It’s Open Enrollment Season for Medicare and Obamacare: Not Paying Attention Could Cost You Money

Category: Health Issues

Note: This is the 4th article in our series on health care insurance and Medicare for baby boomers. Earlier articles explained Medicare, what to do if you are too young or ineligible for Medicare, and how our members feel about Medicare (find links to those articles and more at bottom). Part 4 will explain why open enrollment season is so important, what you need to do about it, plus the issues you should be looking at.

November 25, 2014 — This is the open enrollment period for both Medicare and Obamacare. If you are not getting health insurance from your employer you probably need to use this period to make sure that you are getting the coverages you need at the most affordable price. Changes are everywhere, especially in the new Obamacare arena, so you need to be on top of them.

Two different enrollment periods
Which open enrollment period you need to worry about depends on whether you are talking about Medicare or the Affordable Care Act (Obamacare).
Medicare enrollment started on October 15 and runs through December 7. In other words, it’s almost over!
Affordable Care Act enrollment goes from November 15 to February 15 (half the time it was in 2014).

What is an Open Enrollment Period
An open enrollment period is the time during which you can sign up for coverage for the upcoming year if you don’t have it now. You can also change your policy and plan for the next year without penalty. In some circumstances you can change your plan outside of this period if you have a qualifying event like you have moved or had a baby.
1800Medicare
Because Medicare and Obamacare are so different we will discuss enrollment periods for each type of health insurance separately.

The Medicare enrollment period
Why does it matter?
As you probably recall Medicare has several parts to it. Part A (hospitalization and skilled nursing) is the main form of Medicare you must enroll in. You also have a choice to enroll in Part B (doctor visits and outpatient) or Part C – Medicare Advantage (more of an HMO type plan). You can also choose Part D (prescription drug plan) as an add-on. Medicare premiums for Parts A and B will be unchanged for most people in 2015.

There are any number of reasons why you should look to the open enrollment period as an opportunity to review your plan and make sure it still meets your needs, before the new billing year begins. One big one is the sheer range of options available – 29 drug plans, 18 for Medicare Advantage, and 10 for supplemental plans. Here are some of the considerations you should be looking at:

– During the open period you can decide to move from Part B to Part C (Medicare Advantage), or vice versa. This is a major decision because although Medicare Advantage plans tend to have very low premiums and copays, they also have a limited range of “in-plan” doctors and providers.
– Do you have Part D (prescription drug coverage)? If not, should you add it?
– Do you have supplemental (Medigap) insurance). These standardized plans from the private sector help cover what Parts A and B do not. There are 10 standard plan levels from A to N.

– Drugs are added and dropped by the plans. So you need to be sure the drugs you need are covered, and to what extent.
– Doctors and doctors groups go in and out of the various plans, especially Medicare Advantage
– Do you travel a lot or are you a snowbird? You need to know what will happen if you are away from your home base and require medical services – will you be in or out of network?

What to do if you are confused or overwhelmed by all these choices
Medicare has published a wonderfully helpful booklet – “Medicare and You“, which you have probably received in the mail. Or call 1 800 MEDICARE, or go to www.Medicare.gov.

Obamacare and the Open Enrollment Period
Assuming that you don’t have health care insurance from your employer or some other source, people ineligible or too young to qualify for Medicare can sign up for or change their medical insurance plans for the next year during the enrollment period. You can, however, change your plan outside of the enrollment period if you have a qualifying event like a move or the birth of a child. You can change carriers, coverages, types of plans, deductibles, etc. during this time. You probably have received a letter from your insurer which details changes in premiums, coverages, etc. If you do nothing, in most cases the plan you have now will automatically renew. Fines for not having insurance are higher this year – if you don’t have insurance you will be fined 2% of your income or $325 per adult, whichever is higher.

Although it might be a pain, it is very important that you go onto the exchanges (there are 13 state exchanges and the federal site, www.HealthCare.gov) and compare your current plan with other options available for next year. The biggest reason is that this market is so new that everything is changing, including about 25% more companies offering plans. In a few states like Maine, Montana, and New Hampshire costs will go down as more carriers enter the market. But in others, usually where fewer insurers are competing, the premiums might go up. Premiums are expected to go up about 5% nationwide. By shopping around, you can help guarantee that you get the best plan for the least amount of money. Marilyn Tavender, Administrator of the Centers for Medicare and Medicaid Services, has advised that “Consumers should shop around…(as they are) likely to get a better deal.”

These are some of the important considerations you need to look at during the open enrollment period:
– If your income changes next year the amount of your subsidy will change, but you won’t know by how much unless you enter your new information into the exchange
– If you are in need of or are considering a major procedure like a knee replacement, you need to know what your payment responsibilities will be under the plans you are considering
– Know how rates have changed for your insurer, or others you might want to consider
– Be aware of how your plans and coverages are changing
– Understand if deductibles and co-pays will change
– Drugs are added and dropped along with co-pays – how does that affect the ones you need?
– Doctors and doctors groups go in and out of the various plans (this might involve you calling the providers to find out, the exchanges don’t always have complete information on this)
– What constitutes “out of network” and what will you pay – are your doctors and hospitals in the plan your have?

To find out more visit the exchanges www.HealthCare.gov (that site will tell you if you need to visit a state exchange).

For further reading:
Now That You’re 65 – 10 Things You Need to Know (Part 1 in a series – includes how to sign up for Medicare)
Part 2: Topretirements Survey Results: Our Members Love Medicare!
Part 3: How to Solve the Health Care Puzzle If You’re Not 65 Yet
Why Obamacare Open Enrollment Matters to Boomers (MarketWatch)
Beware of Shifting Medicare Options (NY Times)
Healthcare.gov – Start here for answers to almost all your questions about Obamacare.
Medicare.gov
Affording Health Care Costs in Retirement
Consumer Reports info on Medigap Policies

Comments?
What are your questions and concerns about Medicare and coverage under Obamacare? Is it working for you? Please share your experiences in the Comments section below.

Posted by Admin on November 24th, 2014

10 Comments »

  1. I can use help on a problem that has come up. We are from Wisconsin and have now become Texas residents. We spend 7 months in Texas and 5 in Wisconsin. A medicare advisor in Wisc. told us to get Network health and it would cover us in both places. Got to Texas and found out we could go to the emergency room but not covered to see a doctor. So in Texas we got advice from a different Medicare advisor and got Aetna. My husband went back to Wisconsin and needed to see a doctor and found out ourAetna was only good in Madison and Milwaukee. So once again we are not covered part of the year. We could buy some that would cover us in both places but it would be twice as much: $250 per person per month. What we have decided as of this minute is to psy cash if we have to go to the doctor in Wisconsin.
    We can not be the only people facing this. Would really appreciate your help.

    by susan — November 25, 2014

  2. We have had cancer in this family so we made sure that we could go anywhere in Florida, requiring a PPO which, of course is more expensive. None of the docs here want anything less that the 2 biggies – AARP/United Healthcare or Humana & most won’t take the HMO’s. Yeah, I know, greedy little ppl but it is what it is & better off knowing that than getting in trouble later. We can also go out of state but you have to be careful & get all of your questions down pat. Ask around … this is a good site to see what people feel they should have asked. Call those docs & hospitals direct in the area you’re traveling to back-and-forth & ask them which insurance they will take/which they prefer. Don’t rely on ins reps cuz some don’t know what they’re talking about. We found that out the hard way also.

    Good luck,all & Happy Thanksgiving!

    by Jeanne C — November 25, 2014

  3. What this country needs is NATIONAL Healthcare without the insurance companies! They are a bunch of bloodsuckers (like the drug companies) who pay loads of lobbyists in Washington D.C. to persuade our congress members with election & reelection big bucks to legislate in THEIR not our behalf. Good luck trying to live in 2 places, it’s complicated enough in 1 place. I’m disgusted with the entire system. It works for people with lots of money but for the majority of us it’s a series of big headaches! At least the ACA program closed the system that kept really sick people out. Now there’s a Dummies book for the ACA it is so complicated. Maybe you could be helped by it?

    by D. Aller — November 25, 2014

  4. D. Aller – you are sooooo right on this. I agree completely. Well said!

    by John H — November 25, 2014

  5. I agree with D Alller. There is no peace of mind with the present system. I live in Northern Vermont and have like three choices for Medicare Advantage Providers for 2014 I found that MPV offered a plan that met my needs. Now for 2015 the same plan with MPV will cost me almost twice as much, it is increasing about 90 percent. I know you don’t believe it. Well I didn’t either! What is going on? As long as “health” care is controlled by the profit motive we will continue to spend our lives in fear for our health. Savor the peace you find.

    by Mike C. — November 25, 2014

  6. Susan, From what I have found, most Medicare Advantage programs (Part C) do not cover you outside of your state. Since we spend 3-4 months in Florida and the rest in Indiana, I went with the AARP/United Healthcare plan, which works anywhere in the country for Part B coverage. The premiums are reasonable and deductibles/copay are minimal with type N plan.

    by Bill — November 26, 2014

  7. Susan, Maybe I’m not understanding you .. I have Medicare with a United Health supplement plan. I reside in FL 6 months and NC 6 Months.. I have no problem at all being covered in NC for what ever… Is yours an Advantage plan? As Bill stated, that’s probably your problem… I have a friend who is a PT in an extended care facility and warns against Advantage plans. Also , from what I understand not all states have those plans so this may be your problem.

    by gail — November 26, 2014

  8. My nightmare at the moment is that The Sarasota Memorial Health Care System (our biggest here) Has refused to accept United Healthcare due to a dispute and they are now in court! Great!

    by gail — November 26, 2014

  9. […] 4. Not reviewing your plan choice every year during the open enrollment periods. Every year you need to review your situation against your coverage. And the time to do that is during the open enrollment period, which starts on October 15 and runs through December 7. For example, is Plan C still a good choice for your situation, or is Plan B better? Maybe you have moved and the doctor network that covers you is not nearby. Perhaps the cost factor between B and C plans has narrowed. Maybe you can get a lot better deal on your Medigap insurance, or you need to step up coverage because of your changed medical situation. Failure to review your situation could mean that you don’t have the access or the coverage that you need. See our article on “Open Enrollment“. […]

    by » Don’t Make These 5 Medicare Mistakes - Topretirements — July 27, 2015

  10. I need some input from some of you have gone from Obamacare to Medicare. Right now both my Hub and I are on Obamacare. My Hub is 1 1/2 years older than me and will move to Medicare before I do. Right now we are in the bracket of 400% poverty level which the maximum income for two people is $63,720. Our income is less than that and our subsidy is $1,104.00 per month. My question is once my Hub transfers to Medicare, what might my subsidy be? We are currently in a Silver plan. We have to claim all household income for Obamacare even though he will transition to Medicare. Have any of you gone through this? Our health insurance without the subsidy for two people is $1547.00 a month or about $773.00 per person per month. I have a bad feeling I won’t get much and have to pay high premiums. Thanks in advance!

    by Louise — February 16, 2016

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