Employer Plans


Most Americans obtain health insurance through their employer. This is called group health insurance coverage because, as a group, all the employees are pooled together to obtain insurance. This leads to a lower insurance premium because the risk is spread out among the group of members, with the employer typically paying the majority of the premium for the employee and very little for dependents.
Another option is group membership-sponsored health plans, also known as association health plans. Association health plans allow members of a group or profession to band together in order to negotiate better premiums for their members, similar to the way an employer-sponsored health plan would work. Except the members of an association or group do not work for the same employer. Instead, they share an industry, interest, or other common thread that allows them to define themselves as an association.

Think about what membership groups you may already be in. For example, unions, alumni associations, or professional organizations, including your amazing local chamber of commerce. As an example, most of us have heard of the National Association for the Self Employed, www.nase.org. This is a membership organization dedicated to providing resources and benefits to Small Businesses and the Self Employed. They provide group benefits to their members, among many others. They do have strict guidelines for being a member, but their organization is just one of many available providing group health insurance to their members.

There are many organizations and membership groups offering plans, help, and services to their members. It is worth finding out if you can take advantage of a group membership plan to save money on your health insurance costs, if one is available to you. The best way to save money on health insurance is to shop around, learn about your options and see how they compare to what you and your family need. Your friendly health insurance expert (that’s me!) can assist you with this.

Premiums for health insurance sold on the federal marketplace are expected to increase by at least 16.9 percent in November due to changes in the Affordable Care Act, spiking premiums for Americans by $1,011 per year. The average unsubsidized health insurance premium for a 40-year-old male buying a health policy in 2019 will be $6,995. About 1.7 million Americans enrolled in the health insurance marketplace this year, with nearly 80% receiving subsidies in one form or another. Starting January 1, 2019, the individual mandate is gone since it was repealed as part of a tax overhaul that passed this past December.

So, what exactly is open enrollment? It’s the time when you can buy an ACA health insurance plan or make changes to your existing ACA plan. You’ll be able to pick more than just medical coverage. Other benefits to choose from include dental, vision, disability, and life insurance plans.
There are actually a few different open enrollment periods depending on where you get your health insurance. ACA health insurance open enrollment on the marketplace or individual state exchanges runs from Nov. 1 to Dec. 15. Medicare open enrollment is Oct. 15 through Dec. 7. And Medicaid open enrollment, along with non-ACA plans (private sector), is year-round. If you receive health insurance through your employer, employers typically set aside two weeks between October and November for their open enrollment periods.

People with employer-sponsored coverage will receive information at work about their plan options. To help improve the enrollment process, some employers are adopting online platforms designed to personalize and simplify the experience, to help people select a health plan based on their personal health and financial needs.

If you don’t get your health insurance through work, you can find information on open enrollment through your local health insurance agent. There is also a tool through Amazon Alexa called “Answers by Alexa”, where you can ask common health insurance-related questions, such as, “What’s an HSA?” It’s a health savings account or a special savings account that can only be used for health expenses, including things like appointment co-pays, acupuncture, even band-aids.

If you need an ACA plan, it’s important not to miss the open enrollment period because once open enrollment closes, you can’t change your ACA coverage until the next open enrollment period… unless you have certain life changes. These are called ‘qualifying events’ and include things like having a baby or getting married, thus requiring you to update your coverage. Losing your insurance coverage also counts as a qualifying event. Other qualifying events are divorce, legal separation, or if someone on your plan has died. If you have a qualifying event, you might qualify for a special enrollment period that lets you sign up for ACA coverage outside the open enrollment period. Medicaid and non-ACA plans have year-round enrollment.

When signing up for health insurance, it’s really important to take your time to explore your options so you understand what benefits you’ll be getting for the price you’ll be paying. People should pay attention to more than just the monthly premium and instead take into account the plan’s out-of-pocket costs, including the deductible, copays, and coinsurance. It’s also a good idea for people to consider any health changes during the last year or if they have any major health events planned for 2019 —such as having a baby or surgery— to determine if the current coverage is still appropriate. It’s also important to check and make sure your doctor is in-network with whatever health insurance plan you’re considering, so you don’t pay out-of-network fees. Strong and nationwide networks are very important.

That means you’re going to have to crunch some numbers, but it’s worth it so you don’t have any surprise medical bills. Do you have regular doctor appointments you have to go to? Regular prescriptions you need to fill? What if you get sick and need to go to urgent care or the emergency room? What if you need surgery? These are the out-of-pocket costs we’re talking about. You can’t predict the future, but you do need to think about the ‘what if’s’. And you need to be properly protected in case something unexpected or catastrophic occurs.
Be sure to consult with an expert in the health insurance industry to ensure you look at all your options and choose the option that works best for you, your family, your needs and, most of all, your budget.

Here at Dave Knows Health®, Dave understands health coverage isn’t the easiest to understand. Dave strives to make it as easy as possible for Americans to comprehend & obtain.

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