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it's open enrollment so let's discuss
some important changes and take a look
at those 2023 plans hi there as always
if you have any questions whatsoever
please feel free to send us a message or
give us a call at the number on the
screen and as always please make sure to
subscribe to stay up to date and of
course make sure to click that Thumbs Up
Button give us a like so that we can get
this information out there so today
we're going to be talking about those
2023 plans for Marketplace insurance but
before we dive into that let's go over
the basics of marketplace insurance for
those who maybe haven't had it in the
past and as a refresher for those who
have had Marketplace Insurance in years
past now under the ACA which is the
Affordable Care Act a Marketplace plan
cannot charge you more or deny you based
on a pre-existing condition additionally
all Marketplace plans must offer at
least the 10 essential benefits and
these 10 essential benefits can of
course be found on healthcare.gov
ambulatory patient services Emergency
Services
hospitalization pregnancy as well as
maternity and newborn care
mental health and substance use
disorders prescription drugs
rehabilitative services and habilitative
services and devices
laboratory services preventative and
wellness services and chronic disease
management and Pediatric Services
additionally plans must offer birth
control coverage and breastfeeding
coverage and of course plans do often
offer additional benefits but these are
the 10 essential benefits as listed on
healthcare.gov and of course if you so
choose you can also purchase dental and
vision insurance now the next thing I
want to talk about is those metal tiers
you may or may not have heard of these
it is the bronze silver gold and
platinum metal tier plans now these
names have nothing to do with the
quality of the plan it has nothing to do
with the benefits offered or the network
size or anything like that it only
indicates the cost sharing structure so
that is to say the co-insurance now if
you're unfamiliar with the term
coinsurance basically it is a percentage
of the service rendered that your health
insurance carrier will cover and then
you're responsible for the remaining
percentage so for a bronze level plan
your health insurance carrier will pay
60 you pay 40 percent for silver it is a
70 30 Split For Gold it's an 80 20 and
for platinum it is a 90 10. two more
important things to note if you are
eligible for premium tax credits which
we're going to cover in just a minute
you may notice that it says that you may
be eligible for additional savings if
you choose a silver plan also since
we're talking about that cost sharing
you may also notice that bronze level
plans tend to have lower monthly
premiums and platinum plans tend to have
higher monthly premiums and that is
directly related to the cost sharing
structure you'll also be able to choose
between hmos epos and possibly ppos
although PPO coverage is pretty rare on
the marketplace
so an HMO generally speaking will have
lower monthly premiums however you will
have to have a PCP which is a primary
care physician to provide referrals for
Specialists and you will only get
coverage in network
a PPO on the other hand generally
speaking will have higher monthly
premiums but you don't have to have a
primary care physician you don't need
referrals for Specialists and you will
have coverage in and out of network and
then there are epos which are somewhere
in between you don't have to have a PCP
and you don't need referrals but you
will only have coverage in network
now let's talk about some changes coming
in 2023 namely I want to talk about
those premium tax credits so under the
American Rescue plan act the eligibility
for premium tax credits was expanded as
was the size of those premium tax
credits themselves now these were set to
expire at the end of this year however
under the inflation reduction act the
expanded and extended premium tax
credits have been extended through 2025.
so when you enroll in a Marketplace plan
you may be eligible for a premium tax
credit this is determined by your income
and your household size basically it is
just a tax credit that's paid up front
as opposed to when you pay your taxes or
receive a refund and of course this is
reflected in a discounted monthly
premium now in the past those who made
more than 400 percent of the FPL which
is the federal poverty level were
ineligible for a premium tax credit now
the subsidy Cliff was a term used to
describe those who basically fell
abruptly off the precipice of
eligibility for a subsidy so a single
person who made more than fifty one
thousand five hundred twenty dollars
would be ineligible and might in fact
fall prey to the subsidy Cliff the
American Rescue plan and thus the
inflation reduction act have actually
smoothed out the subsidy Cliff so more
Americans are eligible for premium tax
credits than in years past
actually many people have been able to
access a plan for ten dollars or less
per month so if you've had Marketplace
Insurance in the past you can expect
that your premiums will be largely
unchanged now that the inflation
reduction act has extended those
expanded premium tax credits so now
let's dive in and take a look at the
plans
so if you're unsure whether your state
uses healthcare.gov or an individual
State Marketplace healthcare.gov will
actually redirect you so I'm going to
put in a zip code for New York which
actually does not use healthcare.gov and
then you'll see your State's Marketplace
is New York state of health visit and
then this is a clickable link and it
would redirect you towards your
individual State's Marketplace
now if I were to use a Florida ZIP code
which uses healthcare.gov then it would
let me see the plans and prices on
healthcare.gov it's going to ask you a
few questions to determine your
eligibility for premium tax credits
now of course you can choose to skip
this if you'd like and you'll see the
full price plans but let's take a few
minutes to just look at some of these
options
so we're going to skip this current plan
ID
now if it's just you or you and other
people again you can skip but not really
recommended so let's do you and other
people
so let's see answer yes if legally
married know if divorced separated
unmarried living together or widowed so
let's say no
so if you have any dependence don't
count yourself or your spouse as a
dependent so we said it is going to be
you and other people so we'll say yes
how many people let's say two
so let's tell us about you let's say a
35 year old man
we're not going to put eligible for
Healthcare Bridge through a job Medicare
Medicaid or chip we did say that we were
claiming somebody as a tax dependent not
pregnant not a tobacco user and then we
will click next dependent one let's say
dependent one is five
and none of these apply so we're going
to continue and let's say dependent two
is three
none of these apply
so we'll continue
then it asks you to confirm your
household member so we said we're a 35
year old man who is a legal parent or
guardian of children under 19 and here
are the two dependents that we added
now it's going to ask to estimate your
income so let's say that it is
55
000 per year continue
based on the income and household
information you provided your household
may qualify for an estimated premium tax
credit of 808 dollars per month this is
an estimate so that means you'll see a
discount reflected on your monthly
premium of about 808 dollars per month
again an estimate you'll also see here
that you may be eligible for extra
savings if you pick a silver plan we did
mention that earlier in the video so
let's view plans
so it's going to show you quick
definitions you can filter and select
plans to compare which we're going to do
in just a moment
here's also what I mentioned earlier the
bronze silver gold and platinum and
again you notice the bronze average
premium significantly lower than the
Platinum average monthly premium that is
because you pay more when you get care
your deductible is very low and your
plan pays nearly all of your health care
costs and then these plans are of course
somewhere in between
so this one is lower on a monthly basis
but when you utilize your services
you'll pay more this one is more
expensive on a monthly basis but when
you utilize your services you will pay
less
and now it's offering you all of the
plans available so this one is showing
us 224 plans available currently it is
sorting by lowest monthly premium but of
course you can also sort by lowest
deductible there's also an inverse
relationship generally speaking with
deductibles and premiums so if I'm
picking a plan with a lower monthly
premium usually it may have a slightly
higher deductible if I'm picking a plan
with a lower deductible generally
speaking it will have a higher monthly
premium let's go back to the monthly
premiums
okay so let's take you through exactly
what highlights you're going to look for
so here is your monthly premium the
amount that you pay on a monthly basis
to keep your insurance active and here
is your deductible this is the amount
that you have to pay out of pocket
before your insurance begins to
contribute to the Cross chair now this
is a bronze plan so in that case your
insurance carrier would pay 60 and you
would pay 40 percent however there are
often many services that are covered
even prior to meeting the deductible
generally speaking these are basic
services like wellness visits
here are some more important information
this is your out-of-pocket maximum so
should you incur medical expenses not
including your monthly premium that come
to a total of eighteen thousand and two
hundred dollars that's it for the year
your insurance carrier will take over
the rest of the medical bills now this
is to protect you from major medical
debt this is not really what is expected
this is not your expected yearly cost
but it is to protect you in case you
should have major medical bills in if
you're in need of major medical
procedures or care
here are some other important costs
emergency room care is a 50 coinsurance
after you've met your deductible generic
drugs 35 copay after deductible no
charge for a primary care doctor and no
charge for a specialist now what you
would want to do is see if your medical
providers accept this plan that's very
important if you know the doctor that
you like to visit if there are
Specialists or hospitals that you plan
to utilize or just want to have as an
option you want to see if they are in
network
the same with prescription drugs if you
take any prescription drugs you'd like
to see if they're covered and at what
cost
you can also look over here at the plan
details and we will get to that in just
a minute now let's look at some other
plans so this one also has a zero dollar
monthly premium a fifteen thousand
dollar deductible and an eighteen
thousand dollar out of pocket maximum
again you would want to check with your
doctors and hospitals and prescription
drugs 50 co-insurance after deductible
25 generic drugs it doesn't indicate
that you have to meet the deductible
first fifty dollars to visit your
primary and a hundred dollars to visit
your specialist
now since we're going by premiums some
of these numbers may seem a little bit
similar however the benefits provided
and the networks could vary quite
greatly
so let's scroll up here and I want to
compare these to lowest deductible
so you'll see here so this plan you have
to pay 383 dollars and 10 cents on a
monthly basis to keep your insurance
active however the deductible is zero
dollars so your insurance will
immediately begin to contribute to the
cost share and your out-of-pocket
maximum is ten thousand dollars your
co-insurance is 30 generic drugs
fourteen dollars primary care doctor
five and specialist 60.
this plan offers Dental
this plan has pretty low price generic
drugs
this plan has a pretty low out of pocket
maximum
so this plan might be for somebody that
has significant medical needs because
yes you are going to be paying a lot on
a monthly basis but once you've hit four
thousand dollars in medical bills not
including your monthly premium your
insurance carrier would take over the
remainder of your medical bills so very
often
people that have higher medical needs
and you'll see here this is a platinum
plan very often people that have higher
medical needs may be better served with
a plan that has perhaps a higher monthly
premium with a lower out-of-pocket
maximum a lower deductible and very
often those Platinum plans will be
better served for people that have more
extensive medical needs
now let's scroll back up and I'd like
you to look at the filters here because
sometimes there are things that you know
are very important to you and you really
want to weed out the plans that aren't
going to offer you what you're looking
for
so first and foremost very easy to
determine exactly what your monthly
budget is if you know you cannot spend
more than five hundred dollars monthly
on your health insurance
and you'll see here that there are epos
and hmos so let's say that the thought
of having to go through your PCP to get
a referral is just something that you
cannot tolerate well then you want to go
with an EPO
so let's apply those filters and see
what happens
well we've cut our available plans down
by about half let's go back to filtering
rather sorting by lowest monthly premium
okay so this plan is an EPO so that
means no PCP no referrals but you do
have to stay in network to have coverage
zero dollar monthly premium
fifteen thousand five hundred dollars
deductible
and an eighteen thousand two hundred
dollar out-of-pocket maximum
so now what I would like to do is
compare a couple of these plans so let
let's pick some that seem pretty
different
let's pick this one here
we'll compare this one
let's pick
C
this plan
11 pages
and
let's pick this one I'm going to compare
three plans
so I did pick three bronze plans but you
would notice it's different if you
picked a silver a gold or a platinum so
first it's going to compare our monthly
premiums
0.29.69 and 72.85 here it's comparing
the deductibles this is 7750 for
individual 15 500 for family so the
difference between an individual and a
family deductible it basically works the
same way for your out-of-pocket maximums
as well this is designed to help you
save money so as an individual as you're
spending towards your deductible your
health insurance plan is keeping track
of that and once you have met that seven
thousand seven hundred and fifty dollars
your insurance will begin to contribute
to the cost share but there are other
members of your family as well and just
because you've met your deductible
doesn't mean they've met there so their
plan would basically not contribute to
their cost share however as you are all
spending on your medical needs if
combined you reach fifteen thousand five
hundred dollars then you will all be
covered so even if only two people
basically met their individual
deductible the entire family would now
have the cost share as opposed to having
to pay for everything out of pocket
and it works the same way with the
out-of-pocket maximum these are all epos
here we could check if we had medical
providers we would see which ones were
in network and which ones weren't
you'll also see here the star rating
plan documents these are very very
lengthy and very very complicated this
is why we always recommend working with
a broker even if it's not us somebody to
help walk you through the summary of
benefits and make sure that you really
understand what is covered by your plan
costs for medical care
okay so this is just going to give you
some basic ideas of what things might
cost
now this plan is eligible for an HSA
which is a health savings account and
that's because this plan is considered a
high deductible Health Plan
and it does offer an HSA not all high
deductible Health Plans offer hsas in
HSA like I said is a health savings
account basically you can contribute up
to a certain amount whether you are an
individual or a family
and that amount of money is pre-tax so
it will lower your taxable income it
will also lower your Magi which is what
healthcare.gov uses to determine if you
are eligible for a premium tax credit
now that health savings account is your
money in an interest-bearing account and
as long as you use that money for a
qualified medical expense and the list
is very very long as long as you use
that money for qualified medical expense
there is no tax on it now you can choose
not to touch that money also and the
interest accrued is not tax and you can
even invest a certain portion of the
money and if you manage to hold on to
that HSA until you're 65 you can
withdraw the money and use it as you
would a regular savings account
let's move on to prescription drugs
so here you will see exactly what the
cost might be so for generic drugs
3.23 no charge after deductible here's
preferred brand drugs 250 no charge
after deductible no charge after
deductible this is definitely a pattern
50 coinsurance after deductible no
charge no charge specialty drugs 50
co-insurance no charge no charge
here's a list of covered drugs if you
wanted to look through all of that
so your prescription drug deductible is
included in your plan deductible it is
not a separate deductible
here's access to hospitals and doctors
National provider network no because
these are not ppos need referrals to see
a specialist no because this is an EPO
this is what your hospital costs might
be
and here this is just to give you an
idea of some
basic health care costs adult dental
coverage it is not covered in either of
these plants but there is coverage in
this secondary plan now do remember you
don't need to choose a plan based on
whether it offers Dental or Vision there
are add-ons that you can choose and of
course there is private insurance for
dental and vision and it is much less
expensive than you might think it is
especially much less expensive when
compared to health insurance and the
added benefit to that is like I said uh
it's very hard to find ppos on
Marketplace plans obviously here they
weren't offered at all
but if you go to private dental
insurance route you can choose a PPO
plan which certainly opens up your your
opportunities much more than having to
go with an HMO or in this case a dhmo
since we're talking about dental
insurance
and then child dental coverage as well
here's Medical Management Programs if
you wanted to learn more about whether
those are offered with your plan
and any additional other services so
sometimes there are additional benefits
that aren't necessarily offered by all
plans but might be offered by your plan
so right here you see something about
easy pricing so right here you'll see
that these types of plans actually offer
certain services with just a co-payment
before you've met your deductible so
you'll just be responsible for a copay
as opposed to the entirety of the cost
of the service so some of these plans
offer co-pays for doctors and specialist
visits
Urgent Care physical speech and
occupational therapy and prescription
drugs so these plans are sort of a happy
medium so if you are somebody that is
insistent on doing it by yourself if you
don't want to work with a broker to help
guide you these plans can be a little
bit easier to understand that's not to
say they are better plans they're just
easier to understand
so you'll see here here's where it's
annotated this is an easy pricing plan
in most States Open Enrollment is
November 1st to January 15th however it
can vary by state so make sure to log on
to healthcare.gov for more information
and if your state uses an individual
Marketplace you'll be redirected at that
point of course if you have any
questions whatsoever please feel free to
send us a message or give us a call and
we can not only assist with answering
your questions but also helping you to
enroll in a Marketplace plan if you so
choose and of course please make sure to
subscribe and click that like button to
stay up to date thank you so much for
watching we wish you the best of luck in
open enrollment this year and have a
wonderful day bye-bye
