According to the U.S. Census, 92% of people in the United States had health insurance for some or all of the year in 2023. Having health coverage helps ensure people have access to a regular source of care without financial hardship. You can help educate your patients about their health coverage options and how to find community-based enrollment resources whether they’re eligible for marketplace-based coverage, Medicare, or Medicaid.
Health Insurance Marketplaces: Since opening in 2013, the Affordable Care Act's health insurance marketplaces have helped millions of people shop for and enroll in health coverage. You can help educate your patients about open enrollment and community-based enrollment resources.
Open enrollment for 2025 starts on November 1, 2024, and ends on January 15, 2025, for states that use the federal marketplace. The deadline in states that operate their own health insurance marketplaces may vary slightly from the federal enrollment period. Missed the open enrollment period? Patients may qualify for a special enrollment period if they experience a change in family status (including marriage or birth of a child), residence, or income; loss of health coverage; or other qualifying circumstance.
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Patients who need coverage can visit www.healthcare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325)
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ACP's Guide to Helping Patients Enroll in Coverage: A one-page document with essential information for patients on open enrollment, where to shop for coverage, and who to ask for help. The document can be printed out or posted to your practice website.
Medicare: If your patients need coverage and are age 65 and older, they may be eligible for Medicare. Younger people who have disabilities, End-Stage Renal Disease, or amyotrophic lateral sclerosis or ALS may also be eligible for Medicare coverage. Medicare open enrollment runs from October 15 to December 7. During the open enrollment period, patients may add, drop or change their Medicare Advantage or Part D coverage, or switch to Original Medicare from Medicare Advantage or to a Medicare Advantage plan from Original Medicare. Patients can visit Medicare.gov before the start of open enrollment to preview the health and prescription drug plans available to them.
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Medicare Advantage and Part D plans have different formularies, cost sharing structures, and networks, so shopping around for the right plan is important. Doing so can save money, which may help prevent cost-related nonadherence, where patients forego taking their medications due to cost.
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Finding the right kind of Medicare coverage can be confusing, but help is available. Patients can review their Medicare coverage options at Medicare.gov or call 1-800-MEDICARE 24 hours a day, 7 days a week to talk with a counselor.
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Free, personalized, objective, local assistance is also available through State Health Insurance Assistance Programs. Visit shiphelp.org or call 877-839-2675 to find a counselor.
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Your patients may be eligible for financial assistance to lower their drug costs. They can apply for the Extra Help program online or call 1-800-772-1213 (TTY 1-800-325-0778.
Medicaid: The Medicaid program provides health coverage for people with low incomes. During the COVID-19 pandemic, states were given a boost in federal Medicaid funding if they allowed enrollees to remain in the program. In 2023, state Medicaid programs began “unwinding” the continuous enrollment provision to determine if Medicaid enrollees were still eligible for coverage. Although most people renewed coverage, an estimated 25 million as of September 2024 were disenrolled from the Medicaid program, primarily due to procedural reasons such as failure to complete the renewal process. If you have patients who were enrolled in Medicaid but lost coverage, they may be able to renew their coverage through their state Medicaid agency or enroll in coverage through the Health Insurance Marketplace or Medicare. Patients can find out how to apply or renew Medicaid coverage by contacting your state’s Medicaid agency.
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Information on how to apply for Medicaid coverage.
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CMS Clinician Toolkit: A toolkit offering physicians and other health care professionals information on patient-centered messaging to get the word out about Medicaid and CHIP renewals and other coverage options available for patients who have been disenrolled.
Additional Resources
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From Coverage to Care: From Coverage to Care is an initiative designed to help people understand how health insurance works and find the physician or health care professional that's right for them. Resources include videos, educational brochures, and a poster (or posters). Materials are available in English or Spanish.
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HHS Info about Marketplaces: For Professionals| For Patients (English) | For Patients (Spanish)
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Web MD: Health Insurance Checklist
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Internal Revenue Service: Information on Reporting Income Changes for Premium Tax Credit