Dr. Larry Antonucci, M.D., MBA
Open enrollment is the yearly period during which people can enroll in, renew or change their health insurance coverage for the upcoming year.
There are several ways to enroll for health insurance in the coming months:
Open Enrollment for health insurance on the Affordable Care Act Marketplace Exchange is now open and continues through Jan. 15.
Many employers who offer insurance to their employees also have open enrollment to select health insurance for the coming year, usually between October and December.
Medicare Open Enrollment is from Oct. 15 to Dec. 7.
Healthcare.gov (the ACA Marketplace) has promised improved user experience, simplified plan choices and potential state variations 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 simple the enrollment process is, it can still be confusing. Questions regarding what’s covered, what’s not covered, in-network, out-of-network, deductible, copays and much more are an annual refrain nationwide.
As a result of varying levels of coverage and annual changes typical for health insurance, everyone, whether signing up in the Marketplace or not, should take the initiative to ensure their plans provide the expected coverage.
Many people are unaware that some plans don’t cover primary, preventive and hospital care at Lee Health. In fact, several Marketplace plans currently exclude Lee Health as a participating provider. Without full coverage for the medical care provided by trusted doctors across our entire network of services, your healthcare costs could increase significantly.
For example, a few of the plans on Healthcare.gov will cover your visits to your Lee Health primary care physician with in-network and less expensive coverage, but coverage at Lee Health hospitals may be out of network, and more expensive for you, on the same plan.
In emergencies, Lee Health’s emergency departments are open to everyone, regardless of insurance coverage. Federal law mandates emergency departments to provide care without considering a patient’s ability to pay or insurance status. However, that doesn’t mean your visit is free. If your insurance plan does not include Lee Health, you could be responsible for the cost of care.
Here are some reasons to make sure you review your health insurance plans:
If you already have Marketplace coverage, you’ll automatically be re-enrolled in the same plan for the next year if you do not make changes. It is worth checking to see if your current plan’s coverages or participating providers have changed. That way, you can select another plan if needed.
Commercial health insurance plans, like employer options, may also offer varying levels of coverage at Lee Health.
Not all healthcare practitioners who provide services in Lee Health’s hospitals participate in the same health insurers or health maintenance organizations (HMOs) that Lee Health does.
Medicare plans are also facing changes. Cigna Medicare Advantage Plan is discontinuing its individual PPO Medicare Advantage Plan in Florida in 2025. Florida Blue Medicare Advantage in 2025 does not include Lee Physician Group primary care providers as preferred, while still including Lee Health hospitals and specialists. Patients who continue to see Lee Physician Group primary care doctors on this plan may incur additional costs in 2025.
For individuals uncertain about their coverage by insurance plans or HMOs, we recommend contacting both your insurance provider and Lee Health’s billing department to confirm Lee Health is a network or preferred provider on any plan. This proactive step ensures clarity for details such as copayments, deductibles and any additional costs. Understanding the financial aspect of your healthcare journey is crucial to avoiding unexpected bills.
Selecting the right health insurance to cover your medical care requires a thorough understanding of your insurance plan, network status and available financial assistance options. Proactively addressing these considerations during open enrollment ensures you can access the services you need while minimizing financial strain. As the healthcare landscape evolves, staying informed and engaged in your health decisions remains paramount for a healthier future.
To check if you are covered on the Marketplace with Lee Health, visit LeeHealth.org.
Dr. Larry Antonucci, M.D., MBA, is the president and chief executive officer for Lee Health.
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