Open enrollment season is here! And with it the annual confusion and scrambling. We’re thinking this week’s blog can eliminate some of that.
REINFORCING THE BASICS.
What is open enrollment? Annual Open Enrollment (AOE) is this tightly scheduled period each year in which you sign up for health coverage. What is super, super HUUUGE about open enrollment – NO UNDERWRITING. Underwriting is risk assessment by the insurance company. It is a nosy and invasive process that will determine if you get coverage, how much coverage, and at what cost. Open enrollment, in most cases, is going to avoid all that.
What does Medicare offer? Part A = Hospital insurance; Part B = Medical insurance which is healthcare needed to diagnose and treat a medical condition and also preventive services, healthcare needed to prevent or detect an illness; Part C = Medicare Advantage Plans which package Parts A & B and usually D into one plan; and Part D = Prescription drug coverage.
What is Medigap/Medicare Supplement? You probably have figured out that Medicare Parts A & B don’t pay for everything. Medigap is supplemental insurance offered by private insurance companies like Blue Cross, Humana, and CIGNA. We actually saw a TV commercial the other night by Humana advertising their Medicare Supplement plans. It helps pay for copayments, coinsurance, and annual deductibles. Medigap is a secondary payer that pays some or all costs the primary payer didn’t pony up and pay for.
What is a Qualifying Life Event (QLE)? For purposes of health insurance, a QLE is not getting your driver’s license or even losing your driver’s license; it’s not graduating from anything; it’s not your birthday; and it’s not even adopting a shelter pet. For purposes of health insurance, a QLE falls within four categories:
- Loss of health coverage – losing existing health coverage; losing eligibility for Medicare, Medicaid, or CHIP; or, turning 26 and falling off parent’s plan.
- Changes in household – marriage; divorce; birth; adoption; and, death. And no, not adopting a shelter pet.
- Changes in residence – moving to a different zip code/country; student moving to/from school; seasonal workers moving to/from where they live and work; or, moving to/from shelter/transitional housing
- Other qualifying events – change in income affecting coverage; becoming a U.S. citizen; starting/finishing AmeriCorps service; getting into a federally recognized tribe; or, getting out of jail/prison.
What is a Special Enrollment Period (SEP)? SEP is the 60 days you get to sign up for health coverage after a QLE. Your workplace plan must give you at least 30 days after a QLE. (If you are interested in the other SEP – Simplified Employee Pension; check out our 10/17/18 blog, “Self-employed Plans”.)
WHEN IS OPEN ENROLLMENT?
Employer-provided Health Coverage. Most employers schedule the AOE period during the fall, which is now. Employers have flexibility in scheduling AOE. So, if you haven’t received a packet or reminder, reach out to HR or who ever it is at your workplace that pays the company’s monthly health insurance bill or who yanks the premium out of your paycheck.
Medicare. The AOE period for 2019 coverage is October 15, 2018 through December 7, 2018. These dates will stay the same every year for the foreseeable future. Whatever you do, don’t confuse this with General Enrollment Period which is January 1 to March 1.
Medigap/Medicare Supplement. The absolute surest and best time to get Medigap is during the initial 6-month open enrollment period. This open enrollment period starts the month that you re 65 AND enrolled in Medicare Part B.
The Market Place. The AOE period for 2019 coverage is November 1, 2018 to December 15, 2018. You snooze; you lose.
WHAT CAN YOU DO DURING OPEN ENROLLMENT?
Employer-provided Health Coverage. You can opt in or out of plans. You can make changes to the plan you have now.
Medicare. You can do a lot of switching: From Original Medicare (Parts A & B) to Medicare Advantage. From Medicare Advantage to Original Medicare. From one Medicare Advantage Plan to another Medicare Advantage Plan.
Medigap/Medicare Supplement. An important thing you can do is take advantage of the “guaranteed-issue right”. This is a legal right to any and all Medigap plans offered by any and all insurance companies in your area. This is super important if you have pre-existing conditions.
The Market Place. If you had Marketplace health coverage in 2018 you can renew, change, or update your plan. You should get two snail mail letters: one from your insurance company and one from the Marketplace.
WHAT CAN’T YOU DO DURING OPEN ENROLLMENT?
Medicare. You cannot enroll for the first time. You should do this during the 7-month Initial Enrollment Period (IEP) (which is three months before, the month of, and three months after your 65th birthday).
Medigap/Medicare Supplement. “You can’t always get what you want”; federal law doesn’t require insurance companies to sell Medigap policies to people under 65. You might not be able to even buy yourself some Medigap that you really want if you are under age 65. Only 32 states offer at least one Medigap policy (Florida is one).
WHAT IS THAT GENERAL ENROLLMENT PERIOD (GEP)?
This period is January 1 through March 31. If you didn’t sign up during the IEP and have no QLE to get you an SEP this is when you can sign up for Medicate Parts A and/or B. Coverage will kick in July 1, but don’t be surprised if there is a higher premium for late enrollment.
WHAT ELSE SHOULD I KNOW?
⇒ Where to go for help. You can compare different plans at https://www.medicare.gov/find-a-plan. And a really cool place is https:/www.shiptacenter.org. SHIP is State Health Insurance Assistance Programs. It is local, in-depth, and objective counseling and assistance about all things Medicare. https://www.mymedicare matters.org is another really cool website that guides you through eligibility, enrollment, plan comparisons, all the extra costs and more.
⇒ Where to go for Marketplace help? Heathcare.gov is a great website for all sorts of information on Marketplace insurance and Medicaid and the Children’s Health Insurance Plan (CHIP).
⇒ You can enroll in Medicaid and CHIP any time of year, whether you qualify for a SEP or not.
⇒ If you live in an affected area designated by FEMA as eligible for either individual or public assistance you can apply for more time to sign up for 2019 coverage: Exceptional Circumstances Special Enrollment Period (SEP) by calling 1-800-318-2596.
⇒ If you live in an affected area designated by FEMA as eligible for either individual or public assistance and you had a QLE in 2018 and missed the deadline, you can apply for Exceptional Circumstances Special Enrollment Period (SEP) by calling 1-800-318-2596.
If you didn’t have health insurance in 2018, we can figure out if there is an exemption that fits your situation. If you’re not so lucky we can calculate the exact amount of the Obamacare penalty. We are also awesome at getting you the maximum premium tax credit allowed. We’re gonna warn you ahead of time; our fee is not as cheap as Lucy’s five cents. Keep checking out our dope blogs because we intend to talk about more health coverage and health insurance topics.
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