The family glitch which before made people ineligible for marketplace subsidies if they had an offer of “affordable” employer based coverage, including the coverage through a family member's employer has changed. In 2023. Now access to marketplace coverage is based on the worker’s premium contribution for family coverage. If that premium contribution is more than 9.12% of household income, then family members have the option of buying coverage through the marketplace. Additionally, if you fall behind on premium payments or even lapse coverage, you can still enroll in a 2023 policy offered by that insurer, and that policy binder premium cannot be applied to past due or lapsed premiums. Most importantly, if there is a life qualifying event, you can still sign up for marketplace coverage midyear.
There are more qualified health plans issued. Up 88% from 2022.
Reviewing your options are very important. If you have a low income or if you have a family qualifying event, especially if you are struggling with an expensive illness, you cannot afford to have a lapse in coverage and therefore a lapse in treatment. When reviewing your options, always make sure the plan you are getting provides the best possible coverage for your condition. Don’t just consider your doctor visits, but also your medications and whether your current medical providers are in-network. And look at the true cost of your out-of-pocket costs, not just the premium. Unlike before, people with low incomes will be able to sign up for Marketplace coverage year-round, not just during the open enrollment period. And the coverage will start on the first day of the month after they sign up. Because of the enhancements and changes to insurance plans coverage, don’t assume you are in the best plan for you. If you are automatically enrolled yearly, your benchmark coverage plan may have changed. Your cost may go up as well, and you may not be aware of the subsidized premiums you are eligible for. It is encouraged that you review your options yearly. There is more enrollment help and resources for enrollees than before. Go to HealthCare.gov. The Find Local Help link provides contact information and hours of operation for the nearest program.
Review your health insurance plan, private and federal plans yearly. Make the best decision for you and your family. Don’t let opportunities pass you by.
Diahanna Vallentine, BCPA
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