Newsletter

Volume 4, Number 39

FIRST STAGE OF OPEN ENROLLMENT ENDS DECEMBER 15

While ACA open enrollment runs through January 15, you must choose a plan and enroll by December 15, as well as make the first month’s payment (called a “binder payment”) before January 1 if you are enrolling for the first time or changing carriers to have a January 1 effective date.

If you choose a plan and enroll between December 16 and January 15 (as well as make any applicable binder payment before February 1), your effective date will be February 1, 2023.

If you don’t enroll by January 15 you can enroll thereafter (and before the 2024 open enrollment period)ONLY if you have a qualifying life event, e.g., loss of employer group coverage; move outside of the service area; lose Medicaid status; marriage; and birth or adoption of a child. Some qualifying life events require you to have prior coverage and others do not. (You do not have to have prior coverage or a qualifying life event to enroll during open enrollment.) 

Remember To Choose A Primary Doctor And Submit Any Required Proof

All of my clients have chosen plans that are either HMO or EPO (Exclusive Provider Organization) plans. Both of these types of plans require that the subscriber choose and utilize a primary care doctor for primary care services. If the subscriber doesn't choose a primary care physician, the carrier will automatically assign one.

I've advised all clients (1) to call their carrier about 5 days after choosing their 2023 plan to verify the carrier shows the client enrolled in the chosen plan with the net premium indicated at time of enrollment; (2) to make a binder (advance payment of the first month's premium) payment (or verify that the binder payment is reflected in the carrier's records if the first payment was made online at time of enrollment) if they are changing carriers or enrolling for the first time; and (3) to make sure payment provisions are made for all of 2023.

In addition, clients changing to new carriers or enrolling for the first time should choose a primary care doctor when they call in to the carrier per the above paragraph. Many carriers also permit this choice to be made online.

Also, a few clients received notices when they enrolled that they must provide certain proof (e.g., income, citizenship status, Social Security number) when they made their application. Generally, these proofs must be provided within 90 or 93 days, depending on the type of proof required. Failure to provide such proof within the required time frame can result in loss of coverage.

Please contact us at 786-970-0740 (cell) if you have any questions or need any help on the above.

AVERAGE LENGTH OF HOSPITAL STAY IN U.S. COSTS 504 HOURS OF WORK

According to an October 21 article in Value Penguin, the length of an average hospital stay in the U.S. is 4.6 days.  

The national average cost of a hospital stay (the latest year for which data are available is 2020) is $2873 per day. Based on the national average hourly wage of $26.22, this means that the average person works 504 hours to pay for the average 4.6 day stay. This is a 98% increase since 2004 and is a 35% increase in real income terms.  (In Florida the average cost of a 4.6-day stay is $11,637. This works out to $2530 per day and based on the average Florida wage of $24.98 means that the average person works 476 hours to pay for the average length of stay.)

STAYING HEALTHY THIS WINTER: TEN QUESTIONS ANSWERED

COVID lingers, flu season is at hand and germs are everywhere. This article by Jessica Migala that appeared in the October 28 issue of the AARP Bulletin tells you how you can reduce your risk

About Paul Cholak

Paul has over forty years of benefits experience and has been Director of Employee Benefits for large companies, as well as a benefits consultant with major consulting firms. He understands the health and life insurance needs of individuals and families of all ages. He also has considerable experience in selling health and life insurance to employer groups.

He guides you through the steps of getting health and/or life insurance and is available to help you both BEFORE and AFTER you've made your purchase decision.