Do You Want or Need to Make A Change in Your Health Plan?

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This fall season will be an active time period for most people under age 65 who do not have employer sponsored group insurance and people with Medicare Plans. These annual enrollment periods are usually the only time people 65+ can change their Medicare Advantage Plan or under age 65 change their Obamacare ACA Plan.

Medicare: People who buy Medicare Plans, including Medicare Advantage Plans (MA), Medicare Drug Plans (Part D) have an annual enrollment period (AEP) to make changes. Some people may move from an MA to a Medicare Supplement; from a supplement to an MA, others from one MA to another MA and still others will change their Medicare Drug coverage. The AEP time period for people on Medicare to change coverage for year 2018 is 10/15 – 12/7/2017. Note: People with Medicare Supplements may change from one supplement to another anytime during the year.

For those on Medicare and with a limited annual income and resources may qualify for assistance called “LIS” or limited income subsidy. The 2017 limits are: Income under $18,090 for a single – $24,360 per couple; and Resources under $13,820 for a single and $27,600 for a couple.

Obamacare – ACA: People on Obamacare (ACA) have a slightly different open enrollment period (OEP); from 11/1/2017 to 12/15/2017. Some people are able to change coverage during other times of the year due to “special election periods” (SEPs). SEPs are usually for life changing events such as involuntary loss of insurance, a marriage or birth of a child. For other SEPs, contact an ACA agent or go to

Whether you are researching a plan for people under age 65 through ACA (also called Obamacare), or a Medicare Plan you should consider the following:

First, ask if the Plan has a network. If so, confirm that the providers and/or pharmacy you wish to use are in the network.
If there is a network: is there coverage for covered expenses incurred outside of the network? How are they covered?
Look at any deductibles, co-pays and out of pocket maximums.
Consider the value of the insurance plan, not only the price. Will you have an agent? Is that agent accessible ( here locally)?
Confirm the drugs you take are covered by the plan. Ask if the plan has any drug restrictions such as prior authorization, step therapy or quantity limits.
Where can you secure medical care or prescriptions if you are traveling and had an emergency or non-emergency medical or prescription expense?

For those under age 65: gather information as to whether or not you may be eligible for a “subsidy” (also called tax credits toward premiums) and “cost sharing” (reduced deductible and out of pocket costs). ACA premiums and sometimes coverage can be based on one’s family unit income. Also, people who choose not to buy qualified coverage may well have a penalty. If this is your case, learn how the penalty works.

Some people spend more time researching a purchase of a car than they spend researching what will be their access to healthcare. Your health and ability to seek care from the providers you wish has great value. Spend time and see professional help. Agents specializing in Medicare Plans and Certified ACA insurance agents can help you understand your options and this help is at no cost to you.

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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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