Updated: Sep 12, 2020
Here we are in October and still in the midst of a pandemic. Life has changed and so has the way we can enroll you in or make changes to your Medicare and Individual health insurance.
October marks the beginning of the annual health insurance open enrollment periods for both Individual/Family health insurance and for Medicare health insurance plans. This is the time you can sign up for a plan for the first time, review your current plan, and change plans. IMPORTANT: If you miss the Open Enrollment Period for Individual/Family or the Annual Enrollment Period (AEP) for Medicare you may not be able to make changes until next year in most cases.
This year Senior Centers and Community Centers are not open, and we cannot have information tables or give educational presentations in person there. Due to infection concerns medical offices are not allowing information tables on their premises. Medicare and insurance companies are recommending no in person meetings as a safety precaution. So, what do you do to get information and help in enrolling or changing your insurance?
The answer is - we are still here and working to assist you to make sure you have a policy that will meet your needs. We still will be doing our no obligation, no cost, annual reviews of coverage for our current clients and education for those who are new to the process. The difference is that, instead of in person meetings, we have worked hard to setup “No Contact” enrollment processes. We can assist you by phone and by internet for those who would like a virtual face to face meeting. We can even conduct Virtual meetings for more than one person or a group. Our insurance companies have done their part by providing electronic access to the Enrollment Summary of Benefits books and information, and by creating signature processes that can be completed by phone, electronically on a website, or by email. For those who don’t have access to email or internet we will do a No Contract drop and pickup off at your home of the Enrollment Summary of Benefit books and applications. We will then go over them by phone with you following along as we explain the benefits and costs.
Now on to the AEP information:
Medicare Insurance Plans Annual Enrollment Period for Medicare Advantage Plans (MAPDs) and Medicare Prescription Drug plans (PDPs):
● Existing Members: October 15 - December 7,2020 for plans to be effective January 1,2021
● New to Medicare members have an Initial Enrollment period (ICEP) or Special Enrollment period (SEP) and the exact dates and duration of your SEP will depend on the reason you are new to Medicare.
● There may be additional SEPs available for example if you have recently moved to a new service area, receive Extra Help, and more. Dates and duration vary by reason. Contact us and we can review your eligibility and options.
There are several reasons you should review your existing Medicare plan every year. Medicare Advantage plans make changes and improvements for 2021 and it may be to your benefit to review those changes to see if a different plan will better fit your needs in 2021
If you take prescription drugs, the insurance companies’ formularies which determine the coverage and cost of your drugs are subject to change each year. We recommend to our clients that we review their drug list annually and advise them of the most cost-effective plan for them each year. This protects against any surprise drug costs in January and allows you to take advantage of lower costs that may be available to you.
Starting in 2020 the Medicare Supplement (also known as a Medi-Gap) Plan F which covers the 20% of medically necessary costs not paid by Medicare, was no longer available to members turning 65 after 2019. There are other similar (but not identical) plans available to them in its place such as Plan G or Innovative Plan G.
Plan F and its variations are still available for those who turned 65 before 1/1/2020. Those members may keep an existing Plan F or can change to a Plan F in the future by using the California Birthday rule for a guaranteed issue or qualifying based on underwriting requirements. There may be other guaranteed issued circumstances which we can check for you including, if you’ve recently lost or will be losing other qualifying coverage such as a group health plan.
Covered California and private individual/family plans
Covered California Open Enrollment periods are:
● October 15 – December 1,2020 for plans to be effective January 1, 2021
Private health plans also have open enrollment periods under Federal guidelines.
If you don’t currently have insurance, California has implemented an individual mandate penalty. And if you do currently have coverage, California is expanding subsidies so even if you haven’t qualified in the past, we recommend reviewing your coverage and options as they may change for 2021.
The California individual mandate penalty will encourage more consumers to buy health insurance. The new State Subsidy program may provide nearly one million consumers with financial help to pay for premiums, including newly available help for some middle-class consumers with incomes between 400% and 600% of federal poverty level such as individuals making $50,000 to $75,000 or families of four making $100,000 to $150,000.
California’s Initiatives Will Lead to Hundreds of Thousands Gaining Health Care Coverage With Lower Premiums and New Financial Help:
● California’s individual market will see a preliminary rate change of 0.6 percent in 2021, This marks a record-low for the second consecutive year and follows California’s efforts to build on, and go beyond, the Affordable Care Act!
● All 11 of Covered California’s health plans will be returning for 2021, and two plans will be expanding their coverage areas. As a result, 88 percent of Californians will be able to choose from three carriers or more and 99.8 percent of consumers will have two or more choices.
Finally, as we tell our clients, insurance is complicated. Take the time to review what you have (or don’t have) and make sure to find an insurance agent who will take the time to educate you and help you find the right plan for you. The least expensive plan may not be the best for you, or it may be. But if you don’t have the right insurance, medical costs can be significant. Take the time to do your homework and don’t be afraid to ask questions.