Alecia Batson (she/her)The least desired season of the year has arrived, again, in the United States: so-called “open enrollment” (a.k.a. “annual enrollment”). For those unfamiliar, it’s a period of approximately 53 days during which people are permitted to make changes, if desired, to their health insurance benefit by selecting a different plan and/or provider. 🧵
Employers typically offer a handful of plans to full-time employees through one or more providers and may shoulder a portion or majority of the monthly premium cost.
But those who are a freelance #actor and #performer (like me!), often acquire insurance directly from a provider or through a state-maintained exchange. I have never yet qualified for insurance through my #union-covered work with SAG-AFTRA, but hope to one day.🤞🏻
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The health insurance plan I’ve held for 2025 will still exist in 2026 (😅 sometimes plans are closed) but the premium price has increased 36%, coming to within a few dollars of my monthly housing cost.
(n.b., In the U.S., the premium paid only opens the door. There are other out-of-pocket costs such as copayments; deductibles; in-network fees, out-of-network fees, facility fees, lab and test fees, and more which must be met before insurance coverage begins) 🧵
Now, I must decide:
Do I keep the current plan, though I cannot afford it?
Do I “shop” through the literally hundreds of plans available by contacting every provider individually and manually creating a massive, sortable, filterable table?
Do I go without (which can result in bankruptingly-high costs to sick individuals)?
If this is a topic of interest, like this thread and I’ll keep it updated throughout the stomach-churning experience.
Answers to common questions.
Q: Are less expensive plans available?
A. Yes, less expensive plans are available for 2026. None of them are accepted by my physicians or their practices at this time.* To use such plans, I would leave my current physicians of 15+ years, identify new physicians who are accepting patients, apply to those practices, and wait to see if I am accepted.
*Physicians and medical practices in the U.S. are free to choose which insurances they do and do not accept. 🧵
Q: Are subsidies available to offset the high costs of health insurance premiums?
A: For 2025, income-based premium subsidies are available through the federal Affordable Care Act (ACA). However, the U.S. government is currently shutdown due to an impasse over food subsidies and health insurance subsidies. As it stands, health insurance subsidies will cease at the end of 2025. 🧵
Q: Researching and potentially changing insurances, selecting new physicians — these seem time consuming. Are they?
A: Yes, millions of people in the U.S. will spend quite a bit of time reviewing available plans and researching which plans are accepted by their current physicians. Annually, on average, I spend 20-30 hours on this research in order to identify plans that:
• meet my medical requirements
• are accepted by my physicians
• are affordable according to my budget
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Q: Are there people who can help refine the options available?
A: Yes, there are “brokers” or “enrollment assisters”. Some health insurance companies have employees to help facilitate direct-to-consumer sales. Some state exchanges/marketplaces offer phone- and web-based individuals to support the selection and enrollment processes. There are third parties who primarily help businesses negotiate with providers to acquire products at the right price. Some of these services will have a cost. 🧵
Ironically, I’m breaking out in a stress-related rash because of the angst health insurance open enrollment brings me — and today is only the first day of the period. 😑
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Q: But citizens have a right to good health, don’t they?
A: It’s important to remember that while there are countries which enshrine good health and access to health care as rights guaranteed by their constitutions, the U.S. Constitution does not endorse these as rights. In the U.S., access to health care and good health are luxuries available to those who can afford them. 🧵
Q: Does plan choice truly have so great an impact?
A: Indeed, it can. Plan selection influences those physicians to which one has access, prices of medications, accessibility to medications, the costs of ambulance and emergency visits, and coverage area. Some plans, while less expensive, may not include certain medications in their formularies, and may only provide coverage limited to the state in which one lives. One could rack up quite the bill if taken ill outside the coverage area. 🧵
Day 3 of #healthinsurance #openenrollment szn. Today I’ve spent two hours researching/contacting the 15 listed #health insurance entities my current medical practice accepts.
• four do not offer coverage in this state
• two only offer supplemental coverage for specific medical conditions
• five are “middlemen”, offering some form of health plan design/administration/networking
• two are owned by a single, larger parent organization
• three offer individual plans only through marketplaces
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Premium quotes from #healthinsurance providers I connected with are eyewateringly high.
• one company quoted products I didn’t request; range from USD$850 to USD$878
• one provider lists quotes ranging USD$511 to USD$870
• another’s range USD$796 to USD$911
• yet another provider’s span USD$702 to USD$1011
These prices are for one (1) person per month. Each plan requires a deductible* of thousands of dollars which must be met before coverage begins. 🧵
*premiums don’t count toward deductibles
To be clear: the #healthinsurance quotes requested were already limited by certain factors. Had my inquiry been broadly vague — such as, “coverage for one individual” — quotes for anywhere from 20 to 50 “products” would have been received.
For each of the groups of quotes received, based on the limitations, there were anywhere from two to eleven “products” listed, each with different premiums. 🧵
Day 4 of #healthinsurance #openenrollment.
I emailed the company that provided quotes for products which do not fulfill my requirements. An email response was received that required the creation of an account to access their secure messaging platform. The contents of the reply housed therein?
“Please contact our Sales Department at 800-XXX-YYYY for additional quote requests. Thanks so much.”
Evidently a consumer-oriented, low-friction, product selection environment is not their focus. 😑
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Day 5 of #healthinsurance #openenrollment.
As a member of SAG-AFTRA, the #union that represents approx. 160,000 media professionals, I was interested to see this news item indicating it has filed a formal complaint against an insurer which applied a 40.5% increase to its premium. While this action doesn’t impact me, I’m glad the union is engaged in protecting #news anchors and #reporters • https://www.sagaftra.org/sag-aftra-condemns-405-health-premium-hike-harvard-pilgrim-7news-employees
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I contacted my current #healthinsurance provider to verify that the notice received, which indicates a 36% increase in plan premium cost for CY2026, is correct. According to their sales department, it is, even though:
• the plan has not changed
• the coverage has not changed
• the model has not changed
• services have not changed
Apparently, everyone included in this plan received such an increase — an increase which was set through a filing with the state. 🧵
I contacted the state to learn if there might be a state law, statute, code, or regulatory body which establishes limits or ceilings for #healthinsurance premium increases year-over-year — limits which cannot be exceeded.
Apparently there is no such regulation. Health insurance companies are free to decide for themselves what premium increases should be each year.
It was suggested I contact the insurance company to find out if I could negotiate a less expensive premium for the same plan. 🧵
Day 6 of #healthinsurance #openenrollment.
Today I communicated with my physician to learn what would happen if I
• select a less-expensive insurance plan the practice does not accept
• go without #health insurance altogether
In both cases, I *should* be able to continue to visit the practice but would pay for all appointments, services, and laboratory tests as a “direct pay patient”. To gather more data and evaluate costs and pricing, the business office phone number was provided. 🧵
Day 7 of #healthinsurance #openenrollment.
I contacted the billing department within in the business office at the medical practice I’ve attended for 15 years to understand what a complete year’s worth of medical services could cost if paid directly by a patient. Fascinating details were learned:
• there is no available list of prices for services; no such list exists
• cost estimates for services can be provided if the “billing code” for each service is known
But wait, there’s more… 🧵
(Day 7, continued)
• most medical services have “price tiers”, ranked 1 to 5 (or higher?), which are determined by the level of required activities prior to, during, and after any medical visit; these data determine the exact “billing code”
• cost estimates, therefore, are always ranges and not precise prices
• the billing department cannot provide an estimate without a “billing code”
How does a patient find out what billing codes are?
Start by looking at past bills received.
Still more… 🧵
(Day 7, continued)
• price ranges do not vary patient to patient, but individuals can only acquire estimates for themselves; they cannot request estimates for other patients unless they are a parent or guardian
• “no one has ever” requested an estimate for an entire year of baseline services, according to the person with whom I spoke
Learnings continue… 🧵
(Day 7 and *fin*)
• estimates cannot be provided by telephone or email; one can only use the HIPAA*-authorized communication portal to contact the billing department by internal message
• all “billing codes” must be provided directly by the patient and/or must exist already within a patient record
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*HIPAA is an acronym representing Health Insurance Affordability and Accountability Act, a 1996 Act of the U.S. Congress • https://en.wikipedia.org/wiki/Health_Insurance_Portability_and_Accountability_Act
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David August ❌👑@aleciabatson that's not good. So much is so messed up.