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.
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.
Affording Health Care Costs in Retirement
Consumer Reports info on Medigap Policies
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.