This Fall People Under and Over Age 65 May Make Changes in Health Plans 

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New Medicare Changes and Benefits

This fall season will be an active time period for most people who do not have employer sponsored group insurance.  People who buy Medicare Plans, including Medicare Advantage Plans (MA), Medicare Drug Plans and Medicare Supplements have an annual enrollment period (AEP) to make changes.  Some people may move from an MA to a 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 2016 is 10/15 – 12/7/2015.

People on Obamacare (ACA) have a slightly different open enrollment period (OEP); from 11/1/2015 to 1/31/2016.  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 healthcare.gov.

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 Medicare 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.  Certified ACA insurance agents can help you understand your options and this help is at no cost to you.

Columns in the next months will focus in more details on Medicare Plans in October and ACA plans during their AEP and OEP.

Also, you can use as resources: Medicare at www.medicare.gov; ACA at www.healthcare.gov, and our website at www.MRMS-INC.com for general, educational information on Medicare, Medicare Plans and ACA.   As always, feel free to contact our office if you have questions at 309-693-1060.

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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