Like just about everything these days, open enrollment — the time when you can sign up for new health insurance and other benefits — is looking far different than years past.
Employers, insurers and Medicare have made changes in an effort to respond to COVID-19 and consumers themselves are looking at their benefits, particularly health insurance, with a more jaundiced eye. About 70% of employees say they will take more time to review benefits as a result of the pandemic than they did during the last enrollment period, according to a survey from financial planning firm Voya.
For their part, employers are making it easier to compare benefit plans beyond the usual information posted on corporate websites. Employers are offering webinars, virtual enrollment fairs and online sign-up options, said Julie Stone, managing director for health and benefits at insurance brokerage Willis Towers Watson. Meanwhile, the Centers for Medicare and Medicaid Services (CMS) have continued to add tools and improvements to Medicare.gov’s Plan Finder tool.
Here’s what health care consumers should be aware of as they dive into open enrollment 2021:
If you are insured through your employer
Open enrollment for most employees runs from late October through November. Check with your employee benefits department for your employer’s exact dates.
COVID-19 coverage is up in the air
Most major insurers have extended waivers for cost-sharing for COVID treatments through the end of the year. They have indicated they will consider extending those provisions further into 2021, especially as the rate of infections increases in several areas of the country and the winter flu season arrives.
But those moves are not certain. And that means there is no way to compare how your various plan options will cover COVID related illness in 2021. Your best strategy is to look closely at what each insurer has done so far, Stone suggested. You want to look specifically if the plan has eliminated co-pays and deductibles and waived out-of-network charges for COVID-19-related treatment.
The federal government has mandated that all insurers must provide no-cost COVID-19 testing. But ambiguities in the mandate have led to surprise bills for a small percentage of patients who find themselves on the hook for anywhere from a few dollars to thousands of dollars in hospital and lab fees for their supposedly free COVID-19 tests.
Check carefully if plans have covered COVID tests from all types of providers, including out-of-network labs and hospitals, at no cost. Also check if the plan has fully cover preliminary tests used to rule out other illnesses before a COVID test is administered.
Telehealth is here to stay
Before the pandemic hit, a majority of insurers and employers offered low-cost Telehealth services as a volunteer benefit. These were usually stand-alone services such as Teledoc, Doctor on Demand or MDLive that members can use in lieu of expensive emergency room visits for routine problems such as earaches or rashes. In spite of the push, only a small percentage of employees used telehealth services before the pandemic.
Once COVID hit, receiving health care over video or the phone became a fact of life as practitioners and patients looked for ways to handle medical care without risk of infection. Providers of all kinds across the country reported the number of virtual visits increasing as much as 175 times last spring, according to a McKinsey & Co. report.
As a result, Medicare, employers, insurers and several state regulators scrambled to increase reimbursements to practitioners for virtual visits so payments would be on par with in-person appointments. They also made efforts to ensure that patients paid no more in cost-sharing than they would for a traditional visit.
In addition, employers and insurers dramatically expanded virtual mental health benefits. Almost nine in 10 employers will offer access to online mental health resources this open enrollment season, including apps, videos and webinars, according to the Business Group on Health, a non-profit research organization.
The result, Stone said, can be a wide range in what various plans will cover for virtual services. When comparing your options, check which plans cover telehealth appointments with providers in your network, not just practitioners at the various independent telemed services. You’ll also want to compare what your copay or coinsurance will be for telehealth visits, both with your providers and at stand-alone companies.
“In the confusion of the pandemic many people got hit with large telehealth copays or denied bills because billing systems hadn’t caught up to the changes,” Stone explained. “Going forward it’s important to understand exactly what’s covered in each of your options,” she added.
Prepare for more plan choices
Continuing the trend of the past couple of years, employers are offering more plan choices, including policies with high deductibles or plans with narrow provider networks.
More choice means more research, particularly in the wake of the pandemic. Stone suggests paying special attention to plans with tight networks. For the lowest cost you will have to seek treatment in- network, but insurers have made strides in attracting high quality providers, she explained. “Paying more isn’t necessarily always the best option,” Stone said.
While you’re researching, Stone recommends looking at changes in all of your employer’s benefits. “Life and disability income insurance may take on new significance with COVID-19,” she said. Stone also has noticed employers offering creative benefits such as the buying and selling of paid time off and more flexible leave policies for people with children at home during the pandemic.
If you’re covered through Medicare or Medicare Advantage
For the most part CMS led the way with COVID-related coverage changes, especially in the areas of no-cost testing and expanded telehealth services.
There are also two changes, not directly related to COVID, worth paying attention to if you are considering a Medicare Advantage plan or a Medicare Part D prescription drug coverage plan. Medicare open enrollment began October 15 and ends December 7.
Starting in 2019, new government rules have allowed Medicare Advantage plans to offer supplemental benefits that go beyond strict medical care and provide support for elderly and chronically ill patients. This opens the door to coverage for adult day-care services, home-based palliative care, in-home support services, caregiver support, non-opioid pain management, memory fitness services, home and bathroom safety devices and modifications, transportation, meal delivery, pest control, over-the-counter health items, virtual health services and acupuncture.
Not all Medicare Advantage plans offer the new benefits. And for those that do, you won’t know if you’ll receive much of this supplemental coverage until you are enrolled in a plan. That’s because the plan will need to confirm your diagnosis and determine if you meet the plan’s eligibility rules, something that can’t be done before you are a member, said David Lipschutz, associate director of the Center for Medicare Advocacy.
This makes comparing plans difficult. If you’re using Medicare.gov’s Plan Finder tool or calling plans directly, you can determine what benefits are offered, but not if you will qualify for many of those specific benefits.
“The changes allow us greater flexibility to treat members holistically. Now we can identify a true need and address that need,” said Christopher Ciano, president of Aetna Medicare. He pointed out that some of the supplemental benefits, such as Aetna’s Healthy Food Debit Card, which allows seniors to buy fruit and vegetables at a discount, are available to all plan members. But programs designed to help patients with congestive heart failure, for example, or to prevent at-risk seniors of falling do indeed require qualification.
Medicare Advantage consumers have a second chance to change plans if they find they signed up for benefits they may not receive. If you enrolled in a Medicare Advantage plan, you can change to another Medicare Advantage Plan during the three month Medicare Advantage open enrollment period starting January 1 and ending March 31.
A new prescription drug savings program
If you are shopping for Medicare Part D prescription drug coverage, either in a stand-alone plan or as part of a Medicare Advantage plan, and you suffer from diabetes, this year you may find a plan that offers access to insulin with a limited copay of $35 a month. CMS announced that 1,750 Medicare Part D and Medicare Advantage plans will participate in the “Senior Savings Model” that offers this lower copay. The program could result in hundreds of dollars in savings for diabetes patients each year.
You can find Part D and Medicare Advantage plans that are participating in the program on Medicare.gov’s plan finder. But when comparing, make sure to screen for “yearly drug and premium cost” not just lowest premiums. From there, look at each plan individually and see if the $35 copay comes up for your drug. It won’t always be obvious that the plan or in-network pharmacies are participating in the new program, so you’ll need to check copays for each plan that comes up in your search.
If you’re shopping in the health insurance exchanges
The big news: The Supreme Court will hear oral arguments on November 10 for a case that will determine the Affordable Care Act’s future. A decision on those arguments is expected in June 2021. If the Court decides to overturn the ACA, the effect on consumers could be profound.
That said, for the time being, open enrollment for plan year 2021 will take place in each state starting November 1. For most states the period will end December 15, although several states have extended the deadline.
There is good news. Health insurers in the exchanges have lowered rates in some areas and overall have instituted only small premium increases for the coming year. You can find exchange plans in your area on Healthcare.gov.