Special Enrollment Period
This enrollment period is for those that qualify for Marketplace insurance through healthcare.gov and either missed Open Enrollment last fall or who are a current policy holder that would like to change their plan. This does not impact health insurance for those 65+. But if you know someone who would qualify, please have them contact our office to make an appointment. Enrollment dates: Feb. 15 – Aug. 15.
ANNUAL ENROLLMENT PERIOD
Open Enrollment happens every year from Oct. 15-Dec. 7. During this time, it is important to meet with a licensed Medicare agent to review your current prescription list and Medicare plan to make changes for the upcoming year if needed. It is important to do this every year because drug plans and health plans (as well as your own health needs) can and often do change.
Should I enroll in Medicare? When a person becomes eligible, they should enroll in Medicare Part A because it is free. You should also meet with a licensed Medicare agent to discuss all Medicare coverage options, best timing for enrollment, and to find the plan that is just right for you.
- Medicare Supplement & Prescription Drug Plan.
- Medicare Advantage Plan.
- Medicare Cost Plan & Prescription Drug Plan.
- Dental & Vision Plans.
- Indemnity Plans to cover the gaps in Medicare.
Our response to COVID-19 is to make lemonade out of lemons! We’re doing this by making adjustments that will allow us to continue to provide the highest level of service to our clients. For the protection of our clients’ and agents’ health, our appointments will be virtual this year (via Zoom meeting or phone call.) If you are not familiar with Zoom, no worries! We will help you through this.
HOW WE HELP YOU CONNECT THE DOTS
Fireside Chat Series with Chris McPike
Medicare is confusing, especially when you turn 65 and begin using Medicare. The terminology is different; there are important deadlines you need to understand; and you have to make choices when you first enroll in Medicare that impact your healthcare, potentially for the rest of your life. Chris’s Fireside Chat Series “Medicare Simplified” helps you connect the dots of Medicare.
If you misplaced your card you can visit your carriers website to print out a temporary card. To get a new card you may contact us or your carrier to replace the old one.
Most insurance companies have Member portals where you can view claims, see benefits, find an in-network doctor and print an ID card. Many sites also include options for viewing the cost of different procedures and finding the best priced facility for a certain service.
Every insurance company offers benefits through a specific network of physicians, hospitals and other providers. Your benefits will be reduced if you use a provider that is not in the network. Each insurance company’s website offers a “Provider Search Tool.” You can also contact your doctors’ office to find out if they are in your network. Look on your insurance card to find the website URL.
A formulary is a list of prescription medications that are covered by an insurance plan. The medications are categorized as Tier 1 through Tier 4 with Tier 1 being the least expensive and Tier 4 being the most expensive. Some insurance companies use more than 4 tiers. If your pharmacy tells you that a drug is not covered, then the first step is to call the customer service number of your insurance company to find out why the medication is not covered. The most common reasons are that a drug is new and not yet on the formulary, has been replaced by a generic medication, or requires that you try less expensive medications before the more expensive one will be approved. There is also a process where your doctor can submit a request that the medication be approved because of special circumstances.
Coverage can vary from one insurance company to another, so check it out before you travel. It is typical for US based coverage to provide benefits for emergency services only when you are out of the country. It is wise to purchase a travel policy that provides additional medical insurance benefits plus coverage for other expenses you might incur if a medical event happens while you are traveling. Benefits such as emergency travel home or evacuation expenses may be available on travel policy. The cost is minimal and provides valuable benefits when something unexpected happens.
Give our office a call and we can assist with researching the formulary of your prescribed medication. Also suggest to contact your prescribing doctor to find other alternative medications that may be covered.
Those who have dental insurance are more likely to see their dentist on a regular basis than those who do not. The dental insurance plans that are available to individuals offer more limited benefits than group dental plans. The decision to have dental benefits should be based on your desire for good dental health and the cost / benefits of the insurance. One popular plan offers coverage for $27 per month. Annually that is $324. Preventive care (A services) is paid for at 100%. B services (extractions, fillings, etc) require a 6 month waiting period and are then paid at 80%. C services (crowns, root canal, etc) have a 12 month waiting period and are paid at 50%. The maximum benefit is $1000 per year. Compare the annual cost to what you would pay if you did not have dental insurance and consider how likely it is that you will need more than preventive services.
An EOB is an Explanation of Benefits. It explains how the insurance company processed your claim.
No, the over 65 market is not subject to the Affordable Care Act laws.
If you are not enrolled in a compliant plan, you will be penalized on your tax return $695 per person or 2.5% of your total income.
Most people are eligible for Medicare benefits when they turn 65. Benefits can begin on the 1st of the month in which you turn 65. Step one would be to get signed up for Medicare A and B. Typically, you will enroll in Medicare Part A and Part B which provide benefits for medical expenses associated with being in the hospital, outpatient services, doctors, and other medical services. You can do this as soon as 90 days ahead of your 65th birthday. Second step is to research the Medicare Supplement options. We recommend either Mutual of Omaha or BCBS of Nebraska supplements.