Boost Valentine’s Day Flyer by Kelly Burke
*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.
During this time, individual policy holders can enroll in a health plan or make changes to their existing plan.
What to Expect in 2022
- Open Enrollment has been extended to January 15th! Please note, changes made AFTER December 15th will take effect February 1st.
- NEW CARRIERS: Molina Healthcare, Oscar Health Plan, and United Healthcare will offer plans for 2022. Blue Cross Blue Shield continues to be the only carrier offering a PPO network.
- OFF EXCHANGE Plans: While the network is the same on exchange or off exchange, Blue Cross Blue Shield, Bright Health, and Cigna will offer off exchange plans. This means if you do not qualify for assistance you do not have to go through the Marketplace. Blue Cross Blue Shield is the only carrier offering a PPO network.
- NO penalty continues! This means you will not receive a penalty for not having coverage or for obtaining a plan that does meet the minimum standards of the Affordable Care Act.
- Blue Cross Blue Shield, Bright Health, Cigna, and United Healthcare will offer virtual visits. While Blue Cross Blue Shield only offers this service with their PPO network, Cigna, Bright Health, and United Healthcare 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.
- Out of pocket maximum will increase to $8,700 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 continues to 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.
- Carriers are offering Visa gift cards for participating in their rewards program. Some are offering up to $500! Rewards are given for signing up for an account online, obtaining an annual physical, signing up for text message reminders, selecting a primary care physician, etc.
- Cigna is offering plans tailored to those with asthma, COPD, and diabetes. This means lower drug costs, $0 cost for labs, pulmonary rehab, and supplies (including certain brands of insulin pumps)
I am now license in Florida!! Insurance Counts can service plans in Illinois, Indiana, Wisconsin, Texas, and Florida.
Medicare Open Enrollment is happening NOW
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.
If you have a Medicare Supplement Plan, you are not obligated to make changes at this time. You can enroll in a Medicare Supplement at any time. Please note, if you are interested in making a change outside of your initial enrollment period, Medicare Supplement plans are subject to underwriting. This means you can be charged a higher rate or denied due to past medical history.
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 doctors 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 Part B deductible and $20 co-pay for doctors’ visits.
*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 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 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 $1,484 and most people do not pay a monthly premium.
Part B is also provided by Social Security and covers DOCTOR VISITS at 80%. In 2021 the Part B premium increased to $148.50/month. Most people have the premium deducted from their Social Security. The deductible for Part B is $203 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 2022 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. $203 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 plan today is Plan G. These plans cover the Part A deductible and the Part B co-insurance (20%). Medicare Supplements are provided by private insurers (i.e. BCBS, United Healthcare/AARP, Mutual of Omaha, Aetna, 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 for each month that you do not have coverage. Once a drug plan is selected, the penalty will be added to the premium. Please note, the penalty is NEVER removed.
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.