverage, and HRAs, please do not forget that our platform will stroll you thru all the course of and aid you select a plan that won’t solely give you the results you want however one which will even work together with your HRA.

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

Our platform will stroll you thru all the course of and aid you select a plan that won’t solely give you the results you want however one which will 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 insurance plan. For 2023, it is from November 1st to January fifteenth in most locations, though there’s a couple of exceptions. Some states are completely prolonged by means of January thirty first, like California, Nevada, New Jersey, New York, Rhode Island and Washington D.C. Massachusetts has completely prolonged by means 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 means of December seventh to evaluate 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 forestall opposed choice.  Opposed choice occurs when sick individuals join a well being plan, however wholesome individuals don’t, which throws the quantity of danger 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 firms to buy from “{the marketplace}” or “alternate.” These plans are known as  “on-exchange” plans. Most states use the federal alternate, Healthcare.gov. Some states, like California, New York, Pennsylvania, and some different states, have their very own state-run exchanges and enrollment programs. 

Once you store at Healthcare.gov, you’re solely seeing “on-exchange” plans. Nevertheless, insurance coverage firms solely make a fraction of their plans obtainable “on alternate.” 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 superb place to start out procuring as a result of you possibly can have a look at ALL of the obtainable plans facet by facet (together with “off-exchange” plans) to check – and see which plans are “Straightforward-Enroll”. True to the title, Straightforward Enroll plans have straightforward, quick enrollment (Take Command takes care of it!) and our workforce can assist you with the Provider! Search for the Straightforward Enroll tag for added peace-of-mind.

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

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

The Reasonably priced Care Act created a medical insurance alternate, or on-line market, the place people can store for particular person medical insurance plans and examine their well being plan choices. That is recognized 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 means of the alternate.

Why is Open Enrollment vital 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 necessary to notice that you’re going to have to enroll by December fifteenth, 2023 for protection that begins January 1st, 2024. Open enrollment continues by means 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 on 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 shall be a to do checklist in your dashboard. If you’re new right here, we are going to stroll you thru onboarding which can embody looking for a plan. After Open Enrollment begins in November, you will recieve an electronic mail to login or you possibly can comply with this hyperlink to create a log in, sign up and get began looking for particular person medical insurance.

Part 2: How To Purchase Particular person Insurance coverage

How do you purchase particular person insurance coverage?

It may be a bit overwhelming! Earlier than you store, begin by fascinated about what’s necessary for you and what well being wants you anticipate for the yr. Good inquiries to ask your self embody, Is it extra necessary to have a low premium or a low deductible? Do you recurrently see a specialist that should keep in-network? Do you will have a number of prescriptions that you’re going to want lined? Are you anticipating any medical wants this yr (i.e., ongoing bodily remedy, surgical procedure, or being pregnant?)

It is good to suppose this stuff by means of, as a result of what actually drives prices–and subsequently your plan selection–are the issues about: prescriptions, physician visits, remedy, medical gear, and so on. For those who’re wholesome, possibly you propose on none of this stuff–which is simply as necessary to know. Unpredictable prices, like catching a chilly, spraining an ankle, or a hospitalization, should not impression your plan selection. 

Our procuring portal means that you can enter a supplier’s title to see which plans present them as in-network and see if particular prescriptions are lined in a plan’s drug formulary.

Greater than 75% of your healthcare prices within the subsequent yr are predictable based mostly in your wants.

How are you aware you are getting the perfect value on your plan?

Here is some excellent news for simplicity: any given plan bought throughout Open Enrollment shall be priced precisely the identical irrespective of the place you discover it. For those who discover a plan you want, say a Blue Cross Blue Protect silver plan on Healthcare.gov, it’ll legally be priced the identical whether or not you buy it on the Trade, or from a dealer buddy. 

The costs on our particular person medical insurance procuring portal will present you the perfect costs for all your well being plan choices. 

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

Collect spherical, buddies. This can be a actually necessary query. Why? As a result of not all plans combine with HRAs, which means that not all plans shall be reimbursed by means of an HRA and never all plans will qualify you to take part in your organization’s HRA. Greatest 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 embody 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 means of Healthcare.gov or your state’s public market, your plan is a Main Medical plan, and your reimbursement by means of QSEHRA shall be tax-free.
• Scholar insurance coverage
• Your partner’s plan (varies by QSEHRA plan): For those who’re lined 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! Nevertheless, the IRS doesn’t need you to “double dip” and likewise get a pre-tax QSEHRA reimbursement, so your QSEHRA declare on 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 means of QSEHRA!
• Authorities plans: Medicare, Medicaid, CHIP (kids’s medical insurance applications), 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 will be reimbursed by means 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 will be reimbursed tax-free by means of QSEHRA. When you have dental and imaginative and prescient advantages by means 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 on 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 embody short-term plans, fastened indemnity plans, accident plans, and some 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 will be reimbursed tax-free by means 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 simply buy on the Trade shall be compliant together with your HRA. Main medical off-exchange plans which are obtainable throughout Open Enrollment will qualify as effectively.

And this is extra excellent news: our platform will maintain your hand by means of this complete course of. 

Professional-tip: To see if a plan integrates together with your HRA, test for a metallic tier (silver, platinum, bronze) within the title or description of the plan. That is a superb signal. 

What if I am on Medicare with my HRA?

Nice information! Medicare is reimbursable together with your HRA. Keep in mind, you have 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 can aid you discover the precise Medicare Benefit and Medicare Supplemental plans which are designed to assist cowl the prices of varied deductibles, co-payments and coinsurance fees that Medicare alone doesn’t embody.

All you will must do is select a protection possibility from main insurance coverage firms 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.

Study extra on our Medicare partnership with Chapter right here.

Vital: Medicare Open Enrollment runs October fifteenth to December seventh. That is the time to guage current Medicare protection and your likelihood to make adjustments to your Medicare protection.

What are some issues you need to keep away from whereas looking for a plan?

To begin with, be an knowledgeable shopper. Obtain our PDF on “Well being Insurance coverage 101,” the place you will discover the essential definitions of key phrases you will have to know whereas looking for medical insurance (like formulary!). Understanding medical insurance jargon will preserve you out of hassle and scale back these stress ranges. 

One other factor to pay attention to is that in case you are procuring outdoors of an alternate, for instance by means 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. 

Additionally necessary: For those who’re leaving an organization and COBRA is an possibility, 99% of the time, COBRA is a nasty deal. Don’t simply settle for it as a result of it’s straightforward. You will be billed for as much as 102% of the full 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 completely happy together with your particular person plan and the insurance coverage firm is providing it once more in 2024, you possibly can renew your plan typically.

For those who had an “Straightforward Enroll” plan with Take Command in 2023, you might even see the choice to resume your plan while you log in to buy. In some instances it’s possible you’ll not see this selection. 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 transferring, you’ll possible want to buy to be able to select the identical plan. 

Earlier than protecting the identical plan, take a while to think about your loved ones’s well being wants for 2024, which medical doctors you could preserve in-network, and what prescription protection is necessary. If the identical plan from final yr nonetheless meets your wants, then merely renew or select it once more! 

Keep in mind, it by no means hurts to browse different plans to ensure your current plan continues to be your most popular plan.

To get began looking for a plan, head on over to our particular person medical insurance procuring web page to check plans facet by facet and discover one that can give you the results you want and your HRA.

 

Do I have to cancel my previous well being plan?

Sure!

For those who’re altering insurance coverage firms for 2024, be sure you name and cancel your previous plan from 2023 earlier than they auto-renew – and cost you for a January 2024 premium!

Even when you’ll 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 need to pay for 2 plans! Be aware that some carriers course of funds in the midst of the month, so early December is the perfect time to cancel a 2023 plan.

Keep in mind that you’re protecting your 2023 plan efficient by means of the top of December as your new 2024 plan will grow to be 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 insurance bought by means of the ACA Market, or Trade. To obtain a premium tax credit score, you have to meet sure necessities.

One approach to pay an excessive amount of for medical insurance is to go away cash on the desk. We see many people assume they are not eligible for tax credit after they truly are. Relying on the place you reside, a household of three or 4 that makes $90,000 a yr will possible qualify for a tax credit score.   

Our particular person medical insurance procuring portal will aid you calculate your premium tax credit should you qualify. 

How are you aware should you qualify for Premium Tax Credit?

Typically talking, tax credit are tied to measurement and revenue. In addition they differ throughout zip codes. You might qualify for premium tax credit should you: 

• Fall inside a sure revenue vary
• Can’t be claimed as a dependent 
• Don’t file a tax return utilizing the submitting standing of Married Submitting Individually
• Have medical insurance protection by means of {the marketplace} or alternate.
• Should not in a position to get reasonably priced protection by means of an eligible employer-sponsored group plan that gives MEC.
• Should not eligible for protection by means of a authorities program, like Medicaid, Medicare, CHIP or TRICARE.
• Pay the share of premiums not lined by advance credit score funds.

Take Command Well being can assist you determine how a lot you’re eligible for on our particular person medical insurance procuring portal. 

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

This can be a difficult one. The way in which HRAs and PTCs work together is dependent upon what sort of HRA you will have. 

For QSEHRA: We’ll begin by explaining how QSEHRAs and Premium Tax Credit work collectively. Scroll right down to skip forward when you’ve got an ICHRA. 

Normally, QSEHRA allowance will scale back premium tax credit greenback for greenback.

Principally the worker shall 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 obtainable to them. 

For example, in case you are eligible for a $500 tax credit score and your employer affords a $400 QSEHRA allowance, your PTC shall be decreased to $100 ($500-$400). 

It’s very necessary that staff buying a plan by means 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 end in having to pay again the tax credit to the IRS throughout tax time.

FOR ICHRA: When you have an ICHRA, this is what you need to learn about PTCs and ICHRA.

Staff can select to take part in ICHRA or obtain a PTC. You can’t have each.

A pleasant characteristic of the particular person protection HRA is that as an worker, you will have the choice to take part in your employer’s ICHRA or opt-out yearly by means of the opt-out provision. That is totally different then ICHRA’s predecessor, QSEHRA, which doesn’t permit staff to opt-out. 

For those who settle for the Particular person Protection HRA, you can not declare any premium tax credit for the yr for both your self or any relations. For those who opt-out of the Particular person Protection HRA for the yr, you might be able to declare premium tax credit.

The Trade will then decide if the ICHRA supplied is deemed reasonably priced or unaffordable for you. In instances the place an worker has opted out of ICHRA and the HRA is taken into account unaffordable the worker is allowed to assert premium tax credit for themselves and dependents. In instances 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 Trade plan, the Trade will ask if the person is obtainable any protection by means of their employer. This consists of protection by means of the Particular person Protection HRA. Staff shall be required to present discover to the Trade of their ICHRA providing. 

Through the onboarding course of with Take Command, we are going to aid you perceive these nuances and decide what’s finest for you.

How are you going to get extra details about Premium Tax Credit?

First cease, have a look at your plan paperwork in your portal. The worker discover, particularly, could have nice info on what to do about your PTCs that is tailor-made to you and your precise plan. Additionally take a look at 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 insurance plan that is bought on the ACA market or federal alternate (a.okay.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 straight by means of them as an alternative of from the alternate. 

Our particular person medical insurance procuring portal reveals each on- and off-exchange choices. 

Can I purchase a plan that is not bought on the alternate? Are there different choices in addition to Obamacare (ACA)?

Normally, there are different plans outdoors of the ACA plans and the off-exchange plans talked about above. However bear in mind, you could have a plan that qualifies for reimbursement by means of your employer’s HRA. For QSEHRA, there are some various insurance policy that qualify if sure situations are met. We will information you thru the method of weighing your choices and join you with a companion we belief. 

For those who’re enrolled in an ICHRA, nonetheless, you will 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 hardly ever get sick or want medical providers, aside from 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.  
• Count on to pay 40% out of pocket, 60% paid by your plan

Silver:

• Your loved ones members have one or two delicate situations that require some remedy and specialist visits, however nothing needing shut monitoring or frequent care.
• Your loved ones members are able-bodied and below 70.
• Any youngsters are elementary age or older and wholesome, and play few or no sports activities that usually trigger harm.
• Count on to pay 30% out of pocket, 70% paid by your plan

Gold:

• You or a member of the family has a persistent situation, sees medical doctors continuously or wants costly remedy that might be not possible to afford out of pocket.
• Your kids are preschool age or youthful, needing frequent pediatrician visits.
• You might be older or at the next danger for colds and flu than most individuals.
• Count on to pay 20% out of pocket, 80% paid by your plan

Platinum:

• You or a member of the family has an costly persistent situation and takes a number of drugs.
• You search pressing or emergency care greater than as soon as per yr on common, continuously want exams to handle a situation or see medical doctors greater than as soon as monthly.
• You’re older or at very excessive danger for colds, flu, or accidents.
• Count on 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 on your medical insurance. The premium is what your month-to-month allowance for an HRA will cowl.

A deductible is the quantity of lined healthcare prices you pay earlier than your medical insurance begins to cowl the prices. When you have a $2,000 deductible, you will be paying $2,000 out of pocket earlier than insurance coverage kicks in. 

Professional-tip: Your month-to-month premium doesn’t depend towards your deductible. 

What are the variations between the community varieties (HMO, PPO, EPO)?

An HMO (or “well being upkeep group”) is usually probably the most reasonably priced, however least versatile community sort. Right here a couple of key ideas of a HMO:

• You’re required to pick out a major care doctor (or the insurance coverage firm can assign one for you) who’s your first-stop for well being wants. You will have a referral out of your major care doctor to see a specialist.
• For those who select to see a physician outdoors of the community or with out a referral, you’ll typically must 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 popular supplier group”) is usually probably the most versatile, but costliest community sort. Right here a couple of key ideas of a PPO:

• You don’t want to pick out a major care doctor and you don’t want referrals to see a specialist.
• For those who see an in-network supplier, you’ll solely be answerable 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 typically must pay a bigger portion of the invoice than you’ll for an in-network supplier.
• You’ll have entry to out-of-state suppliers which are thought of in-network.

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

• EPOs are extra versatile than an HMO, and are sometimes cheaper than a PPO.
• Like a PPO, you don’t want a referral to get care from a specialist.
• Like an HMO, you’re answerable for paying out-of-pocket should 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 a couple of key ideas of a POS:

• POS plans are extra versatile than an HMO, and are sometimes cheaper than a PPO.
• Like an HMO, you have to a referral out of your major care doctor to be able to see a specialist.
• Like a PPO plan, you’ll have entry to out-of-network suppliers (at an elevated value).

Can I alter medical insurance plans in the midst of the yr?

You may solely change plans and purchase on-exchange plans throughout Open Enrollment (from November 1st by means of January fifteenth) except you meet sure situations that qualify you for a Particular Enrollment Interval. These circumstances embody having a child, getting married, getting divorced, or altering jobs. In different phrase, huge 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 effectively, the place you will have 60 days to join a well being plan that meets your HRA necessities. 

Professional-tip: We suggest you benefit from Open Enrollment to join 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 generally are included in well being plans bought on the Market or state-based exchanges. Once you examine plans on our window procuring instrument and even on Healthcare.gov, you can see which of them embody dental protection. In these instances, your premium would cowl each well being and dental protection. 
2. Separate dental plans: In case your well being plan doesn’t embody dental protection, it’s possible you’ll to buy a separate dental insurance coverage plan. Simply bear in mind, should you decide a separate dental plan, you’ll pay a separate premium. That is along with the premium you pay on your particular person medical insurance plan. Typically, while you’re procuring on the Trade, you will see an possibility so as to add a dental plan. It will present additional choices for you. For our shoppers, we’ve got researched high quality particular person medical insurance plans by means 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 have some 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.

Glad Open Enrollment, everyone! 🎉