*Healthcare: Open Enrollment has been extended until January 15th. Current policy holders can submit changes to their existing plan or submit a NEW plan. Once the 15th has passed, you will not be able to make any plan changes. NEW policies submitted during this time will take effect February 1st.
*Medicare: Medicare Supplement policy holders ages 65-75 have the option to change to another Medicare Supplement plan without requiring underwriting approval. To qualify for the Birthday Rule, you must enroll in a plan with the same or lesser benefits. The change must be done within 45 days AFTER your birthday.
*Medicare: Medicare Advantage policy holders are currently in a second Open Enrollment period until March 31st. During this time, you can change to another Medicare Advantage Plan.
*Auto/Home Insurance: Many policies renew during the month of January. When reviewing rates consider these tips:
+Always review the total package (i.e. home and auto). Often, some carriers will have a better rate on the home as opposed to the auto however, the total calculation needs to be reviewed when determining the best scenario.
+Make sure you are matching coverages. Some carriers are notorious for removing full coverage to reduce the rate. Sadly, some people do not realize that until they have an accident. Full coverage means the carrier will fix your vehicle in the event of an at fault accident. On the flip side, liability only means your vehicle is NOT getting fixed in the event of an at fault accident.
*Life Insurance: With the start of the New Year, many will review their financial goals for the year and discuss any gaps. Many people will not buy Life Insurance because they overestimate the cost of a policy. Costs depend on a number of factors, including your health, age, tobacco use, and gender. As one example, a healthy 35-year-old male can expect to pay about $20 per month for $250,000 on a 30-year term.
*Business Insurance: We’ve received LOTS of calls lately regarding employees injured on the job. A workers compensation policy provides wage replacement and medical benefits to employees injured as a result of their job. Premiums are based on the annual payroll and type of work performed.
REMINDER: Medicare Open Enrollment ends December 7th and Health Insurance Open Enrollment ends January 15th.
TIPS to Reducing your Medicare 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 low maximum out of pocket and confirm that your doctors accept the plan before switching.
*Consider switching the type of Supplemental Plan you are in currently (i.e. Plan N is less expensive than a Plan G). I will caution, that changing your plan may require you to pay for services that you have not paid for in the past.
*Consider switching carriers for your Supplemental Plan. Plan coverages are the same regardless of who the carrier is. Please note, you may be medically underwritten which means the new carrier can charge a higher rate or deny you based on your medical history.
*Review your drug lists with other carriers. Medicare.gov 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 have been prescribed).
*Consider switching pharmacies. First, 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.
TIPS to Reducing your Health Insurance Premium…
*Be prepared to discuss your household, estimated adjusted gross income for 2022. This will be used to determine if you qualify for assistance. Thanks to the American Rescue Plan, the threshold has increased. Some families making $250,000 per year can qualify for assistance!
*Those without pre-existing conditions should consider a short-term medical plan. These plans do not provide coverage for pre-existing conditions, maternity, and limited wellness visits. However, these plans are a fraction of the cost of plans offered through the Marketplace and they have a PPO network.
*If you are going to opt to self-insure, protect yourself with an accident or critical illness plan. The plan works separate from health insurance and pays you in the event of an accident (slip, fall, and break an ankle) as well as a diagnosis of a critical illness (cancer, heart attack, or stroke). The purpose is to use the funds to pay towards the unexpected treatment.
Consider splitting your household. If one of you need to be on a plan that covers pre-existing conditions the other can look into the short term medical plan. You can also split plans through the Marketplace.
The American Rescue Plan (ARP) was recently passed to reduce health care costs, expand access to coverage, and ensure nearly everyone who buys their own individual or family health insurance through a Marketplace can receive a tax credit to reduce their premiums. The following is a breakdown of what it means to you.
A New Open Enrollment Period Now Through May 15th
*New enrollees can enroll in a plan without providing proof of a special election period
*Current enrollees can make changes to their existing plan
*Coverage will start the first of the month after plan selection
The new law will lower premiums for most people who currently have a Marketplace health plan and expand access to financial assistance for more consumers. This means that if you made too much, you may now actually qualify for assistance.
In order to take advantage of the savings immediately, you must revisit your application via healthcare.gov. If processed this month, premiums will be lowered effective 5.1.
Consumers who enrolled in Marketplace plans prior to April 1 have the choice of waiting until they file their taxes next year in 2022 to receive the additional premium tax credit amount when they file and reconcile their 2021 taxes.
The increased subsidies are retroactive to 1.1.21.
Explanation on How the Premium Tax Credits Work
For consumers who are eligible for premium tax credits, an individual or a family’s tax credit amount is calculated based on the following factors:
Household’s total expected income for the year
Total number of people in the household that file taxes together
The tax credit calculation uses a percentage of the household’s income that they need to contribute (spend) on monthly health insurance premiums.
Prior to the American Rescue Plan, households had to contribute up to 9.83% of their income to pay for health insurance premiums to be eligible for tax credits. Consumers can choose to enroll in plans that cost more or cost less than the benchmark plan. Households with incomes greater than 400% FPL weren’t eligible for tax credits to help reduce the cost of purchasing a Marketplace plan.
Since passing the American Rescue Plan, individuals and families may be eligible for a temporary increase in premium tax credits for this year and next, with no one paying more than 8.5% of their household income towards the cost of the benchmark plan or a less expensive plan. Meaning, many consumers will be eligible for higher tax credit amounts to help cover their health plan premiums.
Additional Changes
People who were involuntarily terminated April 1st-September 30th and offered COBRA will have their premiums covered for FREE until September 30, 2021.
People can not take the COBRA subsidy if they are now eligible for other coverage (including new group plan or Medicare)
Taxpayers who received unemployment compensation during any week beginning in 2021 may be eligible to receive additional premium tax credits to help pay for 2021 Marketplace coverage. -This part of the plan is not available at this time, but is estimated to be available by summer.
People who underestimated their income in 2020 won’t have to pay back the APTC when they file their taxes. No word yet what happens to those that have already filed and paid. I suggest contacting your accountant for more information.
Bright Health is a new provider that will offer plans via the Marketplace. Their network consists of Palos Medical Group and the Adventist network.
NO penalty continues! This means you will not receive a penalty for not having coverage or for obtaining a plan that does not provide the 8 coverages required by the Affordable Care Act.
Blue Cross Blue Shield and Cigna will continue to offer virtual visits. While Blue Cross Blue Shield only offers this service to their PPO plans, Cigna will offer the same service on all of their plans. Policy holders can call or chat online with a nurse practitioner to obtain a diagnosis and prescription for medication.
Carriers continue to waive cost sharing and co-pays related to COVID 19 testing and treatment. You MUST select an in-network provider/facility.
Northwestern Memorial will now accept plans from Cigna (Connect HMO). They will continue to accept Blue Cross Blue Shield (Blue Precision HMO and Blue Care Direct HMO).
Out of pocket maximum will increase to $8,500 per person. You can offset this by purchasing an accident or critical illness rider. The rider starts at $25 per month and provides coverage to you in the event of an accident or diagnosis of a critical illness (heart attack, cancer, or stroke).
Group plans are still an option for small employers. Blue Cross Blue Shield and now Humana offer relaxed guidelines during this time to allow for a 1-person group. The employer must have at least 2 full time employees that are not husband and wife. The employees can be 1099’d.
How to Avoid Rate Increases
Be prepared to discuss your household, estimated adjusted gross income for 2021. This will be used to determine if you qualify for assistance.
Those without pre-existing conditions should consider a short term medical plan. These plans do not provide coverage for pre-existing conditions, maternity, and limited wellness visits. However, these plans are a fraction of the cost of plans offered through the Marketplace and they all have a PPO network.
If you are going to opt to self-insure, protect yourself with an accident or critical illness plan. The plan works separate from health insurance and pays you based on a diagnosis of a critical illness (cancer, heart attack, or stroke) and in the event of an accident (slip, fall, and break an ankle) the plan will pay you a certain dollar amount. The purpose is to use the funds to pay towards the unexpected hospital or urgent care visit.
Review ALL of your insurance policies. I specialize in personal lines insurance, which includes auto, home, and Medicare. As a broker, I have access to multiple carriers which allows me the opportunity to find the best plan based on your needs. I’ve saved people thousands by reviewing rates with multiple carriers.
Open enrollment 2020 is right around the corner. That means it’s time to check in with me about your health insurance status. While we’re still in 2019, it helps to be proactive to get prepared, know the dates-and plan.
During this time, individual policy holders can enroll in a health plan or make changes to their existing plan. *If you obtain health insurance from your employer, you are likely to have a different Open Enrollment period.*
Whether you’re buying for an individual or a family, here’s everything you need to know about open enrollment 2020.
The penalty has been removed! This means you will no longer receive a penalty for not having coverage or for obtaining a plan that does not meet the requirements of The Affordable Care Act (i.e. Short-Term Medical Plans).
Each carrier will continue to offer virtual visits. Policy holders can call or chat online with a nurse practitioner to obtain a diagnosis and prescription for medication. There is a small co-pay or $0 co-pay for this service (depending on the carrier and plan).
Group plans are still an option for small employers. Blue Cross Blue Shield does offer relaxed guidelines during this time to allow for a 1-person group. The employer must have at least 2 full time employees that are not husband and wife. This includes 1099’d employees (NEW this year).
As carriers continue to decrease or eliminate commissions to agents, I am forced to charge a fee for 2020. The fee will only be charged to Affordable Care Act Plans. This does NOT include Medicare or Short-Term Medical plans.
Short Term Medical plans will NOT offer a 12-month plan period this year. The maximum policy period is 6 months. As a reminder, these plans to not provide coverage for pre-existing conditions, maternity, or wellness visits. However, these plans are a fraction of the cost of plans offered through the Marketplace and they all have a PPO network.
Those that received a subsidy (aka assistance/reduced premium) are NOT obligated to update their income through the Marketplace. This will automatically renew based on income generated from your 2017 taxes.
AND, The Good News. There will be little to no premium increase.
How to Avoid Rate Increases
Be prepared to discuss your household, estimated adjusted gross income for 2020. This will be used to determine if you qualify for assistance.
If you are going to opt to self-insure, protect yourself with a short-term medical plan or an accident/critical illness plan. The plan works separate from health insurance and pays you based on a diagnosis of a critical illness (cancer, heart attack, or stroke) and in the event of an accident (slip, fall, and break an ankle) the plan will pay you a certain dollar amount. The purpose is to use the funds to pay towards the unexpected hospital or urgent care visit.
Review ALL of your insurance policies. I specialize in personal lines insurance, which includes auto, home and Medicare. As a broker, I have access to multiple carriers which allows me the opportunity to find the best plan based on your needs. I’ve saved people thousands by reviewing rates with multiple carriers.
This is an extremely busy time for me. I suggest scheduling early as my schedule will fill up. Contact me at 708-444-0050 or kelly@kellyburkeinsurance.com.
Please include your availability (i.e. mornings, afternoons, or evenings) and the type of appointment you are requesting (face to face or conference call).
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