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    Your Guide to Health Insurance Open Enrollment 2023

    November 1 – January 15th

    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. 

    What to Expect in 2023

    • Open Enrollment has been extended to January 15th!  Please note, changes made AFTER December 15th will take effect February 1st.

     

    • CARRIER CHANGES:
      • Aetna is offering plans this year
      • Bright Health will NOT offer plans in 2023
      • Blue Cross Blue Shield continues to be the only carrier offering a PPO network
      • Cigna will no longer offer the Northwestern network for those located in Cook County
      • We continue to struggle with network issues with Ambetter and United Healthcare.  Their provider finders are not accurate.  If you are considering one of these plans it is best to contact your doctor’s office to confirm they are accepting the plan.

     

    •  ALL carriers will now offer virtual visits.  While Blue Cross Blue Shield only offers this service with their PPO network, Aetna, Ambetter, Cigna, Oscar, 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 $9,100 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)

     

    • 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.

     

    Your Guide to Medicare Open Enrollment 2023

    Medicare Open Enrollment is happening NOW

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

    What is New for 2023

    *Part B premium will be reduced from $170.10 to $164.90.

    *Part B deductible will be reduced from $233 to $226.

    *There is now a Plan G Plus plan which includes dental and vision benefits along with your medical benefits.

    *Many carriers offering Medicare Advantage plans have decreased the maximum out of pocket.

    *Many carriers offering Medicare Advantage plans have increased dental benefits.

    *There is now a Medicare Advantage plan being offered for $187 per month with $0 out of pocket expenses.

    *Part D deductible will increase from $485 to $505.

    *The initial figure needed to enter the donut hole has increased from $4,430 to $4,600.  As a reminder, Medicare is keeping a running total of the full cost of your drugs.  When you reach this figure, your coverage level (i.e. co-pays) change.

    *Part D TROOP will increase from $7,050 to $7,400. This is the amount you are responsible for before exiting the donut hole and entering catastrophic coverage.

    Reminders

    Medicare Supplemental plan premiums increase each year as you age.

    You can change your Medicare Supplemental plan at ANY time; however many carriers will medically underwrite before accepting a new policy.  This means the policy can be denied or you can be charged a higher rate due to your medical history.

    What you need to know about the Basics of MEDICARE

    Part A is provided by Social Security and covers HOSPITALIZATION.  The deductible is $1,600 and most people do not pay a monthly premium.

    Part B is also provided by Social Security and covers DOCTOR VISITS at 80%.  In 2023 the Part B premium will be $164.90/month.  Most people have the premium deducted from their Social Security.  The deductible for Part B is $226.  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. 

    WHAT DOES THIS MEAN???  If you only have 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. $226 per year for doctor visits and $1,600 for each hospitalization outside of 60 days). Medicare will start paying 80% of the bill for doctors’ visits and 100% of the hospitalization for the first 60 days. 

    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.

    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.  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.

    How to Buy a Life Insurance Policy

    • Know the reason why you are looking to purchasing a life insurance policy.  Are you looking to pay off debt when your significant other passes away?  Do you need income to replace the primary wage earner?  Are you looking for a policy to cover final expenses (aka burial costs) only?  Knowing the reason for the policy will help determine the direction to take next.
    • How much coverage you need?  The answer to this question will depend on the answer to the 1st question.  If you are looking to pay off debt, you’ll need to know how much debt you currently have.  If you are looking to cover final expenses, you’ll need to have an idea of the type of burial you want (cremation or in-ground). 
    • Educate yourself on the different types of policies available (term life, whole life, universal life).  Each provides coverage for a separate need.  Term life provides coverage for paying off debt, whole life provides coverage for final expenses/burial costs, and universal life provides a combination of the two.  It is important that you understand how each policy works, especially Universal Life.
    •  Obtain a quote.  Many financial advisors and insurance agents offer life insurance policies.  I suggest obtaining a quote from a company with a strong financial background and good customer service.  You want to be able to talk to someone that has knowledge in the products they are offering and is there when you need them.
    • Fill out the application.  Provide honest answers, without being too honest.  Remember, the carrier only needs to know the health conditions you’ve been diagnosed with, not the conditions you think you may have.
    • Prepare for the phone interview.  Once an application has been submitted, the carrier will reach out to ask you additional questions.  This is to verify the information on the application is correct and to obtain additional information that may not have been asked originally.  Have a list of your doctors available along with medications and dosages.
    • Schedule a life insurance medical exam.  The carrier will contact you to schedule an exam based on your schedule and at your preferred location (work or home).  The medical exam typically consists of height, weight, mouth swab (to check tobacco use), urine sample, and blood.  *NOTE: Not all plans will require a medical exam. *
    • Wait for approval.  The whole process takes about 1-2 weeks depending on your medical history.  If the carrier needs additional information from your doctor, it can take longer.

    While the process may seem overwhelming to some, working with a good agent that can answer your questions and provide updates along the way is important.  If you are unsure on how to begin, don’t over think it, something is better than nothing! 

    WHAT IS COMMERCIAL INSURANCE??

    Commercial insurance protects a company’s financial assets, intellectual property, physical property and liability from a covered loss. There are many risks that a business is susceptible to, including fire, theft, lawsuits, property damage, injuries, loss of income and more.

     

    Most Common Types of Commercial Insurance policies:

     

    Business Owners Policy (BOP) -Combination of property coverage and liability coverage.  The property coverage works like homeowners’ insurance.  If the business is broken into, robbed, or vandalized, it will be covered to replace and repair the property to its original condition.  If tools or equipment are stolen or destroyed by a covered loss, they too will be replaced.

     

    General Liability– Protects the business owner against accidents, injuries, or property damage on the business premises or due to the business operations.  Policy covers costs if a claim is filed against your business for bodily injury or property and advertising damage. If you do not have general liability insurance, you would have to pay for your own defense.

    Many factors affect general liability rates, including the type of business operations, your experience in the industry, the location of the business, and claims history.

    This policy is often confused with workers compensation policy.  General Liability does NOT provide coverage if an employee is injured.

     

    Workers Compensation– Provides compensation to an employee due to an accident, injury, or illness caused by the job.  These policies are rated based on the type of business operations, and employee payroll.  Business owners can opt out of the policy to reduce the rate. 

    These policies are audited so it is important to provide accurate numbers when estimating payroll.  If you use subcontractors in your business, it is important to obtain proof of insurance, otherwise their pay will be calculated in your payroll resulting in higher premiums.

     

    Commercial Auto- Provides liability and physical damage coverage for vehicles used for business purposes.

    Commercial auto insurance is for any vehicle, that is used for business purposes. The number of vehicles you insure, as well as your employees driving record(s) will impact your rate.

    If you are in an accident while driving to see a client or delivering goods, for instance, your personal auto insurance may not cover your losses.  If you are unsure if you need commercial auto coverage, contact your personal lines insurance agent first.  They should be able to tell you if the type of business operation you are handling can be covered under your personal policy. 

    Understanding Health Insurance Claims Process

    Health Insurance Explained

    The number one complaint I receive about health insurance is how confusing it is.  Below are some tips to help explain the process.  I will start with a brief explanation of some of the key terms.

    CO-INSURANCE is often confused with co-payment. A co-payment is typically a fixed dollar amount, while the co-insurance is a percentage that you pay after the deductible has been met. 

    OUT OF POCKET MAXIMUM is the amount you pay before the carrier is responsible for 100% of your medical expenses.  The out-of-pocket maximum is a combination of your deductible, co-pays, and co-insurance.

    DEDUCTIBLE is a fixed amount you are responsible for before the carrier begins to pay their share.  A higher deductible means lower health insurance premiums.

    CO-PAYMENT is a fixed amount you are responsible for a particular service.  Typically, a visit with the primary care physician has a lower co-pay than a visit with a specialist. 

     

    Tips to Filing a Claim

    1. Know Your Network. 

    You should have an idea before needing to use the coverage of who is in network vs out of network.  While you can go out of network on a PPO plan, co-pays and deductibles are significantly higher for an out of network provider.  HMO plans do not allow coverage for out of network providers.  This means you are responsible for 100% of the charges.

    You can keep this simple by sticking with the same medical group (i.e. Advocate, Duly Health, Northwestern Medicine, UIC, etc.).

    *If treated for an emergency, ALL services are covered as in network regardless of the location*

     

    1. Know Your Plan Coverage Limits.  While I do not expect you to know everything, having a general idea of your co-pays and deductible is helpful.  This eliminates any surprises in the end and alleviates stress when something major occurs.

     

    1. Urgent Care vs Emergency Room. Pay attention to the location of the urgent care facilities in your area.  The wait is much shorter than the emergency room AND the cost is much less.  It is common to see a $1,000 copay for the emergency room vs a $40 copay for the urgent care.

     

    1. Wellness Visit vs Follow Up. While wellness visits are typically covered at no cost, if the doctor codes the visit as a follow-up, you will be responsible for the payment.  The service itself is typically shorter and less involved if it treated as a wellness visit.

     

    1. Additional Charges. As a reminder, each service renders a separate bill.  For example, if a service requires additional testing, it is common to receive a separate charge for each service (i.e. labs, x-rays, etc.).  This is the same for hospitalization or surgery.  You can expect to receive a bill for the location, the doctor’s time, and whatever additional testing was required at the time.

     

    1. Consult an agent with any questions or issues. Many assume we are alerted every time someone files a claim, but we are NOT.  Your agent can help set expectations, obtain answers, and fight if need be.  While we are not able to discuss your claim with the carrier (HIPAA requirement), we can help you through the process.
    Questions
    Questions

    Feel free to email or call me with any questions or comments about my services or if you have any insurance related inquires.

    Contact
    Contact

    Phone: 708.444.0050
    Email: kelly@kellyburkeinsurance.com

    Availability
    Availability

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    available upon request