Now is the time to check your options – especially if you buy your own coverage, have Medicare, pay a lot to cover family members or joined Medicaid during the pandemic.
Sure, health insurance isn't a topic that most people enjoy talking about.
In fact, many people dread having to think about it.
But this fall, there's actually good health insurance news for many people – though you might have to take a bit of time this month or next to figure out the option that's best for you. Whether you get your insurance through a job, the government, or by buying it on the healthcare.gov website, new changes could affect your health and your wallet in 2023.
Keep reading to learn more about:
"Health insurance decisions can be complex to navigate, especially if you don't work for a large company, but the decisions you make now will affect you all next year, so it's important to carve out a little time and focus," said Renuka Tipirneni, M.D., M.S., a health care researcher at the University of Michigan Institute for Healthcare Policy and Innovation and primary care physician at Michigan Medicine, U-M's academic medical center. "In many cases, you can find free and trustworthy guidance from people with special training. I often advise my patients to seek out this independent advice."
Some of that guidance can come from the team of patient financial advisors at Michigan Medicine led by Alena Hill. For more than a decade, they've specialized in helping people pick a plan that will work for them.
"The biggest news is that many people who buy their own insurance may be able to find a plan for next year that costs them less than the plan they have this year," said Hill. "It's also important for people who joined Medicaid during the pandemic to be ready to act to avoid a gap in coverage."
Where to get health insurance help
The Michigan Medicine team can help anyone in Michigan, even if they don't get care at a U-M clinic or hospital. Call (877) 326-9155 between 8 a.m. and 5 p.m. Monday - Friday, or email [email protected].
Anyone in the United States can turn to local helpers listed in the Local Help section of healthcare.gov or, for Medicare assistance, to the State Health Insurance Assistance Program run by their local Area Agency on Aging.
Check out a CNN explainer on insurance terms, featuring Tipirneni.
Important deadlines for enrolling
December 7: For people who are eligible for Medicare because they're over 65 or have certain disabilities.
December 15: For people who buy their own insurance through healthcare.gov (or a state-level website in states that offer one) and want to have coverage start January 1.
January 15: For people buying their own insurance who want to have coverage starting February 1.
Even people who work for a company that offers health insurance, but who face high costs to cover their family members on their company plan, may be able to get insurance on healthcare.gov if they act by these deadlines; see below.
Medicaid has no deadline to enroll. But if you have Medicaid now, it's important to know that in 2023 there may be a deadline for proving you still have a low income that would allow you to stay on a Medicaid plan. See below for more information.
And now for the good news
Good news item 1: Lower monthly costs for many people
This year, inflation has increased the cost of many things Americans buy. And for people who get insurance through their jobs, their monthly cost may go up for 2023.
But millions of people with other kinds of insurance will actually pay less every month in 2023:
People covered by traditional Medicare will see a slight drop in their monthly cost and their deductible (amount they have to pay out of pocket) for hospital-based care and other things covered by Part B. This is because Medicare has decided not to cover an expensive but not very effective Alzheimer's disease drug that it had originally budgeted for.
People who choose Medicare Advantage plans offered by health insurance companies will also see slightly lower average costs.
People with any type of Medicare who have diabetes and need insulin to control their blood sugar will now pay no more than $35 per month for their insulin. Previously, these costs could be much higher. The $35 cap takes effect on Jan. 1, 2023 for regular insulin and July 1, 2023 for the kind used in insulin pumps.
More people who buy their own insurance on healthcare.gov will qualify for help in paying for it. This means to their final out-of-pocket cost will go down.
Even some people whose incomes were once considered too high to get this kind of help will now be eligible.
Remember: When you go shopping for a plan on healthcare.gov, you might first see the "sticker price" that may seem high. But once you enter information about your income, family size and other factors, the final cost could be much lower. You can actually use this calculator to estimate what kind of financial help you'll get even before you pick a plan.
In fact, the federal government estimates that 4 out of 5 people who buy their own insurance will be able to find a plan that will cost them less than $10 a month, though they may choose other plans based on their needs.
Also - if your job-related insurance charges you a lot to cover a spouse or children, see Good News Item 4 below. You might be able to save.
You might have also heard about other Medicare changes that will reduce prescription drug costs. These won't take effect in 2023, but they're coming for 2024 and beyond.
Good news item 2: More preventive care covered for everyone
Most health insurance plans have to cover certain preventive health care services for certain people – without charging the patient anything.
These free services include certain screenings, scans, vaccinations and more, for people based on their age or health status.
Some of the new coverage:
People who are eligible for free screening for colon cancer will no longer have to pay if their screening shows they need a colonoscopy to see for sure if they have cancer.
People with Medicare or Medicare Advantage coverage will no longer have to pay for the vaccine that prevents shingles; it will be fully covered.
People with Medicare or Medicaid coverage will be able to get for free any other vaccines officially recommended for them by the Centers for Disease Control and Prevention.
Some Medicare Advantage plans are taking part in a new program that gives them more flexibility to offer additional preventive services, or services aimed at slowing the progress of chronic conditions, without cost.
Some of these provisions, called "value based insurance design" because they base the cost to a person on the value that they will get based on their health status, actually were informed by research done at U-M.
Good news item 3: More plans to choose from
The number of health insurance companies that offer Medicare Advantage plans, and plans available to individuals and families on the healthcare.gov website, continues to grow.
That's why it's important to shop around during your Open Enrollment period – even if you were happy with the plan you had last year.
If you have a Medicare Advantage plan, or you bought your insurance on healthcare.gov, it will probably get automatically renewed if you don't do anything by the December deadline.
But even if you're happy with it, you should still take time to look at all your options – you may find something even better.
Good news item 4: A way to cover family members for less
If you get your health insurance through your job, but it costs a lot to cover your spouse or children up to age 26 on your job-provided plan, there's good news for 2023.
A change made this year means that you may now qualify to get insurance through healthcare.gov and cover any member of your immediate family who needs coverage. (Previously, a "family glitch" in the law made this impossible.)
The new rule only kicks in if the cost of covering yourself and your family members on your job-related insurance would add up to more than 9% of your income.
So, to find out if you qualify, you'll need to do some math with the help of a trained helper like the ones listed above.
Good news item 5: More time to transition from Medicaid if your income has gone up
Back during the early months of the pandemic, when many people lost jobs or had their work hours cut, millions of people nationwide turned to the state-based safety net insurance option of Medicaid, which covers millions of people with lower incomes.
Because of the pandemic, it's been two years since states required people with Medicaid to prove their income is still low enough to keep the coverage. That means some people still have Medicaid coverage, even if their income has gone back up above the usual limits.
This special situation will continue into at least January 2023, as long as the federal government's pandemic 'public health emergency' rules stay in place. But as soon as the special rules are lifted, states will have to start a process of asking people to prove their current income again. If they make less than the limit, they will be able to stay on a Medicaid plan – but if they make more, they'll need to get coverage on healthcare.gov or go without insurance.
No one knows yet when this change will take place. But before it does, if you have Medicaid, make sure your contact information is up to date with the Medicaid agency in the state you live in. You don't want to miss important mail when it arrives.
In Michigan, log in to MI Bridges to update your information, or call your local MDHHS office for help. If you receive mail from the state, or your Medicaid plan, be sure to open it and fill out and return any forms promptly.
Use the calculator on this page to find out if you will qualify for Medicaid in your state for 2023, or if you should transition to an insurance plan you buy on healthcare.gov. Remember, you have until January 15 to choose a plan on healthcare.gov and get coverage starting February 1.
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