Open Enrollment time is here, companies are rolling out 2023 plans: 7 changes for Floridians to consider [South Florida Sun-Sentinel]

With the cost of living up, getting a health insurance plan in Florida that covers your doctors, medications and emergency medical charges at the lowest price can make a big difference in your budget.

But the process can feel so overwhelming.

Whether you're picking a plan through your employer or the federal open marketplace, here's what you need to know about changes for 2023.

More plan choices

Sorting through choices means you need to figure out how much medical care you and your family will need. If you are not big users, you may want to pick a high-deductible plan to save on premiums. If you have a chronic illness or kids that often see the pediatrician, a traditional health insurance plan may be a better fit.

Companies expect to pay about 5.6% more per employee for health insurance in 2023, but most are not planning to increase employees' share of coverage costs, according to the Society for Human Resource Management. This doesn't mean your monthly premium won't rise. Already in Florida, people with employer-provided health coverage pay the highest annual premium in the nation, an average of $7,079.33, according to data provided by the Kaiser Family Foundation.

Many employers are starting to brief workers on the options for 2023. PPOs remain the most common type, much like in 2022, with some broadening the breadth of the provider network in their health plans, according to an Employer Health Benefits Survey.

"You don't want to assume the plan last year will be the best option, and you don't just want what appears to be the cheapest plan," said Louise Norris, health policy analyst for HealthInsurance.org. "Look at total cost of care. You want to compare everything -- co-pays, deductibles, maximum out of pocket -- and make sure your drugs and doctors are covered before you select a plan. Covered provider networks and medications change from year to year on some plans."

For anyone not covered by an employer's health plan or Medicare, Nov. 1 marked open enrollment to buy health insurance on the federal marketplace created by the Affordable Care Act. About 2.7 million Floridians get their health insurance this way, the most of any state. Enrollment runs through Jan. 15.

On the open marketplace, you will find new choices this year. Fourteen insurers are offering coverage in Florida's marketplace for 2023 , including one new insurer (AmeriHealth Caritas).

Most Florida counties have at least five insurers offering plans for 2023. Some have added plans and benefits.

Family/spouse coverage may cost less

This could be the year you save money on your family health insurance.

One of the biggest improvements to the health insurance marketplace is correcting what's called the "family glitch."

Large employers must offer health coverage to employees' spouses and children, but they don't have to pay for that coverage and it can be expensive. Now, there's another option. In 2023, if employer coverage for the family costs more than 9.12% of the household income, they qualify for a lower-cost, subsidized ACA plan instead.

"A lot of families will have a choice between an offer of employer-sponsored coverage and a marketplace plan with subsidies," says Doug Bartel, Florida Blue Market Leader for South Florida. "People who were priced out can now find their way into a plan."

A White House statement said about 1 million Americans will either gain coverage or see their insurance become more affordable as a result of the new rule. An Urban Institute analysis calculates the savings for a family could be about $400 per person.

More preventive care, wellness benefits

Most health insurance plans have to cover certain preventive health-care services at no charge. But the list of preventive services covered for free will grow in 2023, even if you haven't met your yearly deductible.

For women, those services vary by age to include breast-feeding support and counseling as well as bone density screenings. For children, preventive services include newborn screenings for hearing or sickle cell, and teen screenings for depression or alcohol, tobacco and drug use assessments .

In addition, most companies are increasing their spending on wellness as part of their benefits package in 2023.

Glenn Baker, vice president of sales at UnitedHealthcare of Florida, said his plans allow employees to earn money to cover health-care expenses by meeting fitness goals.

"We have a relationship with Peloton and Apple fitness," Baker said. "We offer gym discounts, and trackers allow you to earn dollars to cover expenses by hitting walking goals."

More life-saving medications covered, fewer COVID costs may be covered

Some insurers are changing which medications they cover and at what amount -- a shift that could allow people with chronic conditions to save money.

For example, UnitedHealthcare's Baker says some of its group plans for 2023 will cover life-saving medications at 100% without a co-pay, including Epinephrine (EpiPens), insulin, Narcan and Albuterol. These medications are used to treat emergencies such as severe allergic reactions, hypoglycemia, opioid overdoses and acute asthma attacks.

"That's a very substantive change," Baker said.

However, consumers could soon find themselves on the hook for COVID costs in 2023.

The U.S. government will soon stop paying for vaccines, monoclonal antibodies and drugs like Paxlovid as funding runs out. Many Americans will soon have to pay some or all of the costs, according to the U.S. Health and Human Services. In Florida, most of the government-funded COVID testing sites already are gone.

You will want to find out how much a specific plan covers those costs as the virus continues to circulate. Expensive treatments such as monoclonal antibodies are less likely to be covered.

More mental health coverage, more virtual care

Florida, like most of the country, has experienced a huge increase in demand for mental health services. Employers will continue to expand mental health coverage in 2023.

Twenty-seven percent of large employers report that they are adding mental health-care providers to their plan's network, either for in-person or telemedicine services, according to an annual employer survey fielded by the Kaiser Family Foundation.

Telehealth appointments are now more frequently covered by insurance than a few years ago, and that will continue in 2023.

Florida Blue says this year it is offering a virtual-focused plan called myBlue Connected Care in Broward and Palm Beach counties. Members get direct access to a Sanitas primary care team via video chat, through an app, email or text at any time day or night.

"People want that kind of coverage," Bartel said. "You can be on the phone with a local doctor in minutes."

Subsidies will continue

When you go shopping for a plan on HealthCare.gov, you may first see the "sticker price." But your actual cost could be much lower once you enter information about your income, family size and other considerations.

That's because federal subsidies to be used toward premiums are given out on a sliding scale and make some plans on the ACA marketplace as cheap as $10 a month. Those subsidies, first made available in 2021 under the American Rescue Plan, will continue in 2023.

Greater tax-free savings for medical expenses

The amount you may contribute tax-free to a Health Savings Account (HSA) is about 5.5% higher in 2023. HSAs are used with high-deductible health plans and roll over to the next year if the money isn't spent.

An individual may contribute $3,850, which is $200 more than in 2022, and a family may contribute $7,750, up from $450.

"That's a significant increase," said Norris at HealthInsurance.org. "It's more of an increase than we typically see."

You may also contribute more tax-free to a Flexible Spending Account (FSA), which helps pay for qualified out-of-pocket expenses when you have a traditional plan.

The health FSA contribution limit is $3,050 for 2023, up from the previous year's amount of $2,850.

Sun Sentinel health reporter Cindy Goodman can be reached at [email protected].

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