HARTFORD, Conn. – The open enrollment period for health insurance under the Affordable Care Act begins Friday, and health care advocates are advising people to read the fine print before deciding on a new policy.

The advocacy group Consumers for Quality Care sponsored a survey that found just over half of respondents said they understand "very well" their health insurance coverage for routine doctor visits.

But according to consumer advocate Jason Resendez, a Consumers for Quality Care board member, only 22% said they understood what is covered for out-of-network hospital services or in the event of an accident.

"It's really important for consumers to understand what exactly their plan covers, and really thinking about how to avoid things like surprise medical bills," he stresses.

The open enrollment period for health insurance under the Affordable Care Act ends on Dec. 15.

Resendez particularly advises to watch out for "short-term, limited-duration" insurance plans. He notes these low-cost plans are exempt from many of the coverage requirements of the Affordable Care Act and may leave people with huge medical bills.

"These are plans that often exclude coverage for pre-existing conditions,” he points out. “They're not required to cover preventative services, and have a host of other substantial risks for consumers. So, these are really 'junk plans.'"

Massachusetts, New York and New Jersey have banned the sale of short-term, limited-duration plans.

Even for people with experience in this field, health insurance plans can be hard to understand and are often confusing.

Resendez says the best thing to do when shopping for a new plan is to be your own consumer advocate.

"Get as much information as you can when you're making these decisions,” he advises, “not being afraid to call your insurer and ask questions and then, making the best decision for you and your family."


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Not everybody gets a holiday break, especially caregivers, but advocates of paid family medical leave in Maine say momentum is building for a plan to pass in the upcoming legislative session.

With Democrats in charge at the Statehouse and a ballot initiative which has already gained nearly 70,000 signatures, Mainers could get up to 16 weeks of paid medical leave a year.

Bridget Quinn, associate state director of advocacy and outreach for AARP Maine, said the pandemic exposed the difficulties many Americans face when a medical emergency strikes.

"Caring for a loved one shouldn't mean losing pay and risking your financial security, or even your job," Quinn asserted. "You should be able to do both and care for a loved one, while being able to remain in the workforce."

Maine has the oldest overall population of any state in the U.S. Quinn said by supporting caregivers, more Mainers can age in place and reduce reliance on taxpayer-funded long-term care facilities.

Studies show working women continue to do the majority of caretaking, whether for a new baby, a sick child or elderly parents, providing 20 hours of unpaid care a week, on average. Three-quarters of working mothers with low incomes report losing pay when they miss work to care for family.

Quinn pointed out the lack of a statewide paid leave plan can create greater financial hardships for women down the road, or cause them to simply leave the workforce.

"That can be time that you're not contributing to programs like Social Security, or benefiting from a retirement savings plan that maybe your employer could have," Quinn noted.

If approved, Maine would join 11 states and the District of Columbia offering paid family and medical leave, funded through a combination of employer and employee payroll taxes.

Maine lawmakers approved a bill last year creating a commission to study the issue, which is expected to release its recommendations next month.

Oregon nurses are urging state lawmakers to make hospitals better and safer places to work.

With the 2023 legislative session just around the corner, the Oregon Nurses Association is calling for changes to ensure minimum staffing standards based on patient numbers and accountability for hospitals so there are enough nurses on the floor.

Matt Calzia, director of nursing practice and professional development for the Oregon Nurses Association, said the lack of staffing has real implications for patients. For instance, if a nurse goes on break for lunch, another nurse assumes care of their patients, doubling the other nurse's workload during that time.

"So when you've just had knee surgery and if that period of time falls when you need your next pain medication dose, it may be delayed because right now your nurse actually has eight patients instead of four," Calzia explained.

Calzia pointed out turnover is higher now than during the Delta wave of the pandemic because nurses are burned out. According to the union, turnover was 2% in 2021.

Sean Kolmer, senior vice president of policy and strategy for the Oregon Association of Hospitals and Health Systems, countered under the union's proposal, "community hospitals will have no choice but to reduce access to services if they are unable to hire enough staff" and argued there is a staffing shortage in the state.

Paige Spence, director of government relations for the Oregon Nurses Association, said along with minimum safe staffing requirements, the union proposal would ensure Oregon's current staffing law is enforceable and provide accountability when nurses make complaints. In addition, Spence emphasized an annual review of the staffing plan would include the number of missed meal and rest breaks over the past year.

"To ensure that the staffing levels going forward are robust enough to accommodate nurses' abilities to take the rest break which they need for sanity and physical well-being, and also are entitled to by law," Spence stated.

Calzia refuted claims the state has a shortage of nurses.

"It's not a pipeline issue; it's a turnover issue," Calzia stressed. "You have more nurses leaving the bedside than you can get in, and then you're just burning through them."

Open enrollment for health insurance through the Affordable Care Act is already underway, and ends on Jan. 15.

More than 1.3 million Georgians do not have health coverage according to the Kaiser Family Foundation.

Richard Gordon, an independent insurance broker, said it is time to do some research, and find out what your options are. His is one of many small businesses offering community outreach events to help people to sign up for coverage online.

Gordon explained some health plans are more affordable, as Congress extended subsidies to bring down monthly premiums.

"We try to explain what the Affordable Care Act is, how you can qualify for tax-credit subsidies to help pay for insurance, as well as provide some instant quotes for people," Gordon outlined. "They can actually see how affordable it can be, based on their family size, their income, and the ZIP code that they live in."

The Inflation Reduction Act passed by Congress extended the premium subsidies through 2025.

Gordon noted all health care plans are considered "major medical" plans, which means they cover hospitalization, doctor's visits, lab work, imaging, and preventive services. He added some insurers this year have "zero-premium" plans, which means the government subsidy covers the total monthly cost.

"A lot of the plans have low co-payments for the primary care doctor visit and a specialist doctor visit," Gordon pointed out. "We explain to people that their preventative services are provided at no cost to them. So that will be their annual physical, mammograms, colonoscopy, cervical cancer screenings."

He emphasized screenings for diabetes and outpatient surgeries are also covered, but only a few health plans offer dental and vision coverage, so people often buy those as stand-alone policies. He recommended doing some homework now, as the enrollment deadline is seven weeks away.