The Most Massive Insurance Changes Since Obamacare Became Law

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If you like your plan you can keep it.  If you like your doctors, you can keep them.  Well, not necessarily. The largest individual insurer in Illinois is making major changes to individual Obamacare (ACA) Plans. Their PPO plan is being discontinued.  Their network doctors are changing.  Out of network coverage will have no maximum out of (your) pocket.  Why all of these changes?  Loses due to ACA structure has caused sizable loses – millions of dollars to this company alone.

So, it is extremely important to review your insurance plans.  Look at the benefits, drug coverage and the provider network. Confirm that your doctors and pharmacy are in your plan’s network.  Also confirm the drugs you take are covered.

If you want to look at your alternatives, you should contact your agent. This writer thinks it is more important than ever to seek professional help when considering your insurance options. There are local agents that are certified in ACA Plans.  You can locate a local agent at:  http://www.nahu.org/consumer/findagent2.cfm.

The ACA Open Enrollment Period” (OEP) starts 11/1 and goes through 1/31/2016.  This is the yearly time period when you can change plans

Medicare AEP  To cloud this time period; Medicare has its Annual Enrollment Period (AEP) from October 15 to December 7th.  The AEP is when people who have individual Medicare Plans (and some group Medicare Plans) can change their plans. This includes Medicare Advantage Plans (often called Medicare Replacement Plans), and Medicare Prescription Plans, also known as Part D Plans.

Again, it is highly recommended that you secure professional advice from a local Medicare Certified Agent while reviewing plans and considering changes.  Why is it good to secure professional help?  What could go wrong?  You should confirm your providers are in-network and your drugs are covered.  You can design these plans to be more or less benefit rich according to your situation.  In addition if you winter out of state such as Arizona, how would you be covered?.

A couple of questions being asked:  QUESTION:  I received notice that my Medicare Advantage (MAPD)is being cancelled.  What options do I have?  You actually have many options.  The cancelation creates a guaranteed enrollment special election period (SEP). You can move to a MADP in the same or different company or a Medicare Supplement with a MedicareRX plan.  You have limited time to act and should not delay in talking with a broker.

QUESTION: My family has an ACA Plan. We had our first child last year and my wife is now a stay at home mom.  Do I need to make any changes in my Obamacare Plan?  Yes, not necessarily changes, but if you bought through the exchange, you need to inform the exchange of the income and family number changes.  Depending upon your income and family size, your premiums could drop.  You may get cost sharing (or reduction in your out of pocket costs) or even have your child put on Medicaid.  Seek the help of an ACA licensed insurance professional.

There are ACA certified, and Medicare Plan certified licensed insurance brokers in your community that can help you.  They are trained in the ACA and/or in Medicare products, have experience with health insurance and look at the bigger picture of how your plan can work for you, personally.  Brokers can also shop different insurance companies for you. Be sure to get professional advice and review the benefits, limitations and exclusions carefully.  In addition, you do not pay any extra money for this added service.

PROUD ANNOUNCEMENT – We would like to announce that Skip Meister, RHU; a veteran in the insurance industry since 1988, has joined MRMS.  If you know Skip, feel free to call him at our office.

Written by

Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors, including seminars and consultation on Medicare Plans, Long Term Care and other types of insurance, claims issues, and sales/service of insurance products since 1984.

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