Oct. 28, 2024

This paid piece is sponsored by Avera Health.

As sure as colorful leaves and football games, open enrollment season happens each fall. Don’t miss this chance to ensure you have health insurance coverage for 2025.

Open enrollment on the federal Marketplace at healthcare.gov begins Nov. 1 and runs through Dec. 15 for first-of-the-year coverage. Jan. 15 is the final date to make changes or to set up coverage that begins Feb. 1.

Employers have their own open enrollment season to sign up for health insurance at work, but commonly this happens in the fall as well.

“For most people, open enrollment is their one window of time each year to get or change health care coverage – so don’t let it slip by without taking action,” said Jordan Anderson, senior director of group sales at Avera Health Plans. “For employees, it’s vital to see health insurance as an investment, just like a retirement plan. It protects your savings and income from unexpected health care costs.”

Plan ahead, review your choices, and consider your health from the prior year. “Everyone’s situation and health care needs are unique, but the more you know about the choices and how your plan works, the better,” said Brad Meyer, director of consumer sales at Avera Health Plans.

During open enrollment season, consider these questions:

Should I sign up for health insurance at work? Or go to the federal Health Insurance Marketplace?

If your employer or your spouse’s employer offers affordable health insurance, this is your top option to consider. “About four in five people with health insurance get it through their employer,” Anderson said.

If you turn down that opportunity, you can still get insurance at healthcare.gov, but you might not qualify for tax credits.

Affordability means the premium costs no more than 9.02 percent of your household income. If the annual premium amount is higher than that, you can look to the federal Marketplace and still qualify for tax credits.

You also might fall into other special categories:

• If you are younger than 26, you can get coverage on your parents’ plan, even if you’re living on your own.
• If your income is below certain limits, you may qualify for Medicaid. In South Dakota for a family of four, the monthly income limit is $3,588.
• If you are nearing age 65, you can consider Medicare and related products.

Avera offers fast and convenient sign-up for individual and family Avera Health Plans products that are offered on the federal Marketplace. This sign-up process takes an average of only nine minutes for new enrollees and four minutes for renewals.

Should I consider a high-deductible health plan?

High-deductible health plans offer lower premiums. But if you have a health care event, you’re responsible for covering the entire deductible amount before insurance starts to cover expenses. “High-deductible health plans are paired with a health savings account. You can set aside pre-tax dollars in that account, but the funds can be used only for qualified health expenses. Your HSA savings can roll over from year to year,” Meyer said.

If you know you’ll need health care services but don’t have money saved to cover a high deductible, look for the lowest deductible plan you can afford or consider a traditional plan.

As you select a plan, consider what your total out-of-pocket costs could be for health care. You’ll have the monthly premium even if you don’t use health services. If you have a health event, you’d be responsible for out-of-pocket costs like deductibles, co-pays and coinsurance.

Should I choose a “direct” plan?

Direct plans have a selected network of providers that may be within one health system, like Avera. They offer lower premiums, and you still have a wide range of specialists to choose from. “These plans make special provisions for family members who live outside the area, for when you travel or if you need specialists or health services not available in-network,” Meyer said.

What should I look for in a health insurance plan?

Affordable Care Act-compliant plans must cover a list of 10 essential categories of health services, including 100 percent coverage for preventive care like yearly checkups, annual mammograms, immunizations or more.

Yet health insurance plans may include additional benefits — for example, three covered visits per year beyond your annual checkup. Value-added services may include discounts on fitness memberships and virtual visits.

For 2025, Avera Health Plans is offering MyWeighForward health insurance plans that cover health care services like other plans do but also give people access to health coaching and weight-loss medications to be successful in weight loss. Specifically for people with a certain body mass index and their family members, these plans currently are available only in Minnehaha, Lincoln and Brown counties in South Dakota with individual and family plans, as well as small and large group employer plans.

“MyWeighForward is a unique and innovative concept in insurance coverage,” Anderson said. “We saw the need for it with increased interest in weight-loss drugs, which insurance often does not cover. If people are able to lose significant weight, they are healthier in the long run.”

Note to employers

Employer-based insurance drives retention. More than 90 percent of employers see health insurance as the most important perk for employees. Workers see wages as most important, but insurance is a close second. Some studies show that comprehensive health benefits can lower turnover significantly.

“You do your employees a great service not only when you offer affordable health insurance as a benefit but also if you help them understand the products they’re being offered to choose from and the important timelines related to open enrollment,” Anderson said.

If you are looking into your options for health insurance coverage, get a quote for large group or small group plans at AveraHealthPlans.com.