Marc Neely, President and CEO, Employer and Individual, Colorado and Wyoming at United Healthcare.
Joe Mahoney/Mahoney Images
As the fall open enrollment season unfolds, millions of Americans are currently reevaluating their health insurance options. A recent survey has revealed a concerning trend: approximately 60% of Americans struggle with accurately defining critical healthcare terminology. This significant knowledge gap could lead to suboptimal plan selections, meaning many individuals may overlook plans specifically tailored to their healthcare needs, potentially resulting in missed opportunities for cost savings.
Enrollment timing: For those receiving employer-sponsored insurance, the open enrollment period generally takes place over a two- to three-week span, ranging from September to December. Meanwhile, individuals eligible for Medicare can make their selections during the Medicare Annual Enrollment Period, which runs from October 15 to December 7 annually. Decisions made during this fall enrollment phase will become effective on January 1, 2025. For individuals exploring individual plans via the Health Insurance Marketplace, the open enrollment period commences on November 1, 2024, and wraps up on January 15, 2025, in most states. To ensure continuous coverage starting January 1, 2025, it is crucial to enroll by December 15.
Here are a few tips to consider when choosing a plan that may help lead you to better health and cost savings:
- Plan ahead. Dedicate ample time to fully understand the various benefits, services, and costs associated with the plans available to you. Consider any updates or changes to your existing coverage and analyze more than just the monthly premium. Take a comprehensive view of the potential out-of-pocket costs, including deductibles, copays, and coinsurance, which may significantly affect your overall expenses.
Medicare members and caregivers: As you weigh your options, take the time to assess the differences between Original Medicare and Medicare Advantage. To gain a clearer understanding of eligibility, plan choices, and prescription coverage, visit MedicareEducation.com.
- Help prevent unexpected costs. Verify whether your preferred doctor is part of your plan’s provider network, as choosing in-network providers can lead to substantial reductions in out-of-pocket expenses. Additionally, check that the medications you rely on are covered by your plan for the upcoming year. Opting to fill prescriptions at an in-network pharmacy or via home delivery may provide more cost-effective solutions.
Medicare members and caregivers: It’s important to note that Original Medicare typically does not include coverage for prescription drugs. Therefore, you may want to consider enrolling in a Medicare Advantage plan that includes prescription drug coverage to better manage your medication expenses.
- Explore mental health coverage. In addition to traditional in-person mental health care, many plans offer access to a virtual network of licensed therapists and psychiatrists. Furthermore, there are advocates available to assist you in navigating behavioral health care and accessing the necessary resources.
Medicare members and caregivers: When evaluating plans, prioritize those that provide virtual mental health care options with minimal or no copay.
- Look into specialty benefits. Don’t overlook additional benefits such as dental, vision, hearing, and critical illness insurance, as they can significantly enhance your overall health and well-being.
Medicare members and caregivers: While Original Medicare generally excludes most dental, vision, and hearing services, many Medicare Advantage plans offer valuable coverage in these areas.
- Consider wellness programs. Numerous health plans incentivize members to engage in healthier lifestyle choices. This might include bonuses for completing health surveys, participating in fitness classes, or maintaining a regular exercise regimen. Additionally, some plans offer tailored support for managing common chronic conditions like Type 2 diabetes.
Medicare members and caregivers: Many Medicare Advantage plans come equipped with gym memberships and wellness programs at no additional cost, promoting an active lifestyle and preventive care.
How can consumers address the knowledge gap in understanding their health insurance options as suggested by Marc Neely?
**Interview with Marc Neely, President and CEO, Employer and Individual, Colorado and Wyoming at United Healthcare**
**Interviewer:** Thank you for joining us today, Marc. With the open enrollment period in full swing, what are the most significant trends you’ve observed as people evaluate their health insurance options?
**Marc Neely:** Thank you for having me. One of the key trends we’ve noticed is a heightened urgency among consumers to reassess their healthcare needs, especially given the recent statistics indicating that about 60% of Americans struggle to understand critical healthcare terminology. This knowledge gap can lead to poor plan selections, so it’s essential for individuals to take the time to educate themselves about their options.
**Interviewer:** That’s a concerning statistic. What can consumers do to address this knowledge gap and make informed decisions?
**Marc Neely:** The first step is to plan ahead. I encourage individuals to dedicate sufficient time to research their options rather than making snap decisions. They should look beyond just monthly premiums and consider their overall out-of-pocket costs, such as deductibles, copays, and coinsurance, which can significantly impact their financial wellbeing. I also recommend checking whether their preferred healthcare providers are in-network, as this can lead to lower costs and better coverage for essential services.
**Interviewer:** Enrollment timelines are crucial for many. Can you explain the different periods and what individuals need to keep in mind?
**Marc Neely:** Sure! Open enrollment periods vary. For employer-sponsored insurance, it typically spans two to three weeks from September to December. The Medicare Annual Enrollment Period runs from October 15 to December 7. For those exploring individual plans through the Health Insurance Marketplace, open enrollment started on November 1, 2024, and ends on January 15, 2025. It’s vital to enroll by December 15 if you want your coverage to start on January 1, 2025.
**Interviewer:** Given these tight deadlines, what advice do you have for Medicare recipients specifically?
**Marc Neely:** For Medicare beneficiaries, it’s crucial to distinguish between Original Medicare and Medicare Advantage plans, especially since many people are unaware that Original Medicare does not include prescription drug coverage. I recommend they evaluate their options carefully and consider plans that align with their healthcare needs, including necessary medications. Websites like MedicareEducation.com can be particularly helpful in clarifying eligibility and coverage details.
**Interviewer:** Are there any specific healthcare services or coverages that individuals often overlook?
**Marc Neely:** Definitely. Mental health coverage is one area where many consumers lack awareness. In addition to in-person therapy, many plans now offer robust telehealth options, allowing access to licensed therapists virtually. As mental health becomes increasingly recognized as essential to overall well-being, embracing both types of care can provide significant benefits to individuals and families.
**Interviewer:** Thank you, Marc, for sharing these insights. It’s clear that informed decisions can lead to better health outcomes and financial savings for everyone navigating their insurance options.
**Marc Neely:** Absolutely, and I appreciate the opportunity to discuss this important topic. I encourage everyone to take their time, ask questions, and seek resources to make the best choice for their health care needs.
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To enhance understanding during this crucial enrollment period, health insurance companies and organizations are striving to provide extensive educational resources to their subscribers. As noted, awareness and informed selection are essential, especially as recent enrollment reports indicate over 2.5 million consumers have already returned to the marketplace, signaling a growing engagement in health coverage decisions [[1](https://www.cms.gov/newsroom/press-releases/over-496000-new-consumers-selected-affordable-health-coverage-aca-marketplace)].