It’s that wonderful time of year when every other commercial advertises health insurance options for you to consider above all others, or your mailbox is giving way to the latest shipment of junk mail promising you $0 premiums, extra benefits at no cost to you with outstanding coverage that is all centered on your happiness. What to do, what to do?
There are some things to consider before taking the leap to enroll. Are you currently working with an agent that you trust to confirm that your doctors, hospitals, and medications are covered? A true insurance professional has your interests at heart, and will break down benefits and restrictions so you know what you are buying. Their professional reputation is on the line with every sale.
When reviewing Medicare plans, there are a few things for you to consider. Has anything changed in the past year regarding your health, doctors, or medications? If so, you should reach out to your agent with the changes and discuss what you liked and disliked about your current coverage.
Your current health insurance carrier should be sending you what the new benefits will be for the upcoming year, and if there are any changes to the benefits, premiums, etc. You usually receive this well before your agent has access to them. It is best to reach out to them early in October to discuss.
If you currently have a Medicare Supplement, you do not need to shop for a new supplement plan, since those plans do not change from year to year. If you do decide to change carriers, you may have to go through underwriting and could be declined for the new plan, but still be able to keep your current plan.
On the other hand, if your medications change or you do not like your current plan, you do have the option to switch plans from October 15 through December 7 of each year with the new plan beginning on the first of the following year. I highly recommend that you email your agent with the changes in medications so they can provide you accurate quotes as soon as possible. If you like your plan and nothing really changes, you do not have to do anything; your plan will automatically renew.
Affordable Care Act/Individual Coverage
If you are not Medicare eligible, you do have the ability to look at individual coverage from November through December 15 of every year, with the effective date starting the first of the following year.
The same rules apply as far as changes in doctors, medications, and, in this case, income if you qualify for an Advanced Premium Tax Credit (APTC) to reduce your premium cost. If you do qualify for APTC, you should update your income every year, since benchmarks change from year to year, as well as the calculations of income, age, location, and smoker status. Obviously, you will be looking at the upcoming year for income, which, for the most part, will be a guess. You do have the ability to adjust your income during the course of the year if there have been significant changes. Otherwise, you will be required to reconcile your APTC every year with your taxes. If you make more, you may need to pay some of the APTC back to the government, but if you make less, you may receive a bigger refund check.
If you do not qualify for any assistance through the Affordable Care Act and you like your plan, you can just allow it to renew.
As always, your agent will be your go-to person regarding any changes for the upcoming year, and their services are at no cost to you. As an agent I recommend getting in touch with us as soon as possible, since the enrollment window is short and website systems do go down the closer you get to the end of the election period.
When speaking with your agent, be prepared with your doctor’s names, dates of birth, smoker or non-smoker, preferred hospitals, medications, and income (including the sources) since your agent is very busy trying to help all of their clients in this short election window.
We wish you all a wonderful election period, and will be happy to help you along the way—just give us a call.