Six Key Things You Need to Know During Open Enrollment

Open enrollment for plans sold in the Marketplaces started yesterday and we have Six Key Things to Know Open Enrollmentbeen hearing that there is still a lot of confusion. As a reminder, open enrollment is the time of year consumers can shop for a new plan or make changes to existing plans. For Marketplace and Medicare plans the plan won’t start until January 1, 2018. Employer plans may have different start dates, so check with your employer. Here are six key things you need to know during open enrollment:

  1. Health insurance can be confusing.
    1. Make sure you understand the key terms used in your health insurance policy. Watch our new video – Triage Cancer Presents: Health Insurance Basics to learn more. This information is useful regardless of where you get your health insurance coverage.
  2. Financial assistance still exists for most people who purchase plans in the marketplace.
    1. For 2018, 8 in 10 people have Marketplace health insurance options for $75 or less, a month. This is mostly due to the premium tax credits available to people based on their income level.
    2. Even though the Administration has said that they will no longer pay the insurance companies back for providing cost-sharing subsidies (aka cost-sharing reductions), the insurance companies still have to provide those discounts to consumers.
  3. Individuals shopping for insurance (regardless of where they get it – Medicare, employers, private companies), should be sure to do the math when comparing options!
    1. Often times we only look at the monthly premium of a plan. However, to accurately determine what a plan with cost you for the year, you have to do the math! Assuming that a consumer will reach their out-of-pocket maximum during the year, the way to do the math is to multiply the monthly premium by 12, then add that amount to the plan’s out-of-pocket maximum. You may be surprised to find that the bronze plan may not be your most affordable option.
    2. Consumers should also look at the network of doctors and hospitals, the other costs (e.g., co-payments, deductibles, etc.), and prescription drug coverage.
    3. For more information on how to pick a plan watch our webinar, Choosing Wisely: How to Pick an Insurance Plan or visit
  4. Individuals who are eligible for Medicare are not eligible to purchase plans in the Marketplace. Visit for more information about plan options.
  5. Be wary of short-term health insurance plans.
    1. These plans may look attractive based on their low cost, but they are not considered creditable coverage and when they end, consumers typically aren’t eligible for a special enrollment period to buy a plan in the Marketplaces, which could leave them with a gap in coverage. Additionally, they do not have to include the consumer protections in the ACA and may be able to charge people with cancer more, or exclude covering cancer treatments.
  6. Open enrollment dates may vary depending on where you live.
    1. The federally run Marketplace will be open from November 1 – December 15; however, some states have extended their open enrollment periods.
    2. There are also some extensions available for people who were affected by the recent hurricanes. (see the link above)

Only a few days left to buy health insurance!

Do you need health insurance coverage for 2016?Triage Cancer Only a few days left to buy health insurance for 2016

Good news is that you still have a few days (until December 15th) to pick a plan on your state’s health insurance marketplace and have your coverage start January 1st.

Want even more good news? According to 8 out of 10 people who enroll through the Affordable Care Act’s Health Insurance Marketplaces qualify for financial help to lower the cost of their monthly premiums.

If you’re not sure what to be thinking about when shopping for a plan, take some time to watch our webinar on picking a health insurance policy.

Ready to start your application? Visit and pick your state from the drop down menu.

Make the Most of Health Insurance Open Enrollment!

Open Enrollment for the Health Insurance Marketplace is now open!

Having a good health insurance plan can be a real life and wallet saver and as you may know it is also a requirement! The Open Enrollment period for 2016 health care coverage runs from November 1, 2015, to January 31, 2016. If you want your coverage to begin by January 1, 2016, you have to enroll or change your plan by December 15, 2015.

Triage Cancer - 4 Ways to Get Covered

The requirement to have health insurance coverage is often referred to as the Individual Mandate Penalty. This penalty almost doubles in 2016, for those who don’t have health insurance, to $695 per person or 2.5% of your household income, whichever amount is more.

Triage Cancer - Obamacare Open Enrollment Facts

Source: Obama Care Facts, 2015.

Even if you already have a health care plan that works for you, it is always good to compare different plans. Shopping around can’t hurt, even if you have health insurance coverage through your employer. Plans and pricing can change every year, so you may be able to find new coverage that is more affordable or better fits your needs.

Triage Cancer offers a free tool to you find health insurance options as well as information about other benefits you may be eligible for at the federal, state, and local levels.

By taking the time to compare your current plan with new options, you may find a cheaper plan or find out that you’re entitled to other benefits, like financial assistance. Based on where you live and your household income you may qualify for your state’s Medicaid program or a premium tax credit that lowers your out-of-pocket costs when you chose a health insurance plan from a private health insurance company.

5 key things to look for when choosing a health insurance plan:

  1. Monthly premium cost
  2. Deductible cost
  3. Out-of-pocket maximum cost
  4. Are my health care providers covered by the plan
  5. Are my prescription drugs covered by the plan

We know that these terms and choosing the right health insurance policy can be confusing, so to answer any questions you may have watch our latest FREE webinar recording that covers tips on how to choose a plan that works for you.

Progress has been made on increasing the number of people with health insurance. According to the US Census Bureau, in 2009, before the ACA was passed, about 15.7% of the population was uninsured. Recently, a study done by the CDC using 2015 Census data showed that the total uninsured rate has dropped to 9.2%. In California alone, 4.5 million new people enrolled in health care plans between 2013 and 2015. Even though these numbers are cause for excitement, there is still work to be done. If enrollment rates continue to increase, insured patients can look forward to their health needs being met, and less problems paying for health services than when they were uninsured.

There are so many benefits to selecting the perfect health care plan for you and your family, be sure to make the most of this year’s Open Enrollment and discover the plan that will best suit your needs. Triage Cancer will be posting valuable information about health insurance coverage throughout Open Enrollment.

Here are some other helpful tools:


  1. ObamaCare Enrollment Numbers. Accessed October 28, 2015.
  2. Insure the Uninsured Project Blog Post. Open Enrollment: Lessons from the Field; October 20, 2015. Accessed: October 28, 2015.
  3. Insure the Uninsured Project Blog Post. Summary of the Kaiser Family Foundation Survey of California’s Uninsured; August 11, 2015.

Do you qualify for Medicaid? It depends on where you live.

As a follow up to last week’s blog about the 50th birthday of Medicare and Medicaid, we 50th Medi Bdaywanted to share some additional resources on Medicaid.

This fact sheet explains the difference between Medicare and Medicaid:

The Centers for Medicare & Medicaid Services has also created a series of fact sheets for consumers to help people understand more about Medicaid.

Medicaid is the federal health insurance program that covers people who have low-incomes and meet certain categories of eligibility. Medicaid eligibility varies by state.

Some states expanded their Medicaid programs under the Affordable Care Act, and some did not. The fact sheets are specific to the state in which you live and are available in English and Spanish. Here are some examples:

For states expanding Medicaid:

For states who have not expanded Medicaid:

You can enroll in Medicaid at any time during the year and get coverage right away.

Nearly 70 million Americans receive health insurance coverage through Medicaid.

Happy Birthday to Medicare & Medicaid!

50th Medi BdayOn July 30, 1965, President Lyndon Johnson signed Medicaid and Medicare into law at a ceremony in Independence, Missouri. Congress passed the Social Security Amendments of 1965, after three previous Presidents had fought for the creation of a national health plan.

Former President Truman was issued the very first Medicare card during the signing ceremony. 19 million Americans signed up for Medicare during its first year.

At the time, these two federal programs were a groundbreaking way to provide basic insurance options for Americans without health insurance.

Medicare is the federal health insurance program that covers eligible people who:

  • Are 65 years are older;
  • Have been receiving Social Security disability benefits for 2 years; or
  • Have end-stage renal disease (ESRD) or ALS.

Medicaid is the federal health insurance program that covers people who have low-incomes and meet certain categories of eligibility. Medicaid eligibility varies by state.

Over the years, these government health insurance programs have continued to change, covering more Americans and providing additional benefits.

  • For example, in 1972, President Nixon expanded the coverage of Medicare to people under the age of 65 with long-term disabilities and individuals with
  • In 2003, President George W. Bush signed the Medicare Prescription Drug Improvement and Modernization Act, which created Medicare prescription drug coverage.
  • And in 2010, President Obama signed the Patient Protection and Affordable Care Act, which expanded Medicare to cover free preventive and wellness services and improve prescription drug coverage.
  • Click here to view a video about the history of Medicare.

Today, nearly 50 million Americans receive health insurance coverage through Medicare alone.

Nearly 70 million Americans receive health insurance coverage through Medicaid.

To learn more about Medicare, visit or read Each year, Medicare also releases Medicare & You, which includes details about Medicare, including costs, benefits, and how to find plans in your area.

To learn more about Medicaid, visit For more in depth information about Medicaid, visit

Yesterday, Medicare and Medicaid celebrated their 50th birthday. As our health care system and health insurance options continue to evolve over time, it is important to keep perspective and remember that when Medicare and Medicaid were first introduced, they were not welcomed by many people. But today, they are well-established ways for Americans to get access to health care.

View this video about the history of Medicare & Medicaid.

MediMedi Birthday

Retiree Health Insurance Plans

Has a neighbor told you that his daughter is still covered by his health insurance plan, even though his daughter is 24?

Wondering why you haven’t gotten any information that your son, who is 23, can?

Do you have a retiree-only health insurance plan?

If so, some of the recent consumer protections in the Patient Protection & Affordable Care Act (ACA) may not apply to you and your health plan.

These are all examples of ACA protections that do not apply to retiree-only plans:

For more information, visit:

And for those of you who like to get in the weeds, here is a handy chart with additional information about ACA provisions that don’t apply to specific types of health plans:

This Week: The Supreme Court May Make Your Health Insurance Too Expensive!

Do you have a health insurance plan that you bought from

If so, this blog is especially for you . . .

Source: Kaiser Family Foundation

Source: Kaiser Family Foundation

The cancer community is anxiously awaiting the U.S. Supreme Court’s decision on the King v. Burwell case, in which the plaintiff argues that individuals who buy health insurance from a “federally-facilitated” health insurance marketplace, should not be entitled to financial help to buy insurance plans.

The decision is expected to be announced on Thursday, June 25, or Monday, June 29. To read the oral arguments of the King v. Burwell case, which occurred in March, visit:

This case depends on how the 9 members of the Supreme Court look at one sentence in the Patient Protection and Affordable Care Act (ACA), which says that the financial assistance will be available for people “enrolled through an Exchange established by the State.”

Although, the ACA intended for every state to create their own state health insurance marketplace, aka exchanges, more than half of the states chose not to do so. This left the federal government to create marketplaces for those states.

This chart shows the type of marketplace in each state, for 2015:

State Marketplace Chart June 2015

If the Supreme Court agrees with the plaintiff in this case, then people who live in a state without a state marketplace will lose their financial help to buy health insurance.

It is estimated that 8.2 million people will lose their health insurance coverage, because they will not be able to afford their monthly premiums without the financial assistance provided by the ACA. In Florida, for example, 93% of people with a marketplace plan get financial assistance. Nationwide, 88% people with marketplace plans receive financial help, which on average, cuts the cost of monthly premiums by 72%.

With fewer people participating in the marketplaces, it will increase the premiums for everyone who continues to buy their coverage from the marketplaces. Some estimates suggest Alaska, Wyoming, Delaware, Wisconsin and South Carolina will be hardest hit.

For more details and research about the impact of a Supreme Court ruling for the plaintiff, visit:

For detailed, state-by-state information on the potential effects of the King v. Burwell ruling, visit:

As of now, there is no plan in place to deal with a Supreme Court decision eliminating the financial assistance. It’s unclear if that would mean that the financial assistance would end the minute the Supreme Court makes their decision, if it would end at the end of the month, or even at the end of the year.

Despite such an important decision looming, most people aren’t paying any attention to how this decision is going to impact their daily lives.

For more information about marketplaces in general read this blog post.

Stay tuned . . . We will post a blog update once we have a Supreme Court decision!

4 More Days Left to Enroll!

Do you need health insurance for next year? The open enrollment period has begun and if you want your coverage to begin on January 1, 2015 you must sign-up by Monday, December 15, 2014.

Confused on how to get started? The links below have all of the information you need to be covered for 2015!


If you are not able to afford a plan in the Marketplace and do not qualify for Medicaid or CHIP there are community centers that provide primary care, baby shots, and more. Find a community center near you that provides these health services here:

If you already have health insurance through the Marketplace, it is a good idea to review your current health care plan to make sure it still works for you. These five steps will walk you through how to review and make changes to your plan so that they will go into effect on January 1, 2015:

Want to receive email and text reminders so you will never miss a deadline? Register here:

For more information on the Affordable Care Act and this open enrollment period, listen to our webinar “Updates on the Affordable Care Act & Open Enrollment” by clicking here:

If you don’t need coverage starting January 1, 2015, then you have a little more time, as open enrollment will continue through February 15, 2015. After that date, the only way to be eligible for purchasing insurance in the Marketplace is if you qualify for a Special Enrollment Period after a life event (e.g., losing a job, moving to a new state, etc.).

Health Insurance & Open Enrollment: What You Need to Know

Man-on-a-PathWe know that health insurance can be overwhelming and stressful. But it doesn’t have to be. The Patient Protection and Affordable Care Act (ACA) includes changes to make it easier to shop for, and purchase, insurance.

As we approach the second open enrollment period (November 15, 2014, through February 15, 2015) to buy insurance coverage through the state Health Insurance Marketplaces created by the ACA, here are a few tips to help you navigate health insurance.

  1. Make sure you understand common health insurance terms. Don’t be embarrassed if you’ve heard these terms a lot, but still don’t totally understand them or how they all work together. Here are a few critical ones:
    • Premium: the amount you pay monthly just to have health insurance
    • Deductible: the amount you have to pay each year before the health insurance policy starts paying for your medical expenses
    • Co-Pay: an amount you may have to pay each time you access certain health care services (e.g., $25 when you see the doctor, or $10 for each prescription drug)
    • Cost-share: the difference between what your health insurance policy pays and what you pay for your medical expenses (e.g., 80/20 plans are ones where you are responsible for 20% of your health care costs and the plan is responsible for 80%, after you meet your deductible)
    • Out-of-Pocket Maximum: the most you are responsible for paying for covered medical care each year. The deductible plus any co-pays or cost-share amounts that you pay add up to help you reach out of pocket maximum. Once you reach that amount, your insurance should pay for 100% of your covered medical expenses.
  1. Keep an eye out for hidden costs as you shop for new insurance. For example, if you are in the midst of treatment, a Bronze level plan (60/40 cost share) is likely not going to be appropriate. And pay attention to whether or not plans have separate deductibles for medical services and prescription drugs.
  1. Learn about what is actually included in the ACA and how the law may potentially benefit you. One resource would be Triage Cancer’s Quick Guide to the ACA, available for free at:
  1. Look into possible financial assistance options available to you.
  1. Know that that there are places to go for more help when trying to navigate health insurance:


Three Tips for Navigating Cancer & Your Finances

Cancer rights attorney and advocate, Joanna Morales, shares her advice for managing the financial impact and questions that accompany a cancer diagnosis.      

Most cancer survivors are unaware of their rights and the resources available to assist them through the vast maze of legal, employment, and insurance systems that can arise after diagnosis. And many of those individuals are completely unaware of the financial impact that cancer may have on their lives.  Fortunately, there are organizations and agencies to help cancer survivors and their families answer these questions and others.  Here are 3 tips as you start thinking about these issues:

Tip #1: Decide if you are able to work through treatment or take time off

The decision whether or not to work through treatment is a personal one and it may depend on your course of treatment, so it is a good idea to talk with your health care team when making this decision.  If you want and are able to work through treatment you can ask your employer for a reasonable accommodation under the Americans with Disabilities Act (ADA) or a state fair employment law.  The Job Accommodation Network is a program of the U.S. Department of Labor that helps employers and employees navigate the job accommodation process under the ADA.  Cancer and Careers is a nonprofit organization that specifically focuses on the practical issues related to work and cancer, including free job search tools, resume review services, and career coaching.

If you decide that you want to take time off either for a short or longer period of time, you may be eligible to take time off work under the Family and Medical Leave Act (FMLA).  You may also have disability insurance benefits available to you through your employer, your state, or the Social Security Administration (SSA), which is the agency responsible for providing cash and health insurance benefits to individuals who are unable to work because of their medical condition, through two long-term disability insurance programs: Social Security Disability Insurance and Supplemental Security Income.

Tip #2: Look into your health insurance options

Health care is expensive.  In addition to your monthly health insurance premiums, you may also have co-payments and co-insurance amounts that you have to pay when you get medical care or fill a prescription.  If you are uninsured or if you have insurance, but it is expensive, you can check out the new health insurance options (Medicaid or private insurance) available through the Patient Protection and Affordable Care Act, by visiting or the Health Insurance Marketplace in your state.

Tip #3: Understand your consumer rights

Figuring out what your financial picture looks like can help you identify priorities (e.g., do you need to find a job, do you have a stack of bills that you have been too afraid to open, etc.).  Figuring out your next steps is entirely personal to your situation.  Consider talking with a financial planner.  Financial planners work with people of all income levels so don’t feel like you don’t have enough money to utilize one.  Consumer credit counseling agencies can provide you with practical tools (e.g., financial calculators or budget worksheets) or help you negotiate payment plans or settlements with your creditors.  As a consumer, you still have rights.  Be aware that some debt solutions may negatively affect your credit score.

It is important to check that your medical bills are accurate, dispute them if there are problems, and if you believe a procedure or treatment should have been covered, and it wasn’t, you have the right to appeal that decision.  Talking with your creditors before they turn over your unpaid bills to collections agencies, can help protect your credit.  If you can’t make a payment, ask for more time.  Check to see if they would be willing to negotiate a payment plan or accept a lower lump sum payment.  There are also many financial assistance programs available in the cancer community that may be able to assist you.

Arming yourself with information about your legal, employment, insurance, and consumer rights –  getting assistance from these resources can help you manage the financial impact of cancer.

 *This blog was originally posted on the My Colon Cancer Coach Blog in August 2014. For more information about colon cancer, visit My Colon Cancer Coach at