For millions of Americans, the end of the year is open enrollment season — a yearly opportunity to take stock of your health care needs and select the health insurance plan that works best for you.
Why health insurance? Because every American deserves affordable coverage and high-quality care — and health insurance providers are working harder than ever to deliver more choices, better quality, and lower costs. As your advocate, health insurance providers are working every day to negotiate lower costs for your care and prescription drugs. Health insurance coverage is essential to well-being and financial peace of mind.
There are more choices than ever to help you find a plan that will best suit your health needs. Think of it like planning a trip: you don’t pack a surfboard if you want to hike in the Adirondack mountains. There is a lot to consider when picking your health plan for the next year. Does it include your prescriptions or preferred doctors? What does it cost? Open enrollment is also a great time to explore the benefits already available to you in your current plan, including discounts and wellness opportunities that can save you money and keep you healthy.
Let’s break it all down to help you make your decision.
What You Need to Know
The first thing to know is where you can get a health insurance plan. You may be able to get a plan through your employer. You may want to buy coverage on your own. If you are 65 years old or older or have certain disabilities, you may qualify for Medicare. And families with lower household incomes may qualify for Medicaid.
No matter the type of health coverage you need, there are a few important things to keep in mind.
- Missing a deadline to enroll in coverage could mean missing out. Be sure to pay attention to dates and deadlines for enrollment. Medicare open enrollment begins on October 15 and ends on December 7. Individual coverage through the healthcare.gov online marketplace begins November 1 and ends on January 15 of next year in most states. Your employer will let you know when the enrollment period for your employer-provided coverage starts and ends, since it can vary.
- Make an informed decision. Open enrollment is an important chance to choose the coverage that meets your current needs. Spend the time (with a spouse or partner, if you plan to cover more than yourself) to understand the details and do the math. Typically, plan offerings will cover similar services, but will have different costs and cost structures. For example, if you are willing to pay more toward your premium, you are likely to pay less out of pocket for health care services, and vice versa.
- Know what you want and need from your plan. Learn answers to questions like these:
- Do I regularly see a doctor or clinician, have a chronic condition, or need prescription drugs regularly?
- Are all my doctors in network?
- Do I expect to use services like preventive care and annual check-ups?
- What types of care are covered?
- How much will I pay for my prescription drugs at my pharmacy?
- What are the out-of-pocket costs for my doctors (including copays and coinsurance)?
- What measures of quality are there for the health plans I am considering, and how do I make these quality measures a part of my thinking?
- Do I prefer a lower monthly premium but higher out-of-pocket expenses or a higher premium and lower out-of-pocket expenses?
- Your health plan is an investment in your health and financial security. Use it! The arrival of your ID card opens the door to health care services for you and your plan dependents. Get recommended preventive care, including screenings and vaccinations. Fill and take the medications prescribed to you. And take advantage of wellness programs, nutrition guidance, sleep, mindfulness programs, and other supports your plan offers to help you stay well.
Now, let’s get into some specifics about different health insurance types.
Enrollment Period: Oct. 15 – Dec. 7
If you are 65 or older, disabled, or turning 65 in 2023, it’s time to start thinking about Medicare — and particularly Medicare Advantage plans — at www.medicare.gov.
Medicare is our nation’s health care plan for adults 65 and older and people with disabilities. Original Medicare comes in “parts” that cover hospitals (Part A) and physicians (Part B).
People eligible for Medicare may also choose to get coverage for their prescription medications through Part D.
Medicare Advantage plans offer Americans even more choices. Medicare Advantage plans have a strong track record delivering high-quality care at an affordable price — including many with $0 premiums. Offered by health insurance providers, Medicare Advantage covers all the same services as Parts A and B, along with many other important additional benefits such as dental, vision, hearing, prescription drugs, care coordination, mental health support, wellness benefits, transportation, and social connectivity.
Key Things to Know: Medicare Advantage
- Medicare Advantage is popular. Nearly half of all people eligible for Medicare have chosen a Medicare Advantage plan, up from 42% in 2020. Nearly 30 million seniors and people with disabilities choose Medicare Advantage because it delivers better services, better access to care, and better value.
- Premiums continue to decline. The average premium for 2023 is estimated at $18 per month, down 8% from 2022. And, Medicare Advantage plans cap your annual out-of-pocket costs, which original Medicare does not do.
- Open enrollment ends December 7. Open enrollment for Medicare Advantage starts on October 15 and ends December 7 every year. Learn more about plans in your area at medicare.gov.
Additionally, you have the option to enroll in other programs that supplement Medicare coverage, which work to protect you from high out-of-pocket costs not covered by original Medicare to budget for medical expenses, and even to avoid the confusion and inconvenience of handling complex bills from health care providers.
Enrollment Period: Nov. 1, 2022 – Jan. 15, 2023 (but check your state)
The Individual Marketplace — through online health exchanges — serves people under 65 who buy coverage on their own.
Today, nearly 20 million hardworking Americans buy health care coverage on their own in what is broadly referred to as the individual market. The ability to shop and compare plans online at the www.healthcare.gov health exchange (cuidadodesalud.gov) was established under the Affordable Care Act (ACA) and celebrates its 10th anniversary in 2023. Enrollment is growing thanks to the American Rescue Plan Act premium subsidies, which were recently extended through 2025 to help a record-high 14.5 million enrollees. That is more than 90% of Americans who buy their coverage through the ACA’s health insurance exchanges. The exchanges offer comprehensive coverage with access to 10 essential health benefits, prescription drug coverage, no exclusions for pre-existing conditions, and no annual or lifetime limits.
Key Things to Know: Individual Coverage
- Important dates: Open enrollment at www.healthcare.gov begins November 1 and ends January 15, 2023. If your state operates its own exchange, please check your state’s website for more information about open enrollment deadlines.
- More choices: For 2022, health insurance providers expanded offerings, with more than 200 companies offering coverage through the marketplaces. Consumers have more choices with access to, on average, six to seven qualified health plan (QHP) issuers and more than 100 plans to choose from in every state — more than ever before.
- You may be eligible for a subsidy: You can learn more about your options and find out if you are eligible for premium subsidies by visiting www.healthcare.gov.
Enrollment Period: Varies by Employer
If you get health care coverage through your employer, pay attention to deadlines and be sure to ask questions.
Nearly 180 million Americans
get their health coverage through their job. Thanks to competition among health insurance providers in every state, employees and employers have access to high-quality and more affordable care. Unlike other forms of health coverage like those we’ve outlined above, open enrollment for employer-provided coverage can vary depending on where you work. That is why it is important to stay abreast of deadlines and learn more about the coverage options offered by your employer.
Key Things to Know: Employer-Provided Coverage
Health insurance providers are committed to helping all Americans make informed health coverage choices for themselves and their families.
Health insurance coverage is an important way to protect yourself and your family. There are many choices available whether you are navigating the individual market, covered through your employer, or are eligible for Medicare.
Regardless of where you shop for health care, remember:
- Everyone should take the time to review available coverage choices to decide which plan is right for them.
- When making decisions about your health coverage, it’s important to think about what you want for your health care, as well as what will best protect you financially.
- Use the benefits to help you stay healthy and be an active part of your own well-being.