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Dr. Larry Antonucci, MD, MBA
Dr. Larry Antonucci, MD, MBA
Open enrollment is a period of the year during which people can enroll, renew, or change their health insurance for the upcoming year.
There are several ways to get health insurance in the coming months.
Open enrollment for health insurance on the Afforable Care Act Marketplace Exchange is starting now and will continue through January 15th.
Many employers that offer insurance to their employees also have open enrollment to choose health insurance for the coming year, usually between October and December.
Medicare open enrollment runs from October 15th to December 7th.
healthcare.gov (ACA Marketplace) promises an improved user experience, simplified plan selection, and potential status changes during sign-up. And for the first time this year, Deferred Action for Childhood Arrivals (DACA) recipients can enroll in marketplace plans.
No matter how easy the registration process is, it can still be confusing. Questions about what is and isn’t covered, in-network or out-of-network, deductibles, copays, and more are repeated every year across the country.
Varying levels of coverage and annual changes are common in health insurance, so whether you sign up for the Marketplace or not, everyone can make sure their plan provides the coverage they expect. You need to take the initiative.
Many people don’t know that some plans don’t cover primary care, preventive care, or inpatient care at Lee Health. In fact, some marketplace plans currently exclude Lee Health as a participating provider. Failure to provide full coverage of care provided by trusted physicians across our service network could significantly increase our healthcare costs.
For example, some plans on Healthcare.gov cover visits to Lee Health’s primary care physicians with cheaper in-network coverage, but coverage at Lee Health hospitals is out-of-network and more expensive. It may happen. With the same plan.
In an emergency, Lee Health’s emergency department is open to everyone, regardless of insurance coverage. Federal law requires emergency departments to provide treatment without considering a patient’s ability to pay or insurance status. However, that doesn’t mean the visit is free. If your insurance plan does not include Lee Health, you may be responsible for paying for your treatment.
Here’s why you should definitely review your health insurance plan.
If you’re already a Marketplace subscriber, you’ll be automatically re-enrolled in the same plan next year if you don’t make any changes. It’s worth checking to see if your current plan’s coverage or participating providers have changed. That way, you can choose a different plan if needed.
At Lee Health, commercial health insurance plans, as well as employer options, may offer varying levels of coverage.
Not all healthcare professionals who provide services at Lee Health hospitals participate in the same health insurance company or health maintenance organization (HMO) as Lee Health.
Medicare plans are also facing changes. Cigna Medicare Advantage Plans will eliminate individual PPO Medicare Advantage plans in Florida in 2025. Florida Blue Medicare Advantage for 2025 no longer includes Lee Physician Group primary care providers as a preference, but continues to include Lee Health hospitals and specialists. Patients who continue to see a Lee Physician Group primary care physician under this plan may incur additional costs in 2025.
If you are unsure of your insurance plan or HMO coverage, we recommend contacting both your insurance company and Lee Health’s billing department to confirm that Lee Health is a network or preferred provider for any plan. This preliminary step will clarify details such as copays, deductibles, and additional costs. Understanding the financial aspects of medical expenses is important to avoid unexpected bills.
Choosing the right health insurance plan to cover your medical care requires a thorough understanding of your insurance plan, network status, and available financial aid options. Proactively addressing these considerations during open enrollment will ensure that you can access the services you need while minimizing financial burden. As the healthcare landscape evolves, staying informed and involved in health decisions remains paramount for a healthier future.
To see if you’re covered by Lee Health’s Marketplace, visit: LeeHealth.org.
Dr. Larry Antonucci, MD, MBA is President and Chief Executive Officer of Lee Health.
