With the implementation of the Affordable Care Act/Obamacare, you need to have a Qualified Health Plan to avoid tax penalties beginning January 1, 2014. As you consider the options for your individual health insurance in 2025, as well as the increased subsidies available to many Americans, it may be important to adjust you health insurance plan decision. In addition, as in past years, many carriers made seemingly minor plan or network changes that are neither obvious nor clearly understood but can have a major impact on your out of pocket costs during the year.
Since the implementation of the Affordable Care Act, individual health insurance has changed dramatically. Prices are substantially higher, some benefits are richer, others are poorer. The most dramatic change has been in provider networks. Carriers are reducing their networks and negotiating tighter reimbursement schedules with providers. As such, there are few individual carriers (none, in some parts of the country) where all hospital systems and related providers are in-network. Each year, networks constrict further so it makes sense to check with providers as well as your current insurance carrier to ensure that your doctors will be in-network in 2025. If you are a small business owner with at least one non-owner/owner spouse on payroll working the minimum hours required in your state, it may make sense to consider a small group health insurance option. Small group options offer richer network options and more extensive, richer benefits as well. If you wish to discuss the small group health insurance plan possibility further, please call or e-mail me.
Making the Individual Health Insurance Decision
Here are 10 key questions to ask yourself and your family members as you choose the most suitable plan for the coming year:
- Do I/my family members want unlimited doctors visits for a co-pay or will just a few doctor visits be adequate?
- If I and/or family members have a catastrophic illness or injury in the coming year, what is the most I will pay in 2025?
- Are there specific doctors or other providers I/family members want to utilize and did my 2024 network change if I am considering extending my current plan for 2025?
- Are my/family members’ prescription drugs on the carrier’s 2025 formulary? What will I pay for medications if they are not on the formulary?
- Which 2025 plans offer coverage for alternative care providers (chiropractors, naturopaths and acupuncturists)?
- Do I need a tax deduction such that I would benefit from purchasing an HSA?
- Should I go through my State/Federal Exchange site or directly through a carrier via my broker’s site? What is the difference and what is best for me in 2025?
- Will I qualify for a subsidy and what happens if my estimate of household MAGI (modified adjusted gross income) for next year is off by more than 10%?
- During an open enrollment period, if I miss the cutoff date for applying (15th of the month prior), when will my policy be effective? What are my options for short-term health insurance if there is a temporary break in my coverage?
- What happens if I lose my job during the year and cannot afford Cobra payments?
These are just some of the important questions that can arise during your medical insurance purchase decision. If you need assistance in seeking answers to any of these questions or any others, you need to rely on sound guidance based on the most current, accurate information available from a broker you trust thoroughly and implicitly. Call or e-mail me.
This web site may contain concepts that have legal, accounting and tax implications. It is not intended to provide legal, accounting or tax advice. You may wish to consult a competent attorney, tax advisor, or accountant.