The 2025 Health Insurance Season is Now!

Our Open Enrollment newsletter is a toolkit of resources to help navigate the open enrollment period. We’re here to support you with no charges (we are compensated by the carrier). November 1st marks the start of open enrollment for individual and family health insurance plans, with a deadline of December 15th for a plan start date of January 1st, 2025. If you’re satisfied with your current plan, passive enrollment into the same or similar plan can happen, but be sure to review ALL notices from your insurance carrier and the Health Insurance Marketplace or State-Based Exchange (e.g., Pennie, GetCoveredNJ). Submit any requested documents promptly to avoid potential disruptions in coverage. If you have questions about a document or letter received, please text 267-885-8823 (Robyn). Our resource page is now updated for 2025, providing round-the-clock support and answers to frequently asked questions. Our years of experience allow us to navigate this ever-changing process along with you.

Access AI-powered resource page here.

If you have updates to your application, we can assist you in making changes and rerouting to all available plans and prices. If you wish to switch carriers, plans, or adjust price point, now is the time. To explore all your 2025 options for Pennie, GetCoveredNJ, Healthcare.gov, Maryland Health Connection, Virginia’s Insurance Marketplace, and the new addition for 2025, Georgia Access, without logging into your account, please use the button below..

*Please be advised that Healthsherpa may not be showing accurate subsidy numbers or carrier selections for PA, NJ, or other state-based exchanges. Use this as a baseline until they update their system with the latest data! Healthcare.gov states are not experiencing issues to our knowledge. These are estimates!

GET A QUOTE!

If you have Medicare, our dedicated Medicare page is filled with valuable information and user-friendly tools to help you obtain quotes. We will only reach out if you request us to. Explore it here: https://doitformeinsurance.com/medicare.

For those in search of Individual and Family Health Insurance, who would rather explore on their own, we offer a seamless shopping and renewal experience across platforms like Pennie, GetCoveredNJ, MarylandHealthConnection, and Healthcare.gov. Find quick links below:

Pennie

Get Covered NJ

Maryland Health Connection

Healthcare.gov

Virginia’s Insurance Marketplace

Georgia Access

 

If you decided not to use your applicable Health Insurance Marketplace and instead are enrolled directly with your insurance carrier, your current plan will automatically carry over into 2025 (unless you indicate otherwise or it has been discontinued), as long as your payments are up to date. However, if you’re interested in exploring different options, we’re just a call, text, or email away! You can easily schedule a phone consultation through our Calendly link, where you can choose a time that works best for discussing your health insurance options for 2025.

Book Appointment

What’s New for 2025?

 

A brief overview of the legislation that has impacted enrollment and eligibility in various insurance marketplaces, highlighting the provisions currently in effect:

• The Affordable Care Act’s “Family Glitch” was addressed in a White House Press Release from October 11, 2022. Click here to read! 
• The Inflation Reduction Act’s impact on Affordable Care Act-compliant Individual and Family Plans, along with Medicare Plan Options. White House Press Release.

Pennsylvania and New Jersey residents are entering the 5th Open Enrollment Period (OEP) with state-based health insurance marketplaces, Pennie and GetCoveredNJ. Renewal information is updated for most accounts, with some exceptions. We offer assistance to guide you through changes and explore alternatives. Our services are fee-free, and we respect your preferences, providing hands-on support or guidance and advice.

The Pennie landscape is changing, starting with Cigna’s exit from the state by the year’s end. While Cigna is a well-known name, their plans and limited network were uncompetitive, resulting in minimal impact on most Pennsylvanians.

UPMC announced its withdrawal from several individual counties, including Centre, Columbia, Lehigh, Northampton, Schuylkill, Snyder, Union, Adams, Berks, Lancaster, and York. Known for its presence in the western part of the state, UPMC’s eastern expansion appears to be coming to a halt.

Ambetter’s Pennsylvania company, PA Health and Wellness, will be expanding into counties such as Blair, Cambria, Centre, Clarion, Clearfield, Elk, Fayette, Huntingdon, Jefferson, Somerset, and Westmoreland.

Pennie will welcome Humana, which will offer its range of dental options across all Pennsylvania counties.

Jefferson Health merged with Lehigh Health System—adding over 30 hospitals to its network—and will be expanding its offerings to include Delaware, Lehigh, and Northampton counties.

Pennie Open Enrollment is November 1st to January 15th!

The State of New Jersey will not experience any changes in the number of insurance carrier options. GetCoveredNJ will continue to feature a presence—varying by county—of Horizon Blue Cross Blue Shield, AmeriHealth, Oscar, Aetna, Ambetter/Wellcare, and United Healthcare. Alongside the Advance Premium Tax Credits provided through federal funding, New Jersey will also maintain its state subsidy, both of which are accessible through GetCoveredNJ based on projected income for 2025.
Plans with out-of-state access continue to be a challenge, with most carriers citing out-of-state fraud as the biggest factor. Ambetter/Wellcare (not available in every county) is the only New Jersey carrier that allows consumers to see providers in other states who are in the Ambetter network, with no out-of-network coverage. Since Jefferson Health is in the network, this is an option for those wanting to travel to PA for care. Aetna will allow members to seek care at a CVS Minute Clinics nationwide, which can help when traveling, but it remains a challenge for snowbirds!

GetCoveredNJ’s Open Enrollment is November 1st to January 31st

Delaware, a Healthcare.gov state, will maintain four insurance carriers: Highmark Blue Cross Blue Shield, Aetna, AmeriHealth Caritas Next, and Ambetter (new in 2024). Ambetter is optimistic when it comes to pricing and benefits across the bronze, silver, and gold medal tiers, and looks to give Highmark a run for their money. Platinum plans seem to be extinct in most markets, but Highmark will continue to offer a handful for consumers looking for the best plans available, regardless of cost. When it comes to networks, all carriers are NOT equal, and consumers should make sure to check with their providers before selecting a plan. Highmark not only continues to be the only carrier to offer PPO plan options in Delaware, but PPO is also the only plan type they have in Delaware with the full backing of the National Blue Cross Blue Shield network—perfect for snowbirds!

Delaware uses the Health Insurance Marketplace, i.e., Healthcare.gov, with Open Enrollment from November 1st to January 15th.

Maryland is set to welcome a new insurance carrier in 2025, following Aetna’s entry in 2024. Anthem Blue Cross Blue Shield has announced its expansion into a handful of states under its non-Blue Cross Blue Shield brand, Wellpoint, with Maryland being among them. Wellpoint, formerly known as Amerigroup in certain states, will join established Maryland carriers CareFirst Blue Cross Blue Shield, Kaiser, United Healthcare, and Aetna.

Maryland Health Connection’s Open Enrollment is November 1st to January 15th!

Virginia is now entering the second year of its state-based marketplace, known as Virginia’s Insurance Marketplace. Similar to Pennie, GetCoveredNJ, and several other states, Virginia has partnered with GetInsured’s platform, leading to a functionality that closely resembles those of other states utilizing this system.

Virginia’s Insurance Marketplace’s Open Enrollment is November 1st to January 15th!

2024 was a challenging year for Georgia as it worked to launch its State-Based Marketplace, Georgia Access. Due to filing guidelines from CMS, Georgia could not operate as a fully functioning State-Based Exchange (SBE) at that time. Fast forward a year, and Georgia Access is go for launch. This marketplace will be the first SBE to allow certified Enhanced Direct Enrollment partners, including Healthsherpa, to facilitate enrollments. This means consumers and brokers can use Healthsherpa for enrollment, rather than relying solely on the State’s website, as is the case with all other SBEs.

We continue to work in many Healthcare.gov states that will experience varying amounts of carrier and plan changes, far too numerous to list. Our partnership with HealthSherpa is solid and time-proven and we find their quoting and enrollment tools to be at its best possible given the landscape. By using our official link, we remain your broker and are available for your service needs. As a friendly reminder, if we are not listed as your broker, we do not receive payment and therefore cannot assist with your needs.

Georgia and Healthcare.gov’s Open Enrollment is November 1st to January 15th. 

If you are not one of our clients already, here is a video explaining how you can work with us!

Affordable Care Act Alternatives?

 

In this section of the newsletter, we typically discuss Affordable Care Act (ACA) alternatives and key considerations. There’s no coverage like that found in ACA-regulated plans, especially regarding guaranteed issue and pre-existing conditions coverage. While networks and benefits may be lacking, particularly in rural areas, these plans fulfill their intended purpose and offer a stop-loss through out-of-pocket maximums. We understand these plans may not be affordable or suitable for everyone, so we’ve provided recommendations for viable alternatives.

Short-term medical plans have been a go-to for many, offered by reputable companies like United Healthcare. Consumers typically pay their deductible, after which the carrier covers up to a lifetime maximum of one to two million dollars, depending on the options chosen. This popular alternative has sparked controversy over the years. Initially meant for those between jobs, it gained traction as a longer-term solution with the onset of the Affordable Care Act.

The Obama administration was the first to regulate (via executive order) that a short-term medical policy could not exceed three months. However, there was no limit on how many three-month policies could be purchased in a year, leading to the phenomenon of “3 x 4.” Consumers could buy multiple policies at once while healthy, as a safeguard against illness before the next open enrollment period for Affordable Care Act plans starting in January of the following year.

The Trump Administration reversed the previous executive order with one of their own, allowing states to decide the duration of short-term medical policies. In Pennsylvania, the maximum duration was 360 days (five days short of a year), while states like Florida and Texas embraced tri-term policies, allowing the purchase of three one-year policies at once, many of which covered preventive services after the first year.

The Biden Administration decided to pass another executive order that took effect on September 1st, mandating that a short-term medical plan could only be sold for a maximum of three months, with an option for a one-month renewal for a maximum of four months within one calendar year. This means that there can be no 3 x 4 policies with the same carrier, although the carriers have tried to devise a way in which they could work together (so far, nothing has come to fruition). Many states do not have any short-term medical plans being offered at all (like New Jersey), and others have only one carrier offering coverage. If you need coverage for one to four months, United Healthcare is still top-notch, and you can obtain a quote through this link: Click here to quote and enroll!

Since short-term options are no longer realistic, what alternatives are available? Fixed Indemnity (Fixed Benefit) plans remain unaffected by the recent executive order. These plans pay a predetermined dollar amount for covered services, regardless of the actual cost. For instance, if the benefit is $50 for a doctor visit and the doctor charges $200, either the provider or the consumer receives the $50 (depending on the plan), leaving the consumer responsible for the remaining balance.

Many people don’t realize that the true value of insurance lies in the network-negotiated rates; a $200 doctor visit without insurance typically sees a 40-60% discount when an insurance company is involved. Therefore, a $50 benefit may not lead to significant out-of-pocket costs. However, if the hospital benefit is $1,000 per day with a $10,000 surgical benefit, it can be challenging to trust that the network can negotiate a $900,000 hospital bill down to a manageable amount.

United Healthcare offers many of these plans, aiming for consumers to reach a worst-case scenario close to the out-of-pocket maximum of an Affordable Care Act plan, but there are no guarantees. Be sure to read the fine print and understand your options before you buy!

We believe these plans have their place and can work well with an Affordable Care Act plan. Pairing them with a high-deductible bronze plan may prove to be a better financial move than opting for a more expensive Gold plan. Aflac focuses on enhancing employer-offered plans and does not aim to replace health insurance. This is a case-by-case basis, and we’re happy to discuss it with you!

Additionally, we have significant experience with association and union plans. We previously offered plans through Health-share Ministries, which were controversial, although Metashare appears to be reputable. The main concern is that consumers agree to the Health-share’s terms, and if the Health-share determines a claim is contrary to their beliefs, the consumer has limited legal recourse. For self-employed individuals, we’ve had some success offering coverage through local unions, although this isn’t much cheaper than Affordable Care Act plans.

Currently, we’ve partnered with America’s Choice, which offers plans regulated by ERISA and not subject to State Insurance Departments, similar to union plans. Google is heavily invested in America’s Choice, although the company is relatively new, and pricing varies by plan and age. We’re happy to provide literature on any of these options upon request and review anything that seems “too good to be true” that you may receive!

If you or someone you know needs a Medicare Advantage or Part D Prescription Drug Plan click here!

During this busy time, we will make every effort to quickly return your call if you leave a voicemail.  Feel free to text or email to schedule a call!  [email protected] or text 267-374-0975.

DoitForMeInsurance and Joe Covell also handles your Dental, Vision, Life, Home, Auto, Group Health, and Business Insurance Needs! Shop everything on our website!

Click Here for a FREE No-Obligation Home/Auto Quote!

There are 76 days for most states (beginning Nov 1) to find a 2025 health insurance plan for you and your family! If you still need 2024 coverage you may be able to get it with a Qualified Life Event. Short-term options are available and can begin as soon as tomorrow. Click Here for affordable short-term plans

 

 

Contact us to explore all your insurance options, or to book your November phone appointment. Enrollments can be done over the phone, e-mail, text, or if you prefer to complete an application and enroll on your own, you can select “Jospeh Covell” (National Producer Number 16623825) as your broker on Pennie.com, Getcovered.nj.gov, MarylandHealthConnection.gov, Virginia’s Insurance Marketplace, Georgia Acess or by entering his National Producer Number on Healthcare.gov, so we can assist you year-round. Office appointments are available upon request.  Our Willow Grove, PA office is COVID-19 complaint with all CDC safety precautions. We are a certified Independence Blue Cross #SafeEnrollmentSpace for both over and under-65 communities!  Please email [email protected] or call/text 267-374-0975. If we don’t answer, please text or voice message your name and contact information. You are important to us.

We Handle All Forms of Insurance (Home and Auto only PA, NJ, and MD). Visit our brand-new site for state-of-the-art quoting tools, our blog of past newsletters, and much more information!

 

 

We are not in Financial Planners in the sense that we do not advise, recommend, or sell anything that requires a securities license. We do however work with Indexed and Other Fixed annuity, life, disability, and long term care products. Simply put we don’t work with products that are tied to the market. Since the pandemic we have many clients asking us for life insurance options as well as fixed annuity products that do not lose money when the market underperforms. We work with a team whose vast years of experience allows them to specialize in our clients unique needs.

We are a one-stop-shop for all insurance.  If you would be interested in a no-obligation-to-buy and completely fee-free consultation via phone, zoom, or in-person, feel free to contact us anytime, all of our contact info is at the very bottom! E-mail [email protected] for promptest response.