Health Insurance & Medicare Bits and Pieces

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Medicare open enrollment started 10/15 and continues to 12/7.  Obamacare (ACA) open enrollment starts on 11/1 until 1/31/2017.  So, both older and young people will be seeking information during the same time frame.

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:  I am on Medicare and have a Medicare Supplement and RX Plan.  Do I need to do anything?  No, most people will stay with the coverage they already have.  However, it is prudent to review the Annual Notice of Change (ANOC) from the Medicare RX plan and make sure your drugs are covered, premiums are manageable, see if there are any new restrictions on your drugs, and see if your pharmacy is still in-network. People usually make changes when premiums rise substantially or their drugs or pharmacy change.

QUESTION:  I have a Medicare Advantage Plan (MA) and the premiums and out of pocket costs are raising, what can I do?   MA and MA with prescriptions (MAPD) plans should be reviewed yearly as above.  In some cases your company may have another plan that may better meet your needs; in other cases look at a competing company.

QUESTION:  I have a Medicare Supplement and my premiums are very expensive.  I am in my 90s, do not have many expenses now and do not think I would be aggressive with future medical care, what can I do?  In cases like this, you may wish to look at a MAPD which includes your network of doctors.  It will lower your premiums, but you will have co-pays,

QUESTION: I am under age 65 and have an ACA plan (Obamacare).  Do I need to do anything for 2017?  Maybe, if you have Coventry or United Healthcare ACA exchange plan your plan is being discontinued. You should look at alternative coverage.  If you have a plan which is being continued, it would be prudent to review your plan’s benefits, be sure your providers are in network and see if the premiums have changed substantially. Most importantly, if you income has changed at all, you should seek professional help to make those changes in Healthcare.gov and see if this information alters your premiums.  In some case people will either lose tax credits (subsidies) due to more income; but they may also lose them due to less income.  Seek the help of an ACA licensed insurance professional.

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 these 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 is a common theme in all of these answers.  Many mistakes have been made with both Medicare Plans and ACA plans.  These mistakes can be very costly now and in the future.  In addition, they may result in a person not being able to see the network provider they wish to see.  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.

Also, you can use as resources: ACA Plans at www.healthcare.gov and Medicare at www.medicare.gov and/or our website at www.MRMS-INC.com for various issues including information on Medicare and Medicare Plans.  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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