MEDICARE OPEN ENROLLMENT PERIOD: OCT. 15 – DEC 7TH.
Each year you have the option to change your Medicare Advantage (MA) plan or stand alone Prescription Drug Plan (PDP) during the Annual Election Period of Oct. 15th to Dec 7th with the new plan taking effect on Jan 1st. If you are happy with your current plan, you don’t have to do anything; it will roll over to 2016 (Unless you receive a notification from your insurance company that they are discontinuing your plan.) Your Medicare insurance provider is required to send you the Annual Notice of Change by Sept 30th. This document will itemize the changes (if any) in your plan in 2016. If you are unsure how to compare this document to your current plan, please let me know. I will be happy to assist you. For the most part the 2016 plan designs that I’ve seen have only minor changes from this year.
WHEN CAN I ENROLL IN A MEDICARE SUPPLEMENT PLAN?
You can enroll in a Medicare Supplement plan any time of the year. However, if you are leaving an MA plan you have three times in which you can do this:
- During the Annual Election Period of Oct 15 – Dec 7.
- During the Annual Disenrollment Period of Jan 1 – Feb 15, which allows you to disenroll from your MA plan and go back to original Medicare. Then you can add a Medicare Supplement plan and a PDP.
- If you’ve had your MA plan for less than one year and this is the first time you had an MA plan, you have a Special Election Period to allow you to drop your MA plan and add a Medicare Supplement plan onto Original Medicare.
If you wish to change from a Medicare Advantage plan to a Medicare Supplement plan and are unsure of your ability to make that change, please contact me
UNDER 65 HEALTH INSURANCE PLANS: WHAT DO I NEED TO KNOW?
Open enrollment for all individual health insurance plans under 65 years of age is from Nov 1st to Jan 31st. The earliest effective start date of the new plan is Jan 1st. (You will have to enroll by Dec 15th to get a Jan 1 effective start date.) Unless you qualify for a special election period (SEP) this is the only time you can make a change to your policy. If you are happy with your current plan, you don’t have to do anything; your plan will continue in 2016. (Unless you received a notice that your plan will not renew in 2016.)
WHAT IF I HAVE A SUBSIDY TO HELP PAY FOR MY HEALTH INSURANCE?
If you have a subsidy to help pay for your health insurance, the Marketplace software system is supposed to be able to automatically adjust your subsidy to account for the increase in 2016 health insurance premiums. In 2015, the Marketplace was unable to perform this service, so it was necessary to reapply for your subsidy or you paid the entire rate increase. However, there are instances in which you may have to reapply for a subsidy if: (a) You did not file your 2014 Federal income tax by August 31st or (b) If you owe the Marketplace documentation on income or immigration status.
I HAD A SUBSIDY, BUT IT DISAPPEARED AND NOW I’M PAYING THE FULL PRICE OF MY POLICY. WHAT HAPPENED?
The Marketplace asked you to submit information that either they did not receive, or you sent it and it was misplaced by them. Look at pages 2 and 3 of your subsidy determination letter, under the section “What should I do next?” It may ask you to submit proof of income, or of citizenship, or proof of legal immigration. I’ve even seen clients being asked to prove they were not incarcerated! If the Marketplace did not receive this information by the deadline specified, then they stopped providing the advanced tax credit to assist in the cost of your health insurance. You can still get your subsidy back. Call my office and we will step you through the procedure.
WILL I HAVE TO DO ANYTHING ELSE TO KEEP MY SUBSIDY FOR 2016?
Yes, in order to keep your subsidy for 2016 it is absolutely required that you must submit your 2014 Federal income tax form. Perhaps your accountant told you that you don’t make enough to be required to file taxes. That may be the case, but if you want the advanced tax credit to subsidize your health insurance premium, it is absolutely required. Part of your application states that you will file your Federal taxes. If you are married you must file jointly, even if you have been separated for an extended period of time. As long as your marital status is “married” you must file a joint Federal tax form in order to keep your subsidy.
WILL HEALTH INSURANCE PREMIUMS GO UP IN COST NEXT YEAR? IF SO, WHY?
Expect health insurance premiums to rise by 12 – 18% next year. This isn’t because the insurance companies are making an exorbitant profit; their profits are strictly controlled by the Patient Protection and Affordable Care Act of 2010. The reason for the rate increase is due to medical inflation. The greatest causes of medical inflation are hospitals (including their emergency rooms) and pharmaceuticals. Until Washington does something to curb the causes of medical inflation you can expect similar increases in the next few years.
I HAD MY POLICY WITH ASSURANT THIS YEAR. WHY ARE THEY NOT RENEWING MY POLICY?
Assurant emerged onto the Marketplace in Florida for 2015 with PPO plans that had a large network and great pricing. However, they soon discovered that they were losing a great deal of money. So much that they have announced they will not offer health insurance in 2016. They are trying to sell their health insurance division to recover some of their losses, but don’t expect any established insurer to take on this business. If you have an Assurant policy this year, they will continue to provide service until Dec. 31st. Please contact our firm as early as possible so we can help you select a plan to take effect on Jan 1st.
IS IT STILL POSSIBLE TO GET A NEW POLICY IN 2015?
If you qualify for a special election period, you can still either make a change or obtain health insurance. We continue to write many policies each month due to people moving, having babies, getting married, losing employment and their health insurance from their employer, and other valid SEP’s. For most SEP’s you have to apply by the 15th of the month in order to have the new policy take effect the 1st of the following month. The exception is if you lose health insurance coverage, you can apply as late as the last day of the month and still have the policy take effect the 1st of the following month. If you are looking to get or change your health insurance this year, please contact my office. We will advise you as to whether you can make a change this year or if you have to wait until the open enrollment period.
WHY DO I NEED HEALTH INSURANCE?
While many of the uninsured claim they don’t need health insurance because they are very healthy, the truth is you never know when you will need to visit an emergency room or be admitted to a hospital. I have two very healthy clients who said they would go without insurance until they aged into Medicare later this year, only to change their minds after their doctor gave them a serious diagnosis. (Fortunately this was still during the open enrollment period!) Also, one major health insurance carrier stated in 2009 that 72% of their claims were due to accidents.
The real purpose of health insurance is asset protection. No one would pay hundreds of dollars a month just to see a doctor every now and then. However, most people are unaware of the vastly inflated costs of hospitals. I have been very healthy over the years, but this year my rotator cuff detached from the bone. I had an outpatient surgery to repair it. The cost of the procedure was $42,154! Fortunately with my health insurance plan I only had a small copayment.
WHY SHOULD I WORK WITH AN INSURANCE AGENT? I CAN APPLY DIRECTLY WITH THE MARKETPLACE.
You will find it much easier to work with an agent/broker than to try to select a plan yourself on Healthcare.gov. I write for all of the major health insurance companies, so I can help you determine the best plan for your needs. It doesn’t cost you a penny extra to work with a health insurance agent vs. trying to do this yourself. The Marketplace employees are not licensed health insurance agents. Therefore they cannot legally advise you or assist you in selecting a health insurance policy. I will take away many of the headaches that the website can give you. It will save you time, and you may find that I may direct you to a better plan for your needs that costs less. And if there is a problem with your policy my office can work on your behalf to resolve the problem.
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