Coverage is the gateway to access health services that can ensure healthier individuals, healthier families and healthier communities. Medicaid and Children’s Health Insurance Programs across the country face an historic challenge to ensure those eligible retain coverage and those no longer eligible secure other available coverage as states unwind the public health emergency-related eligibility. The Affordable Care Act marketplaces could provide coverage for as many as 5 million individuals and families who lose Medicaid and CHIP coverage through this redetermination process.
Earlier this year, the purchase of health insurance through the marketplaces reached a record high, with an estimated 15.7 million people either renewing their coverage or signing up for the first time.
For Americans who do not have comprehensive insurance through their employer, Medicare, Medicaid, or another existing program, or have lost their Medicaid coverage during the redetermination process, now is the time to enroll in a plan that offers strong consumer protections. The plans sold through the marketplaces must cover medically necessary care, without regard for pre-existing conditions and without arbitrary limits on that coverage. Eligible individuals and families also may be able to enroll for free or at very low cost as a result of subsidies that can reduce premiums and cost-sharing.
Open enrollment for 2024 health coverage began on Nov. 1 and runs through Jan. 15, 2024 in most states.
AHA will help members get the word out with a full suite of social media tools designed to assist and remind eligible people to sign up or renew their coverage.
No one plans to get sick or hurt, but most people need medical care at some point. Comprehensive health insurance protects individuals and families from health and financial risks in a number of important ways. It provides a shield against unexpected medical bills by covering costs related to hospitalization, treating illness and accidents. It also covers preventive services, like vaccines, screenings and primary care visits, typically with no cost-sharing.
While premiums are certainly a factor while shopping for coverage, it’s important to look beyond the premium and make sure your doctors and medications are covered and that the plan’s deductible and cost-sharing amounts won’t stand in the way of being able to access care.
The good news is the ACA is fortified with important consumer protections, including out-of-pocket limits that ensure coverage kicks in for costly and unanticipated treatments and essential health benefit requirements that ban insurers from refusing to cover things like behavioral health or maternal care.
The AHA urges enrollees to research all aspects of their coverage options and carefully review the steps involved before making a final selection.
Consumers should be aware there also are health insurance plans offered outside of the marketplaces that are not subject to any consumer protections and are likely to have significant gaps in coverage. They may cost less upfront, but it comes at the expense of much lower coverage. For example, these types of plans have been known to deny coverage for emergency care or hospitalizations. On top of that, such plans often exclude the prescription drugs that are needed to help manage a chronic condition.
The risks to patients of these inadequate health plans are exactly why hospitals and health systems have long been strong advocates for ensuring everyone is enrolled in comprehensive, affordable health coverage. This includes working with the Administration and Congress to enact and later strengthen the ACA coverage provisions, including instituting important patient protections, establishing the health insurance marketplaces and reducing the cost of coverage through federal subsidies.
We can never know where life or health may take us. Open enrollment makes it easy to pick the health plan that best fits an individual’s or household’s needs.