MoneyTip$ • Iowa State University Extension and Outreach

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.

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.

Medicare’s annual open enrollment period for 2022 coverage began last Friday and continues through December 7. But why does it matter? Most people enroll in Medicare when they turn 65 — doesn’t that take care of it? The answer is: probably not.

NOTE: Even if you are too young for Medicare, this blog post may be worth your attention if there are people you care about who are enrolled in Medicare. I’d encourage you to touch base with them to make sure they understand their options, and the mailings they are receiving, and help them get help if they need it.

During open enrollment each year, consumers have options to make changes. They also may receive a small deluge of marketing mail, email, and perhaps even phone calls. It’s important that they understand what their options are, and that they pay attention to mailings — especially those from Medicare itself (CMS – The Center for Medicare and Medicaid Services) AND from their current insurance company(ies). There are generally three types of choices consumers make during Open Enrollment:

Prescription Drug (Part D) Plan. This may be the most common decision people make during open enrollment. Most Medicare participants also enroll in a separate insurance plan to help cover prescription costs. These plans are offered by CMS in partnership with private insurance companies, and you may literally have dozens of plans to choose from. Some people make the mistake of assuming that if they like their current plan, they should just stay with it. The reason that’s a mistake is that plans can change substantially from one year to the next. Maybe this year, your plan covered your medications nicely, with low co-pays; but next year, they could choose to drop one of your medications or attach a much higher co-pay. So even if your own medications haven’t changed, it is smart to use the Medicare on-line tool to see which plans offered in your area will cover your medications at the lowest cost to you. (SHIIP can help with this — see below)
Medicare Advantage Plan. Some consumers choose Medicare Part C (Advantage) plans instead of traditional Medicate Part A and B. These are managed care plans operated by private insurance companies in partnership with CMS; they generally have a defined network of participating hospitals, doctors and other medical providers. They often cover services not covered by traditional Medicare (including vision or dental care), but may also have more restrictive coverage on some services as compared to traditional Medicare. Many Advantage plans also have prescription drug coverage built in. These plans can change from year to year as well, and open enrollment is the time to make a change if you wish to.
Medicare Supplement Plans. Many consumers who use traditional Medicare Part A and B also enroll in a supplemental insurance plan, sometimes referred to as Medigap insurance (because it covers gaps – including deductibles and co-pays – that Medicare does not cover). These plans are offered by private insurance companies. Open enrollment is also a time to evaluate your supplement coverage.

Health insurance is complicated for people of any age. Fortunately, excellent help and information is available through the Senior Health Insurance Information Program (SHIIP). SHIIP is an office within the Iowa Insurance Division, so it is completely non-commercial and not sales-oriented. Note: similar agencies are available in other states too. The SHIIP website offers a wealth of information. In addition, they have a helpline during business hours at 800-351-4664 (TTY 800-735-2942). Most valuable of all, however, is the corps of highly-trained volunteers located in counties across the state. Find SHIIP volunteers near you! These SHIIP volunteers kick into high gear during fall open enrollment, typically offering appointments to help consumers understand their options for Part D (Prescription coverage) and other coverage.

If you, or someone you care about, need help during Medicare Open Enrollment, I urge you to connect with your local SHIIP resource today! For general information about Medicare, the annual “Medicare and You” handbook is the best starting point.

Tag: medicare

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