Major medical expenses after open enrollment

Let us start with a question, “What happens with major medical expenses after open enrollment?” So we have come to the end of the special enrollment period. Unless you have a special circumstance that allows you to enroll within a 60 window, you will now need to wait until open enrollment at the end of the year to make any insurance plan changes. These special circumstances that could allow a change anytime in the year, include things pertaining to a life change event – the birth of a child, loss of a job, loss of insurance, a qualified Cobra plan, and others.

However, for the majority of people, the next open enrollment is at the end of the year. In lieu of that, I want to get a head start on assisting my clients. Regular open enrollment will be November 1st – December 15th, unless this gets changed, but for right now this is where it stands. If you selected a Marketplace plan for this year, I suggest that we should look at it again during open enrollment because every year there are new plans that are offered. I’ve heard there are some new companies that are going to offering some new plans in 2022.

Be advised that premiums always go up every year (you should receive a letter in the mail notifying you of this change) and so open enrollment is our chance to look at the various options. One option that many people do not realize that I can assist with is filling in the gaps on any Marketplace plan. We refer to this as supplemental insurance. There are a couple of different ways that I can do this. For example, if you pick a plan that has a very high deductible, there are some things we can put in place to help offset that deductible if you suddenly find yourself needing major medical care.

There are also some options we can use for major medical expenses after open enrollment that will be more like gap insurance. Many people ask, “But can I have two insurances?” Technically, it does not make sense to have two major medical insurances, because they will not both pay for claims. The primary one will pay, and the secondary one, when they see the first has paid, they will refuse to pay. I usually don’t recommend people do this for this reason.

On the other hand, I have people that have Marketplace insurance, which is considered major medical, and then they have a health insurance plan, which is not a major medical (either a private PPO or a type of indemnity plan that pays them benefits regardless of any other coverage they have). People ask me “Why would I need that?” Usually, this is very helpful if you have a large deductible. This can be one way to help minimize your deductible, or your out-of-pocket costs. If you have a private PPO or an indemnity plan, you could actually come out ahead. For instance, when you have to see the doctor or have a surgery, there are some rules for pre-existing conditions. What I will do is conduct a review with my client to see if they qualify for any subsidies. There are currently some new subsidies, and often my client can be enrolled in Marketplace, and because their original private PPO plan is going to pay out cash to them, they can then use their Marketplace plan to have the surgery.

There’s currently a great zero deductible plan that Oscar has that requires only paying copayments. And that’s a really good plan. Particularly if you know that you need to schedule medical procedures, you’d pay a little higher premium. However, your out of pocket costs would only be around $1500 for the copayment for a surgery. Most often, surgeries cost thousands and thousands. So this helps greatly. I am able to advise you on leveraging the system to use your private insurance with it’s outpatient surgery benefit, to offset the copayment of the Oscar plan.

These types of options and leverage are often not known about by many people. That is one of the key reasons to contact me. I can assess your needs and situations and see which of these great subsidies that are available through the end of next year may be applicable to your situation. Often, I can help you switch your Marketplace plan and get supplemental insurance because you know you will have an upcoming health need the next year. It’s important to plan this out before open enrollment. And if we plan ahead, I can help you save a whole lot of money. Like the above example, if we hadn’t made the changes, you’d be stuck with the coverage that you currently have, and paying possibly $8,000 out of pocket to have a surgery done, when you could pay be paying only $1,500.

If you are interested in seeing what options exist for you, head over to my website – jkappconsulitng.com – and book an appointment with me. I’m happy to review your existing coverages. I do suggest you do this sooner rather than later, since open enrollment is a very busy time. I am hoping to help as many of my clients as possible, so by booking an appointment with me, I can book a time to work on your needs and make my recommendations.

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