Tips for Health Insurance Enrollment Season

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:

  1. 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.
  2. 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 ( 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.

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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Nursing Home Residents: Keep your economic impact payment

If finances are tight, the federal economic impact payment being issued through the CARES Act for coronavirus relief may have a big impact on your well-being. Unfortunately, residents of care facilities in many states (including Iowa) are being told incorrectly that they must relinquish their payment.

This problem occurs when an individual is receiving Medicaid benefits to help cover the cost of their care. Nursing home administrators, acting on misinformation, believe they must recover the extra income to defray Medicaid costs. However, the CARES Act specifically labels the payments as “tax credits,” and tax credits are exempt from income and resource limits placed on those who are benefiting from certain government assistance programs.

Nearly every United States household should receive an economic impact payment, including households that receive Social Security, Supplemental Security Income (SSI), or Veterans Administration benefits. The payments should be deposited automatically to the same account where you receive either your tax refund or your SSA, SSI, or VA income. The IRS, which is responsible for issuing the payments, offers a lookup resource to help people track their payment. Note: the look-up link for those who do not file a tax return is separate from the link for tax filers; be sure to use the correct link.

If you have loved ones living in care facilities, especially if they are receiving Medicaid benefits to help cover the cost of care, be on the watch for any attempts to get them to turn over their economic impact payment to the facility. If this has already occurred, it should be refunded; contact the Iowa Attorney General’s office for help if needed. Note: it is important to keep in mind that nursing home administrators who try to claim the payment are not trying to steal; they are trying to do the right thing, but are simply misinformed about what the law requires.

Source: Federal Trade Commission

Barb Wollan

Barb Wollan's goal as a Family Finance program specialist with Iowa State University Extension and Outreach is to help people use their money according to THEIR priorities. She provides information and tools, and then encourages folks to focus on what they control: their own decisions about what to do with the money they have.

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SSI for Premies

photoI now know more about Social Security Insurance (SSI) benefits for premature babies, than I ever wanted to know. After 10 days in the hospital, trying NOT to have a baby, my daughter began receiving visits from a Social Worker, informing her of all the services that were available to her, should she deliver her baby, which at that point would be 16 weeks early. My daughter only half listened because she had no intention of delivering for at least a month, and preferably not for another 2 or 3 months.

He arrived (26 weeks gestation) weighing 1# 13 oz and is amazing everyone as he is weaned from oxygen, glucose, insulin, ultraviolet light and more. Daily visits to the hospital to deliver the milk she has pumped and to spend time, skin to skin, with her little son will continue till he goes home on what should have been his due date, Jan. 2, assuming he reaches 4#, along with several other benchmarks.

The Hospital Social Worker paid her another visit…this time with paper work to apply for SSI benefits for her son. He will receive $30 a month which doesn’t sound like a lot, but when you think about the bills that will rack up over the next three months in a NICU, $30 is $30. A child born weighing under two pounds, ten ounces, is automatically entitled to SSI benefits as well as Medicaid coverage. Once dismissed from the hospital, Medicaid and Social Security will end. Should a child be disabled (blind, deaf, etc. for example) the benefits can again be applied for.

The Medicaid Insurance will be applied to bills that are not covered by his parent’s health insurance. Should both parents have health insurance through their employers, the policy that will be considered as primary would be decided by whose birthday comes first in the year.

In my daughter’s case, the hospital’s social worker informed my daughter about the benefits, brought the paperwork to her and assisted her with the applications. Not all hospitals provide that service. In that case, it would be the parent’s responsibility to visit the local Social Security office or go online to fill out the paperwork.

It is important to contact the Social Security Administration immediately after your child is discharged. You will be responsible to repay any benefits received after the discharge and it is not the hospital’s job to notifying the Social Security Administration.

For more information on applying for Social Security benefits for your preemie, the Social Security Administration has a great website with lots of information and tools as well as an office locator.  ~Brenda

Brenda Schmitt

A Iowa State University Extension and Outreach Family Finance Field Specialist helping North Central Iowans make the most of their money.

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