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Healthcare Open Enrollment

Posted: October 21, 2016



Many have asked about Healthcare Open Enrollment.  Although all of the information is still not fully released, below is what you can expect thus far.


  1. Open Enrollment starts November 1st and continues through January 31st.  If you want or need to change your policy by January 1st, we MUST do so by December 15th.
  2. Land of Lincoln closed as of 10/1/16.  A special election period has been opened up for those that were affected by their closing.  During this time you can enroll in a new plan.
  3. UHC and Harken Health will no longer offer individual plans as of 12/31/16.  Anyone affected by this change will need to enroll in a new plan by December 15th.
  4. Out of Pocket Maximums have increased from $6850 to $7150 (the out of pocket max varies per plan.  The maximum allowed on ANY plan is $7150).
  5. At this point, the remaining carriers are Blue Cross Blue Shield, Health Alliance, Am Better, and Cigna.
  6. Plans purchased before 2014 are still being extended through 2017. 
  7. If you are happy with your plan you do not need to do anything.
  8. *If you are receiving a subsidy (aka assistance) I strongly recommend that you verify the income information that was originally reported.  You may actually qualify for additional assistance!
  9. *Any changes/new enrollment done by December 15th will take effect January 1st.  Any changes/new enrollment done after December 15th will take effect February 1st.
  10. Carriers have opted to remove or reduce the commissions paid to agents.  This will force me to charge a fee for the coming year.  I am still working out the details of what that fee will be and will update you accordingly.

Medicare Open Enrollment is happening NOW

Posted: October 19, 2016

During this time, you can make changes to your prescription drug plan, enroll in a plan, change your Medicare Advantage Plan, or enroll in a Medicare Advantage Plan.


TIPS to Reducing your Premium…

*Consider a Medicare Advantage Plan.  If you are already in one, you may want to consider another carrier.  Be sure to pick a plan with a maximum out of pocket and confirm that your doctor’s accept the plan before switching.  This will protect you in the event of a “bad” year. 

*Consider switching the type of Supplemental Plan you are in currently (i.e. Plan G is often less expensive than a Plan F).  I will caution, that changing your plan may require you to pay for services that you have not paid for in the past.  For example, a Plan N will charge the $166 deductible and $20 co-pay for doctors’ visits.

*Review your drug lists with other carriers. is a great source for reviewing rates with other carriers.  Simply plug in your drug information, select your pharmacy, and review the different plans available (based on the drugs you are taking).

*Consider switching pharmacies.  First, watch to make sure your pharmacy is still in the Preferred Network with your prescription drug plan.  Second, find out what the different pharmacies charge for your drugs.  You may see a difference that can save you some time in reaching the donut hole.


What you need to know about the Basics of MEDICARE

Part A is provided by Social Security and covers HOSPITALIZATION.  The deductible is $1,288 and most people do no pay a monthly premium.

*These figures have not been updated for 2017 yet and may be subject to change.*

Part B is also provided by Social Security and covers DOCTOR VISITS at 80%.  In 2016 the Part B premium increased to $121.80/month.  Most people have the premium deducted from their Social Security.  The deductible for Part B is $166.  As a side note, Part B premium is based on income.  If your income is greater than $85,000 for an individual or $170,000 for those that file a joint return, you will pay a higher premium. 

*These figures have not been updated for 2017 yet and may be subject to change.*


WHAT DOES THIS MEAN???  If you have only original Medicare, you will pay 100% of your doctor visits and hospital visits until you reach your deductible.  Once you meet the deductible (i.e. $166 for doctor visits) Medicare will start paying 80% of the bill.  You are still responsible for the remaining 20%.

It is important to note that not all doctors accept Medicare.  You will need to confirm with your doctor that they accept Medicare before making your appointment.


HOW TO FILL THE GAPS???  Many people purchase a Medicare Supplement plan to fill the gaps.  The most common plans are Plan F or Plan G.  These plans cover the Part A deductible, Part B co-insurance (20%), and in some cases Part B deductible.  Medicare Supplements are provided by private insurers (i.e. BCBS, United Healthcare/AARP, Mutual of Omaha, etc.) and charge a monthly premium.  The premium will vary by age, carrier, and zip code.


Another option is a Medicare Advantage Plan.  These plans have a lower monthly premium, include prescription drugs, and are subject to the enrollment period noted above.  Medicare Advantage Plans are set up as “pay as you go”.  Meaning the monthly premium is less than a supplement/prescription drug plan, however you pay a co-pay for each of your services (i.e. $5 co-pay to see the primary care physician, $10 co-pay to see a specialist, etc.).  These plans are offered by private insurers (i.e. Blue Cross Blue Shield, Human, United Healthcare/AARP, etc.)


WHAT ABOUT PRESCRIPTION DRUGS???  For those that are Medicare eligible, you are REQUIRED to purchase a prescription drug plan if you do not have credible coverage.  Prescription drug plans are provided by private insurers (i.e. BCBS, Humana, United Healthcare/AARP, etc.), NOT Social Security.  Many people think prescription drugs are included in Part A and Part B…they are NOT.  If you choose not to purchase a plan, you will be penalized 1% of the average premium for each month that you do not have coverage (roughly $.03/month).  Although this figure sounds low, it does add up over time.  The penalty is NEVER removed.  Once you are assessed a penalty it will be added to your monthly premium (i.e. $30/month premium + $20 penalty = $50 monthly premium). 

Prescription Drug plans are subject to an enrollment period.  The enrollment period is NOW.  If you qualify for a special election period (i.e. aging in to Medicare or losing credible coverage) you will be eligible for enrollment based on the date of your eligibility.

Prescription Drug plans have a monthly premium, co-pays are charged based on which Tier your drug falls in to, and some plans charge a deductible.  It is important to review your drug list before switching carriers.


WHO IS ELIGIBLE FOR MEDICARE???  People that are 65 or older or those that have been disabled and collecting social security disability for 24 months.