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.
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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.
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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.
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
- 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*
- 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.
- 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.
- 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.
- 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.
- 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.
*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.
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.
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