By Jamie Bosse
Whether you are working, retired, or somewhere in between, this is the time of year to evaluate your health care options for next year. Many employers do their company sign-ups in the fall and there are several deadlines to be aware of if you are on Medicare or using the healthcare exchange for coverage. Here is a breakdown of upcoming deadlines and things to consider for each category of coverage.
Medicare Age – 65 and Older
Important Dates: October 15th-December 7th is the time when you can make changes to your plan.
*What can you do during this period?
*Join a Medicare Prescription Drug Plan.
*Switch Prescription Drug Plans.
*Change from Original Medicare to a Medicare Advantage Plan.
*Change from one Medicare Advantage Plan to another.
*Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to one that does or vice versa.
One of the most common activities during this time is to shop your prescription drug plan (Part D Plan). The drug plan formularies change every year, as do many people’s medications. We suggest that you shop your prescription drug plan every year to ensure that you have the best plan for you at the lowest possible premium cost.
To evaluate and shop plans, go to www.Medicare.gov and review the options. As part of the evaluation, you may want to consider several factors. For instance, are you satisfied with the coverage and level of care you’re receiving with your current plan? Are your premium costs or out-of-pocket expenses too high? Has your health changed, or do you anticipate needing medical care or treatment?
Note – If your income is $85,000 or above (single filer) or $170,000 or above (married filing jointly), you must pay an extra premium amount for your Medicare Part B and Medicare prescription drug coverage [Medicare Part D]. This extra premium amount is called the income-related monthly adjustment amount (IRMAA). This amount is based on your modified adjusted gross income as reported on your IRS tax return from 2 years ago (e.g. the 2016 tax return information determines your rate for the 2018 calendar year premiums).
Under 65 with Group Coverage
Open enrollment for many companies is around this time of year, deadlines depend on the company. Be sure that you know your HR department’s deadlines and who to contact with questions.
What you should be evaluating:
*If you are married and both have group plan options, all options need to be compared and evaluated. It may be better to have the family on the same plan or different plans depending on what you expect for the year.
*Compare premiums, deductibles, co-payments, coinsurance, and network coverage.
*What expenses do you expect this year and how would they be covered under each plan? Examples include surgeries, treatments, physical therapy, births, etc.
Many employers are moving towards higher deductible health plans. These plans may be a big change if you were accustomed to a PPO, HMO or POS plan. High deductible plans usually have much lower monthly premiums, but you pay the full cost of each appointment until you hit the deductible. Most employers offer a Health Savings Account (HSA) option to help offset these out of pocket costs.
Under 65 with Individual Coverage
Important Dates: Open Enrollment is November 1st-December 15th, 2017 for 2018 plans.
If you are buying health insurance on your own, there are several ways to purchase a policy:
*From your state’s health insurance marketplace – check healthcare.gov to find yours.
*Directly from a health insurance company.
*Through websites like Insure.com that offers health insurance quotes from multiple carriers.
*Through a health insurance agent.
If you are currently enrolled in a marketplace health insurance plan, it will automatically renew assuming the plan is being offered in 2018. However, the plan may make changes to its provider network, copays, co-insurance and drug coverage. Your plan must send you a notice of any changes it will make for 2018. Take time to read the notice to see what it means for you. Make certain your doctors and preferred hospital are still in your network. Be aware, you may be able to use out-of-network doctors and hospitals, if you’re willing to pay more. In some cases, you might not be covered at all if you go out of network.
As you may have heard in the news, the individual health insurance market is in a state of flux. Some health insurance carriers have chosen to stop participating in certain markets, and there is a new carrier as well. Most notably, Blue Cross Blue Shield of Kansas City has chosen to stop offering plans in Kansas and Missouri. Centene is a new provider, offering plans branded under “Sunflower” in Kansas and Celtic/Ambetter in Missouri.
Your family size and income determines your eligibility for tax credits and subsidies.
You may qualify for a premium tax credit which is based on income and family size. To qualify, your family income must fall between 100 and 400 percent of the federal poverty level (FPL). See the below table for more information:
No matter where you are on the spectrum of health insurance needs, we are here to help! We can help you review your options and make the best decision for your financial situation. You can schedule a meeting by clicking below, contact Jamie Bosse –jbosse@makinglifecount.com, or call (913) 345-1881.