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 CancerFinances.org.
  4. Individuals who are eligible for Medicare are not eligible to purchase plans in the Marketplace. Visit http://medicare.gov 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)

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:

References:

  1. ObamaCare Enrollment Numbers. http://obamacarefacts.com/sign-ups/obamacare-enrollment-numbers/. Accessed October 28, 2015.
  2. Insure the Uninsured Project Blog Post. Open Enrollment: Lessons from the Field; October 20, 2015. http://itup.org/blog/2015/10/20/open-enrollment-lessons-from-the-field/. 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. http://itup.org/blog/2015/08/11/summary-of-the-kaiser-family-foundation-survey-of-californias-uninsured/

Medicare Open Enrollment: October 15-December 7

Do you have Medicare?

The Open Enrollment Period to make changes to your Medicare coverage began on Triage Cancer Medicare Maze WebinarOctober 15 and will end on December 7!

As there will be changes to how much it costs for Medicare Part B and Part D plans, it can be worth your while to shop around and make sure you have coverage that works for you. Any changes you make to your Medicare coverage will take effect January 1.

Here’s a quick refresher on what exactly you get from your Medicare plan:

  • Part A: Covers inpatient care in a hospital or other similar setting
  • Part B: Covers outpatient care like doctor visits, blood tests, imaging tests, and durable medical equipment. Medicare Part A/B is referred to as Original Medicare and can be used with any provider who accepts Medicare. In 2016, the projected cost for Medicare Part B is $159.30 per month. However, there is currently an effort underway to get Congress to reduce the Part B premium cost for 2016. If you cannot afford the Part B premium, you can apply for help here.
  • Part D: Covers prescription drugs and plans vary where you live. Plan costs will be based on the plan you choose. The Medicare Part D Plan deductible will jump to $360 in 2016, from $320 in 2015.
  • Part C: Also called Medicare Advantage plans, they offer Medicare coverage under Parts A, B, and D, through a managed care plans (HMO or PPO). Plans vary based on where you live, but must provide the minimum coverage required by Medicare. Part C plans can be less expensive, but have limited provider choices.

If you already have a Medicare Part D plan, be sure to review its current prescription drug coverage for any major changes to the prescriptions you take. If you are looking to enroll in a new or different Part D plan, compare your options here.

If you or a loved one is managing the costs of care due to cancer, understanding your Medicare options is especially important. Prescriptions used to help manage pain and nausea or to treat cancer can be costly and enrolling in the right prescription drug coverage is important. As you may have seen in the news, drug prices have been on the rise, and this includes drugs that are being used to treat cancer.

Something to be aware of as you look for Medicare coverage is the presence of fraud or scams. Here are some tips to avoid being a victim of fraud:

  1. Remember you do NOT have to change your plan if it still meets your needs.
  2. Beware of free prizes, trips, or other gifts offered in exchange for enrolling in a plan.
  3. Never give out your Medicare or Social Security number to someone unless you are certain of their credentials. (Rule of thumb: don’t give out personal information to someone who calls YOU, vs. someone that YOU call).

As you start looking for the right Medicare and Medigap plans that are right for you, you may have questions. The Centers for Medicare & Medicaid Services and Medicare.gov are reliable resources to help answer any questions you may have.

Don’t be afraid to ask for help. Your family and friends may be able to help you make coverage decisions. Your health care team can also provide you with useful information about the prescription drugs or treatments that you may need now or in the future, so that you can make sure that you pick a plan that covers those things.

There are also community organizations who are available to help you navigate your Medicare choices, called State Health Insurance Assistance Programs. Click here to find the program where you live.

It never hurts to shop around, even just to get piece of mind that the plan that you already have is the best one for you.

Still have questions? Watch our webinar on Making Sense of the Medicare Maze: https://www.youtube.com/watch?v=FIg1nXYV66g

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!

(c) HealthCare.gov

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: https://www.healthcare.gov/lower-costs/low-cost-community-care/

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: https://marketplace.cms.gov/outreach-and-education/5-steps-to-staying-covered.pdf

Want to receive email and text reminders so you will never miss a deadline? Register here: https://www.healthcare.gov/subscribe/

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: http://triagecancer.org/webinars/

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: http://triagecancer.org/health-care-reform.
  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:

 

Medicare Open Enrollment

medicareandyoucover2-300x225Medicare is a government sponsored health insurance program for most people who are 65 years old and older, or for individuals with a disability, who have been collecting Social Security Disability Insurance (SSDI) for at least 2 years.

Medicare can be confusing to navigate because its coverage is broken into four parts:

  • Part A covers inpatient hospital stays
  • Part B covers outpatient medical services
  • Part C (also known as Medicare Advantage Plans) allows beneficiaries the option of receiving their Medicare benefits through private health insurance plans and combines the coverage of Part A and Part B (meaning that if you have Part C, you do not also need A, B, and D)
  • Part D covers prescription drugs.  Anyone with Part A or B is eligible for Part D

Parts A and B are typically referred to as Original Medicare.  Everyone who is eligible and has paid into the system gets Part A and is automatically enrolled after age 65.  For most people there is no charge for Part A.  To receive Part A for free you generally have had to pay into Medicare for 10 years (40 quarters).  However, if you would like Part B, Part C (Medicare Advantage) and/or Part D you need to take proactive steps to enroll.  There is a fee for each of these Parts.  The standard 2014 premium for Part B is $104.90.  The premiums for Parts C and D will vary depending on the plans you choose.

Each year, during a period of Open Enrollment, you can sign up for a new plan or make changes to your existing plans.  Open enrollment starts October 15, 2013, and ends December 7, 2013.  While you don’t have to make changes this is your opportunity to review your coverage and change plans if you choose.

To find out more about when you can join or change a plan, click here.

To find out more about your Medicare coverage choices, click here or review this Medicare and You 2014 booklet.

Go to www.Medicare.gov to enroll in Medicare, check your current enrollment and compare your coverage options.