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 2024
*Part B premium will increase from $164.90 to $174.70.
*Part B deductible will increase from $226 to $240.
*There is now a Medicare Advantage plan being offered for $202 per month with $0 out of pocket expenses.
*Part D deductible will increase from $505 to $545.
*The initial figure needed to enter the donut hole has increased from $4,600 to $5,030. 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 $7,400 to $8,000. This is the amount you are responsible for before exiting the donut hole and entering catastrophic coverage.
*Part D catastrophic coverage will no longer require you to pay a copay or coinsurance for your drugs. This means you will now be covered at 100%!
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.
The Birthday Rule for Medicare Supplemental plans allows you to change your Medicare Supplement plan within 45 days of your birthday without being medically underwritten. You must enroll in a plan of equal or lessor value.
Medicare Advantage plans are guaranteed-issue.
What you need to know about the Basics of MEDICARE
Part A is provided by Social Security and covers HOSPITALIZATION. The deductible is $1,632 and most people do not pay a monthly premium.
Part B is also provided by Social Security and covers DOCTOR VISITS at 80%. In 2024 the Part B premium will be $174.10/month. Most people have the premium deducted from their Social Security. The deductible for Part B is $240. 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. $240 per year for doctor visits and $1,632 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. Blue Cross Blue Shield, 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.
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)
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What to Expect for 2021
- 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.
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