What You Need to Know
A key aspect of financial planning is ensuring that you and your family have adequate insurance coverage, and this includes when it comes to health insurance. Each year there is a period of open enrollment that allows you to sign up for new health insurance or make changes to your current coverage. Depending on the type of insurance, dates of open enrollment can vary, but fall is typically when you can expect applications to open.
While you may have a health insurance plan that you are comfortable with now, it can be a good idea to take this time to review your current coverage and see if you may benefit from making a change. Maybe your child graduated from college this past year and has now gotten a job where he has health insurance benefits and no longer needs to be on your family plan. You could potentially lower your premium by switching to a different plan. Or maybe you have a new diagnosis of a chronic condition that requires more frequent doctor visits and prescription drugs. A new plan may offer benefits that are more suitable to your current needs. If you are on Medicare, you might want to add drug coverage or switch to a Medicare Advantage plan that gives you a larger dental benefit. Open enrollment is the time to make any of these changes. It may seem easier to stick with the status quo, but you owe it to yourself to do a little research and see if a new plan might be worth it.
As we enter into this year’s open enrollment, here are some things to keep in mind:
- Open enrollment allows you to be proactive in ensuring that your insurance coverage is right for you right now. Your needs may have changed since last year. Assess what is important for you to have in a health plan and seek out insurance options that you can compare.
- Review the expenses and benefits of any plan you are considering. Are your doctors on the new plan? Are your prescriptions covered? What are the out-of-pocket costs? What is covered?
- If you and your spouse each have health insurance available through an employer, evaluate both plans to see which is the best option.
- Don’t wait until the end of the open enrollment period to get started. Give yourself as much time as you can to get answers to your questions and to make the switch if you find a plan that would suit you better.
Open enrollment periods vary by the type of health insurance.
- The Affordable Care Act (ACA) marketplace offers health insurance through state health exchanges. Most state health exchanges have open enrollment from November 1st to January 15th, but some states have a slightly different window of time. You can find more information on the Health Insurance Marketplace on the government’s official website: HealthCare.gov.
- Health insurance through your employer – You should contact your employer or human resources department to find out specific dates and details.
- Medicare has an open enrollment period of October 15th to December 7th.
- Medicare Advantage’s open enrollment runs from January 1st to March 31st.
Medicare Open Enrollment
Medicare is health insurance for people who are 65 and older, and for some younger people who have certain disabilities or conditions. It is only for individuals. If you are on Medicare, you may find that your mailbox is being inundated with advertisements from health insurance providers who want you to switch to their plan. It can easily get confusing. How do you sort through all of this information without getting overwhelmed?
- Assess your situation. Put aside all the advertisements and review your current medical needs and financial situation. Have you had a change in income since the last time you selected a plan? How about your health? Do you have any new diagnoses? New prescription medications? These factors should be considered. You may find that the plan you are currently enrolled in will continue to provide you with seamless care. Or you may benefit from a change. For instance:
- You might already have a Medicare Advantage plan without drug coverage and have a new diagnosis that requires prescription medication. A better fit for you might be a Medicare Advantage plan that has drug coverage.
- Or you may find that another policy offers that same value at a lower cost. As Medicare Advantage plans are private insurance, costs, deductibles and premiums can vary widely. You could possibly save money by switching from one Medicare Advantage plan to another Medicare Advantage plan.
- This is also the time that if you have Original Medicare and want to add a Part D prescription drug plan, you can. Or you may want to switch from a Medicare Advantage plan into Original Medicare.
- Essentially, any type of change to your Medicare plan (within specific plan guidelines) can be done during this window of open enrollment.
- Do your research. How do you know which plan will suit your needs best? Compare, compare, compare!
- Review your current plan thoroughly. Take into account any coverage changes for the upcoming year that will be outlined in an “Annual Notice of Change” (ANOC) letter. The Medicare plan you’re currently in sends this letter to you by the end of September to inform you of any changes to cost or coverage that will go into effect on January 1st.
- What plans are your doctors on? Are you happy with your current healthcare providers but are considering switching to a new plan? Or are you expecting to need specialized care in the coming year, and must enroll in a plan that the new providers participate in? You can contact your doctors to find out more about which plans they accept or verify directly with the Medicare plan you’re interested in.
- Do you need prescription drug coverage? You may want to add or drop this coverage.
- Do you regularly need specialized supplies, such as diabetic monitors? Not every plan will cover the same supplies, so it’s best to verify exactly what is available to you before making any decisions.
- What are the costs associated with your current plan versus one you might be considering? Review premiums, copays, coinsurance rates and deductibles in determining how much your care will cost.
- What additional benefits are provided? For example, you might find that one Medicare Advantage plan may be very similar to another one, but one may offer $3,000 in annual dental benefits and the other may only offer $1,500. If this is important to you, it could help you choose. Vision, hearing, transportation, and even gym memberships might be benefits included in various plans that you can factor in.
- Take advantage of resources that are available to help you decide.
- Visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). You can find out what plans are available in your area and compare.
- The State Health Insurance Assistance Program (SHIP) provides unbiased help and can assist you in reviewing Medicare plan options and answer questions.
- Consider speaking with a health insurance broker. A knowledgeable broker can help you sort through your options and select a plan that is good for you. Keep in mind that agents may work for a single health insurance company and brokers may represent several. You won’t pay anything additional to enroll through them, but some will not enroll you in a plan that they do not represent.
- Know who you are talking to. It’s especially important to be mindful that Medicare Open Enrollment season is a time when you must keep up your guard. Unfortunately, scammers may target seniors with variations of phishing scams and identity fraud under the guise of helping with Medicare changes. Guard your personal information, and never give out details such as your Medicare number to anyone unless you have initiated contact and are sure of who you are speaking with. Medicare will never call you, email you, or text you out of the blue, however, they will respond if you have called and left a message asking for a return call. Remember that your Medicare card should be guarded like a credit card. If you have any questions, contact Medicare.gov or call 1-800-MEDICARE directly.
Comparing the various health insurance plans you may qualify for might feel like an overwhelming task. However, with some research and planning, making a change during the open enrollment period could be well worth the effort. If you have any questions regarding how your healthcare fits within your financial plan, please contact us.