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Get health insurance 2022

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Al Waller: Welcome to Clearpath – Your Roadmap to Health and WealthSM. I’m your host, Al Waller.

The COVID-19 pandemic has cast a laser beam on the importance of having health insurance in terms of protecting us against, as well as helping cover the cost of medical expenses.

And while many Americans don’t have access to health insurance through an employer, Medicare, or other options, the Health Insurance Marketplace® offers coverage for individuals and families. So, whether you’re self-employed, in between jobs, unemployed – or know someone who is, it’s really critical to know what’s out there and available.

Today, Mihaela Vincze, public health expert for nonprofit Transamerica Institute® is joining me, to discuss the importance of health insurance, provide an overview of the Health Insurance Marketplace, and outline key details for 2022 open enrollment — which is just around the corner and runs between November 1st and January 15, 2022 for most states. Mihaela, it’s good to have you back.

Mihaela Vincze: Good to be here, Al.

Al: Now, let’s begin by talking about the basics….in terms of why health insurance is so important? 

Mihaela: According to HealthCare.gov, health insurance is a contract that requires your health insurer to pay some, or all your health care costs in exchange for a premium—the amount you pay every month. Especially now, when many people are feeling spread thin financially, it’s crucial to remember the importance of health insurance.

Let me give you an example, I had a friend in college who wasn’t insured, and she broke her leg. It cost her thousands of dollars and put her deep into debt. I remember how devastated she was. It’s easy to underestimate how much medical care can cost. Fixing a broken leg in 2018, for instance, cost up to $7,500. Health coverage can help protect you from high, unexpected costs. And keep in mind, that was a broken leg. A more serious problem or illness or hospitalization can cost much more.

Al: Exactly, and let’s face it when you’re young, feeling perfectly healthy and invincible it’s hard to see the value in applying your discretionary funds for something like insurance, but as you pointed out, “accidents can happen” and can be costly.

Now, keeping in mind that 2022 open enrollment is between November 1st and January 15, 2022, could you walk us through with an overview of the Health Insurance Marketplace and unpack the types of coverage available by starting with “What is the Health Insurance Marketplace?”

Mihaela: The Health Insurance Marketplace is also known as “Marketplace,” “health exchanges” or simply the “exchange” and is a health insurance enrollment service through which people can purchase health insurance that fits their budget and needs.

Al: Got it. What types of coverage plans are available?

Mihaela: There are a few. Plans are organized in tiers—bronze, silver, gold, and platinum. A bronze plan, for instance, may be a good choice for those who are young and healthy— they have the least expensive monthly costs but generally higher deductibles. For those wondering what a deductible is—it’s the amount paid by the policyholder before the insurance plan starts to pay.

Al: Okay. I follow you there. Now what can you tell us about the other tiers?

Mihaela: Silver Plans have slightly higher monthly costs with some cost-sharing benefit— “cost-sharing” is the share of costs covered by your insurance that you pay out of your own pocket. Silver plans should be considered by those who expect some medical care, however, nothing significant.

Lastly, there are Gold and Platinum Plans. These are the most expensive monthly, but they have low deductibles and strong cost-sharing benefits. Someone who anticipates significant and costly medical care should look into these types of plans.

Al: Thanks for breaking this down for us Mihaela— because I feel like we now have a better sense of the type of plan to focus on for the future. Now, is there anything else listeners should know about when selecting a plan?

Mihaela: Double-check that the health plan you select helps pay for the 10 Essential Health Benefits required by the Affordable Care Act. These include emergency services, hospitalization, and even mental health and substance use disorder services. They also include preventive and wellness services and even chronic disease management. Remember, there are ten of them. So, you can find the full list of essential health benefits at HealthCare.gov.

Furthermore, you may want to review the “provider directory,” which lists all the doctors that participate in the plan’s network, to confirm that any specific doctor or specialist you prefer is actually covered.

Lastly, even if this sounds a little obvious, you always want to consider the costs that you are willing to pay.

Al: Yes, the bottom line. So, perhaps you could shed some light on the affordability of health insurance for us.

Mihaela: The Affordable Care Act has made affordable health insurance available to more people. The law provides individuals with subsidies or “premium tax credits” that lower monthly costs for households with incomes between $12,880 and $51,520. Note: If your income is above $51,520, you may still qualify for the premium tax credit in 2022. Also, if you live in Alaska or Hawaii, the maximum eligible income may be higher. Just check those state’s individual Market Place websites.

Al: Well, given the drumbeat focusing on health and wellness today, especially during the pandemic, is there a health insurance mandate or requirement set for 2022?

Mihaela: Currently, there is not a federal mandate. However, there are state-level mandates in California, Rhode Island, Massachusetts, New Jersey, Vermont, and the District of Columbia. Just keep in mind that even if there isn’t a mandate in your state, health insurance is so important to have— a single trip to the emergency room may actually exceed the annual cost of a health plan.

Al: Absolutely, and in that vein, let’s take a deep dive into 2022 Open Enrollment which (to repeat) runs from November 1 to January 15 in most states. Now for the uninitiated, what exactly is open enrollment period and for that matter, who is eligible?

Mihaela: Those who are 19 to 64 years old — who are not eligible for Medicare, Medicaid, and are without access to employer-sponsored health coverage— can sign up for a health plan through the Marketplace. Also, if you’re already enrolled in a health plan, you can make changes to the health plan during the open enrollment period.

Al: I see…then how would someone go about applying for or changing their health care coverage through the Health Insurance Marketplace?

Mihaela: Visit the federal Marketplace HealthCare.gov for full details. Some states, for example, Maryland and California, require that you go to their state-run Marketplace website. If your state requires it, HealthCare.gov will direct you to its website. You can also check out the Transamerica Institute 2022 Marketplace Open Enrollment guide at transamericainstitute.org/openenrollment.

Al: Well, let’s say you miss the deadline and were not able to enroll, then what happens?

Mihaela: If you miss your state's open enrollment deadline, you can’t enroll in 2022 coverage unless you have a qualifying event for a Special Enrollment Period. Qualifying events may include getting married, having a baby, losing your health coverage, or moving to a new home.

Al: Well, not to strike too fine a point here, but those seeking new health insurance coverage in the Marketplace or making changes to existing coverage, it’s absolutely crucial to enroll during this window, November 1 to January 15, 2022.

Where can our listeners go to learn more?

Mihaela: HealthCare.gov is the federal health insurance exchange website, with so many amazing resources. You can also check out HealthInsurance.org for information on affordable individual health insurance. And lastly, check out our website for more information on the topics covered today as well as many other great resources at TransamericaInstitute.org.

Al: Perfect! And for those 65 and over who are wondering about health insurance options, please check out last month’s Medicare Explained episode.

Once again Mihaela, thanks for sharing your in-depth research and insights with us.

ClearPath: Your Roadmap to Health & Wealth is brought to you by Transamerica Institute, a nonprofit private foundation dedicated to identifying, researching, and educating the public about retirement security and the intersections of health and financial well-being. You can find our weekly podcast on WYPR’s Podcast Central and mobile app, wherever you get your podcasts, and at transamericainstitute.org/podcasts.

I’m your host Al Waller…. until the next time, stay safe, be well and thanks for listening.

This podcast is produced by Transamerica Institute with assistance from WYPR.

Al Waller is a long-time Baltimore native and employment expert with a 30-year career in leading and advising locally and globally based corporations on matters including: Talent Acquisition and Retention, Employee Relations, Training and Development.
Mihaela Vincze is a public health expert and experienced health care educator. Serving as Transamerica Institute’s health care content developer, she shares insights on health and wellness on ClearPath—Your Roadmap to Health and WealthSM. Mihaela earned her master’s and bachelor’s degrees in public health at California State University, Northridge.