Thoughts for the New Year

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Time to Think About Your Insurance Coverage?

The New Year brings reflection of the prior year and the setting of goals for the New Year ahead. This has been a very active and trying year for the economy, Medicare and the insurance industry. It seems that most everyone has been affected. Now, to look ahead:

First and foremost, now is a good time to review all of your insurance coverage. Why? If, while driving, you slide into a car or school bus – are you adequately covered? If you have a fire or storm damage, how is your home covered? If a family breadwinner should become sick or hurt and unable to work, will you have money to pay bills: worse yet, if he/she would die as a result of that sickness or accident? If you would need rehabilitation at a long term care facility – would you have the coverage to be able to get care from the finest facility in your area?

Many people ask about Medicare coverage. Without writing about Medicare reimbursement levels or fee schedules, Medicare is making some visible changes for 2011. The times allowed to join a Medicare Advantage Plan are now limited to the “annual enrollment period” (AEP) or “special enrollment periods” (SEP). The “open enrollment period” (OEP) from 1/1 – 3/31 each year has been discontinued.

Also note: the AEP dates have changed from 11/15 -12/31 to 10/15 – 12/7 in 2011. Moving the AEP dates forward will make it easier for people during the Christmas and Holiday Season. Replacing the OEP is now an “Annual disenrollment period” (ADP). During the ADP, from 1/1 – 2/14 a person can dis-enroll from a Medicare Advantage Plan. They would then have original Medicare and should, most likely, buy a Medicare Supplement and a Medicare Part D prescription drug plan. Note: people can change from one Medicare Supplement to another at any time of the year.

Health insurance for people under 65 will also have changes connected with Health Care Reform. The “Patient Protection and Affordability Care Act” (PAACA) mandates that health insurance carriers standardize documents and definitions; and abide to a medical loss ratio or 85% for large business group plans and 80% for small groups and individual plans. In simplistic terms this means that a health insurance company must spend at least 80% or 85% on claims.

This follows the mandates from 2010 which required all insurance companies to insure dependents up to age 26 without pre-existing exclusions. Lifetime limits have been eliminated, and preventative services have been added. Most people and businesses saw substantial premium increases in 2010.

All of this is complicated and confusing. You know this well if you dealt with Medicare Plans at the end of 2010 or with under age 65 medical plans this past year. Your biggest allies dealing with these issues can be your insurance agents. First choose professionals who specialize in the subjects of your interest. Qualified life insurance agents know the ins and outs of life insurance. Auto insurance agents can know the finer details of auto coverage. However, in many cases these agents do not know the finer details of Medicare. Even if they do, they may not have a variety of companies and plans available.

This new year it is recommended that you review all insurance plans. You would want to know that you have or do not have coverage for situations that may arise. Even if you learn that you would not have coverage for a certain situation, you can either secure coverage or make a decision not to have coverage. At least you would know. Your greatest asset is your insurance agents. Call them. If you do not have an agent, review your coverage with a consultant or find a qualified agent. In many cases, your agent can find ways to restructure coverage to meet your needs and not increase premiums.

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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