Watch for Health Plan Changes

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Have you noticed there seems to be a number of changes this year with health insurance? Whether you are on Medicare or have health plans through an Obamacare Affordable Care Act plan (ACA) or group insurance, it seems deductibles are up, out of pockets are up as are premiums for many.
Now: what’s important; for people under age 65, you may have been insured by one of several major insurance companies who pulled out of the marketplace. If you had United Healthcare (UHC) or Coventry, you may been migrated to another company plan by the government Marketplace. This migration only took into account our type of plan and not the network that you use. So, if you have a Silver plan with UHC you may have been sent to a Blue Cross Silver Plan for 2017. Most importantly, this new plan may not include your doctors. This could even cause treatment you receive to not be covered. This procedure also may assign you to a primary care physician that you have never seen or even heard of. It is prudent to seek professional assistance and find a plan meeting your needs. This whole issue will probably be a big news story within three months.
What’s important if you are on Medicare. As written in the past several articles, Medicare Advantage and Drug Plan benefits, doctors, and covered drugs can change every year. What’s more, a person’s health could change. You should review these plans when you receive your Annual Notice of Change every September.
Let’s talk about a health change and an option: John has been healthy. However, now at age 68, he has found that he will need major surgery and rehab in the first few months of 2017. He enrolled in a Medicare Advantage Plan (MAPD) when he was 65 and it has served him well by keeping his premiums low, providing predictable co-pays and out of pocket limit for covered expenses. With the pending surgery he is now looking for the best options to cover these medical expenses.
If John were to stay the course with his current plan, he would pay about $350.00 co-pay a day for his hospital stay, about 20% co-pays for the surgery and a co-pay for each rehab session. It is prudent for John to review his current coverage and calculate an estimate of out of pocket expense. The MAPD plans have a maximum out of pocket amount that John would pay for 2017, but it is $5,500.00. While John may not reach the out of pocket maximum, he can essentially add the money spent on co-pays to his premiums to come up with his total out of pocket medical costs.
John has an option is to move back to Original Medicare and buy a Medicare Supplement and Part D Plan for drugs. Most Medicare Supplement plans, but not all, require underwriting. The Plan F Medicare supplement pays all of Medicare‘s co-pays, so John would have little to no out of pocket cost for Medicare coverable expenses. In his case, he would pay about $190 more a month in premiums. Therefore, if his projected out of pocket costs with the MAPD Plan are far greater than $2,000 in 2017, the Medicare Supplement may be a good option for John. So, what is the rule:
A person can only leave a Medicare Advantage and return to Original Medicare plan during the Medicare Advantage Disenrollment Period (MADP). Except for other special circumstances, a person cannot join or switch MA plans during this time. The MADP is from January 1- February 14 each year.
If you want to disenroll from an MA-only or an MAPD (includes prescriptions) and return to Original Medicare during this time, you have a special election period (SEP) to join a Part D prescription plan. Your enrollment into your new Plans are effective the first of the following month. In John’s case, it is advisable to seek professional help if he wishes to compare his outcomes or consider making this change.
I would like to wish all a Happy and Healthy New Year. As always, feel free to contact our office if you have questions at 309-693-1060.

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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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