open enrollment

MEDICARE PANIC SETTING IN AS EMPLOYEES APPROACH 65th BIRTHDAY??? LET’S CLEAR UP THE CONFUSION ABOUT INITIAL ENROLLMENT

Can’t tell you how many calls and emails we get from panic-stricken employees nearing that magic 65th birthday and Medicare eligibility.  It happens a lot.  A whole lot.

Some folks think if they don’t sign up three months before they turn 65 they’ll be in trouble. Others think the drop dead date to sign up is their birthday.  And, many, many people think if they don’t enroll in Medicare by those dates they either won’t be eligible at all, or they’ll be penalized and get socked with much higher premiums.

Here’s the scoop:

THE MEDICARE INITIAL ENROLLMENT PERIOD IS 7 MONTHS LONG.  IT INCLUDES YOUR BIRTHDAY MONTH, THE 3 MONTHS BEFORE AND THE 3 MONTHS AFTER.

Here are some basics, courtesy of Medicare Made Clear, that employees approaching their 65th birthday may want to know and save them from hitting the panic button:

1.)  You Have a Set Time to Enroll in Medicare

Your Medicare Initial Enrollment Period (IEP) is 7 months long. It includes:

  • The 3 months before the month you turn 65
  • The month you turn 65
  • The 3 months after the month you turn 65

Medicare Enrollment Date Calculator.

2.)  You Can Delay Medicare Part B

Most people get Part A (hospital insurance) premium-free because they or a spouse worked and paid taxes. Part B (medical insurance) has a monthly premium.

You can delay signing up for Part B if you have other health care coverage like employer-sponsored health coverage.  Having employer-sponsored health coverage gives you to the option to delay signing up for Part B, qualifies you for a Special Enrollment Period, and precludes you from getting hit with Late Enrollment Penalties if you elect to delay Part B.

3.)  There Are Two Ways to Get Medicare

Medicare gives you two Medicare Coverage Options:

  • Original Medicare (Parts A & B), the traditional way
  • Medicare Advantage (Part C), an alternative to Original Medicare

Original Medicare is administered by the federal government. Medicare Advantage plans are offered by private insurance companies approved by Medicare. They must provide all the same benefits as Original Medicare Parts A and B. Many plans include additional benefits, such as prescription drug coverage and more.

4.)  Medicare Doesn’t Cover Everything

Original Medicare doesn’t include coverage for prescription drugs. You may buy a standalone Prescription Drug Coverage (Part D) plan to get this coverage.

Some people also buy a Medicare Supplement Insurance (Medigap) plan to help with some costs not paid by Original Medicare.

Generally, you don’t need additional coverage if you choose a Medicare Advantage plan.

 

7 Months. That should make some breathe easier.

Definition of Predicament: People Who Don’t Have Access to Employer Coverage, Aren’t Medicare Eligible, and Don’t Qualify for Subsidies

Yes, this is a bit anecdotal. Nevertheless, I think it’s  worth reporting and some may find it interesting.

First, recently our team managed the annual open enrollment process for the group health plan of one of our employer clients. After a quick but thoughtful evaluation of options, one employee who was previously covered by an individual market policy opted to enroll on the employer’s group plan (family coverage) and terminate coverage under the individual market plan. Both the individual plan and the group plan were Qualified Health Plans (QHP) under ACA. The plans had similar benefits. And, they were underwritten by the same large insurance carrier.

Savings?

$600 a month in gross premium. That’s quite a spread.  Add in the employer contribution and the savings to the employee were even greater.

The HHS Move to Curtail the Availability of Short Term Health Coverage Will Hurt Consumers In Need of an Affordable Bridge To Other Coverage……

………Like Medicare or Other Employer-Sponsored Coverage.

Yesterday the Obama Administration and HHS announced they were significantly curtailing the availability and use of short-term health insurance.

Their reasons? Not exactly sure.

Maybe it’s due to the myriad of current issues in the individual market – rising rates, carriers pulling out, and actuarially not enough covered lives (especially healthy people) – and the need to get more healthy people to buy individual policies. Take away options and hopefully it’ll drive more people to buy on the exchange.

Maybe, it’s a shot at UnitedHealthcare (UHC is one of the main providers of short –term or temporary coverage). Retribution, possibly, for UHC pulling out of the exchanges?

HHS Publishes Out-of-Pocket Regs for 2017

This is hot off the presses. The most important announcement this past week is that HHS published the increased out-of-pocket regulations for 2017. Originally, the ACA was to cap deductibles at $2,000. That seems like a long time ago and was never really followed.

In the big picture, this increase seems to indicate that they see costs continuing to increase and consumers will need to consider mitigating those increases by moving to higher deductible plans.

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