It’s health insurance enrollment season for most Americans! Health insurance choices are some of the most important choices we make: they determine what doctors and other providers we can see affordably, what premiums we pay, and how much we’ll pay out of pocket each time we receive care. These choices have a huge impact on our finances – and also on our health! After all, if it’s not affordable to seek care, we will often put off the care we need; the delay can lead to poorer health outcomes.
So take control of your health care options by making informed choices! Two key principles to keep in mind:
- Think beyond monthly premiums. Consider how much health care you use in a typical year. Depending how often you need care, and what kind of care you need, you may be better off financially by choosing a higher-premium plan that has a lower deductible and lower co-pays.
- Pay attention to the provider network available as you look at your choices. Make sure the insurance plan you choose allows you to see the providers that you prefer, and that are convenient for you to see.
Tips for those not covered through their employer:
Looking for insurance on your own, with no employer plan? Deadline: December 15.
The Health Insurance Marketplace (www.healthcare.gov or 800-318-2596) is the only place to find comprehensive insurance plans that cover all ten essential benefits. These plans may look expensive if you look only at the retail price. However, many Americans, including middle-class Americans, are eligible for assistance in paying the premiums on these plans through a Premium Tax Credit based on your family size and income. That assistance was expanded during the COVID emergency, and that expansion continues through 2025, so it is worth checking out. Find a health care navigator to assist you; if there is a local non-profit community health care center near you, contact them for help. Alternatively, this site can help you find individuals who have agreed to help consumers select health insurance; to avoid commercial bias, look for one labeled as an “assister” rather than one who is an “agent or broker.”
Wondering how much your premiums might be? The Kaiser Family Foundation has a subsidy calculator that can give you a solid estimate.
Any plan you find outside of the Marketplace is technically not even qualified to be called “insurance,” because it excludes certain types of care; it will have some other label, such as a “health plan.” You may have reasons for considering one of those plans, but read carefully to learn what is not covered; anytime something is offered at a lower price than its competition, you know that some tradeoff is involved.
Signing up for Medicare coverage? Deadline: December 7.
An increasing number of older Americans are selecting the highly-advertised Medicare Advantage plans; unfortunately, research is showing that some advertising for Medicare Advantage plans is extremely misleading or even fraudulent. This does not mean that all Medicare Advantage plans should be avoided, but rather that you should choose very carefully. Likewise if you choose Traditional Medicare, be sure you have good information about any supplement plans or Part D prescription drug plans you consider. The best source for information and guidance in selecting Medicare plans is SHIIP – the Senior Health Insurance Information Program. Find an Iowa SHIIP office near you OR use this link to seek out SHIIP in other states.
Free Coverage may be available to you! Enrollment is open anytime for eligible households.
In Iowa and the majority of states, Medicaid coverage has been expanded beyond the old limits (which limited coverage to families with children and disabled individuals). Now anyone with income below the threshold is eligible, regardless of family composition. What’s more, the income thresholds have been increased. This year for a family of two, the income limit is $24,352; for a family of four, the limit is $36,908. NOTE: those limits are approximate; there are some nuances in calculating income so that in some situations people are eligible even if their income is slightly higher than the standard limit. In Iowa, this state hotline can help you enroll: 855-889-7985.
Children under 19 may be covered for free even if family income is 2-3 times the normal limit, through the Child Health Insurance Program, known in Iowa as HAWK-I.