Open enrollment has begun!

Starting November 1, we have until December 15 to get your coverage for January 1, 2023.

And then, from December 16 through January 15, your coverage will begin February 1. This is good news and bad news. It is bad news in that you could be without coverage for a month if you don’t sign up by December 15. Another option available to you is that if you’ve signed up or have an existing plan, and you’re not sure about changing anything, you still have the window between December 16 and January 15 to change it to a different plan for February 1.

So what’s new this year besides deductibles going up AND premiums going up?

Something I did learn this year, is that the EPO plans that are offered locally, will allow you to have access to the network regardless of zip code. Both Oscar and Friday health plans have robust networks and several options in El Paso, Houston and I believe Lubbock. Remember that  Marketplace coverage is mostly regional. That means if you change the zip code, sometimes the same plans are not available (certainly if you have an HMO, you’re going to be out of network).  With Oscar and Friday, you will now have access to that network anywhere. This can be really important because often time there are situations where people who live here in Austin, have to go to Houston for treatment. If they have an Oscar plan, they’re going to be able to use actually Memorial, and Herman facilities (which are in-network with Oscar this year, which is really big, since they are one of the biggest networks in Houston).

So to summarize, the differentiating factor between the HMO plans and the EPO plans is that you will now have some network access outside your immediate zip code. I feel like that’s huge. You still have to use an in-network doctor, but, you now have a broader network to choose from, very much different than an HMO, where you would not.

And also with an EPO, a lot of people do not realize this, you do not need a referral. If you need to see a specialist and you need to see one quickly, you can. Depending on what your needs are, it may be well worth it to shift to an EPO. And if you qualify for a subsidy, it’s probably not going to be that much of a difference at all.

Regarding subsidies, there are different ways that you qualify for the subsidy. Based on your income, you could receive help with your premium. But you could also get help with your deductible and co-pays. In short, the deductible you are allocated will be based on your income, and it could be less than someone who doesn’t qualify at that income level. That helps to reduce your out-of-pocket costs.

My job is to help you have the lowest healthcare cost per month and get the coverage that you need. Reach out to me to schedule an appointment during open enrollment!