Consumer Alert: It's Open Enrollment. Before you choose a health insurance alternative, know the facts. | WHEC.com

Consumer Alert: It's Open Enrollment. Before you choose a health insurance alternative, know the facts.

Deanna Dewberry
Updated: November 03, 2021 08:48 PM
Created: November 03, 2021 04:56 PM

ROCHESTER, N.Y. (WHEC) — It's open enrollment for many health insurance policies, and Wednesday I read an interesting story in U.S. News and World Report. It featured an interesting new concept introduced here in New York.

A company called Antidote health just launched in January. In one press release, it calls itself a virtual health maintenance organization (HMO).

It's not a traditional HMO, but it is an alternative for the uninsured and underinsured. For as little as $35 a month, you get access to an online primary care doctor who you see online. You get 12 virtual visits a year and membership covers 80 inexpensive medications. Unlike a real HMO, you can't see a doctor in person, and Antidote doesn't cover hospitalizations, imaging, surgery, and expensive drugs.

Fixed Indemnity plans offer pay per service or pay per time period. For example, an indemnity plan might pay a certain amount for every day that you’re hospitalized. That differs from a traditional insurance plan that charges a monthly premium then covers all or part of your care. Here's the problem. The plans aren't always transparent about how they arrive at the amount they provide. Critics point out that if the amount you're charged is more than the amount they pay, you're on the hook for the rest

Then there's traditional insurance. The Health Insurance Marketplace is part of the Affordable Care Act created by the Obama Administration. Enrollment started on Nov. 1 and lasts through Jan. 15. These plans are regulated. They can't deny you coverage based on a pre-existing condition.  And the marketplace offers comprehensive coverage.  But some complain premiums are too expensive or out-of-pocket costs are too high. But many low to middle-income Americans are eligible for subsidies to help pay the premiums. You can easily determine how much money in tax credit you could receive by plugging in your income and family size into the health marketplace calculator.

It's also open enrollment for Medicare. It opened last month and runs through Dec. 7. These are tough decisions, but I'm here to help. The absolute best guide I've read that helps navigate the complications of Medicare is published by AARP.


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