By now you know that the Open Enrollment is the only time where you can enroll or change your health insurance plan. But what you might not know is why the Open Enrollment Period exists. The short answer is that it prevents adverse selection. Which is when people only buy health insurance when they’re sick or need it. However, there is a lot more that went into the creation of the Open Enrollment.
To fully understand how the open enrollment period began you need to understand how health insurance came to be. This way you can see the series of events that shaped open enrollment’s creation and the reasons it was needed. Health insurance as we know it today has been around since the 1850’s. Back then, people who worked on the railroads and steamboats did their jobs in dirty, often dangerous places where serious injuries and illnesses were common occurrences. Even though these jobs paid well, workers were essentially risking their lives every day to the point that many became unable to work at all. And in turn couldn’t provide for their families. So the concern of the general population was, if the worst happens, how would they pay for their care while maintaining a household which often held a spouse and several children.
That’s where health insurance came to be. In 1850 the Franklin Assurance Company of Massachusetts became the first company to offer workers’ accident insurance. This set the standard for other companies in the years to come. Workers could now protect themselves financially from major injuries by putting money into an accident insurance “pool”. Everyone put money into the pool and when claims arose the money for their care was taken from the pool. This meant that healthy workers were helping to pay for injured worker’s care. While knowing that if they were ever in that situation the other workers would be helping to pay for their care.
History Of Open Enrollment
Let’s hop in the Delorean and time jump to 1949 when President Harry S. Truman finally set up the national health care system. This creation would eventually lead to the idea of open enrollment. During World War II, companies started offering health insurance to their workers as a way to draw in more people in a tight job market. This practice of offering health insurance as an employee perk ran rampant, every company wanted in on the trick. So, people started signing up for health insurance in such large numbers that the program’s financial future was in serious trouble if something didn’t change.
This is because unhealthy people had more reason to sign up then immediately start making claims. Which would crash the system because more money was coming out of the insurance company than going into it. This is what led to insurance companies starting to only let people enroll during specific times of the year. Doing this gave the insurance companies the ability to:
Manage their risks by limiting the number of enrollees at any given time.
Handle their cost basis by understanding how many people would enroll and what their health status would be.
Simplify the entire health insurance process by only reviewing applications or updating policies at a certain time of year.
Track their coverage levels so they could manage their ability to fulfill their current policy offerings.
During open enrollment insurance companies were also able to improve ties with other insurance companies. They could now take the time to strengthen the insurance contracts they currently had, make new partnerships, and improve healthcare all around. Most importantly, open enrollment helped health insurance grow a sense of shared duty. Companies could now pool their resources, share the best practices and ideas, as well as figure out how to navigate all the rapid new changes to the industry and market.
What Is Adverse Selection
Okay, now that the history lesson is over everyone back to the Delorean- we’re headed home. Well actually, we’re headed back to the beginning of this article where we mentioned open enrollment discouraging adverse selection. This is what health insurance companies nicknamed the trend in people only buying health insurance when they’re sick. When only sick people buy policies the insurance companys’ risk skyrockets. This is because they end up having to pay out more money than they have because there’s more claims than premiums. Health insurance companies only stay in business if they get more money from premiums than they give out in claims. So, it needs more healthy people than sick ones to properly pay out claims as well as pay to keep the company running smoothly.
Here’s what we mean. Let’s say that a health insurance company charges an annual premium of $4,200. Brianna is a member of this plan and she gets sick and her care costs $10,000 for that year. Brianna’s premiums aren’t enough to cover those costs by themselves. So, the health insurance company has to tap into the premiums of healthy policyholders who haven’t needed any healthcare that year to cover the difference for Brianna’s care. If there isn’t enough available money from healthy premiums. Then Brianna’s care comes out of the business’ pocket and their company as a whole goes into the red. This would lead to the health insurance company having to shut down or raise their premiums to supplement their loss. Both hurt everyone across the board.
Consequences of Adverse Selection
At the end of the day, health insurance companies are businesses. And adverse selection is a surefire way to bankrupt said business. In addition to paying out claims, insurance companies also have other expenses. Things such as employee wages, building rent, utilities, taxes etc. are all a part of running a healthy business. Not to mention health insurance is private in the U.S. Meaning these companies also have to make money after paying out claims and bills. Otherwise, the business closes its doors. So, what makes it so harmful to not only the companies, but also the general public as a whole?
Lack of Competition
The more health insurance companies close the more other companies begin to hold a monopoly on the market. When an insurance company has a hold on the market it has no competition so there’s no reason for them to try to improve their policies or create new upgraded ones. They can also charge whatever they want because other companies aren’t around offering cheaper options to pull customers away from them.
Less Accessibility
If health insurance companies start going the way of dinosaurs, there’s a chance that you won’t be able to get health insurance at all. Health insurance companies tend to focus on specific areas like certain states, counties, and even cities. So, if the health insurance companies in your area go out of business, you won’t have access to a plan that you want or need. If you do manage to get a plan from another area that’s extended its coverage a little, you may end up having to travel long distances to reach their in-network providers.
You Leave Yourself Vulnerable
If you wait to get health insurance until you’re sick, your medical bills might end up not even being covered. The point of health insurance is to protect you in case of something happening. It helps pay the costs for the unexpected injuries and illnesses. The thing about health insurance is that coverage doesn’t start right away. It usually begins at the beginning of the month after you enroll or even at the beginning of the next year, whichever comes first. So if you try to get coverage because you need it right then it most likely won’t be covered because your policy will not pay for anything before it’s active.
How Open Enrollment Prevents Adverse Selection
Health insurance companies can’t entirely erase adverse selection, but they can lower the risk of it happening by only accepting applications once a year. Everyone who wants health insurance can sign up or make changes to their plans during the open enrollment. This keeps healthy people from assuming that they can just wait until they’re sick to get insurance because it’s always available. They won’t be able to sign up for health insurance when they’re sick unless they happen to get sick during the open enrollment period. As we noted above, the open enrollment period comes with a waiting period between enrolling and your coverage beginning. This keeps people from signing up for health insurance on their ride over to the hospital in the hopes that their new plan will cover the bill.
The Affordable Care Act did originally have a plan to stop adverse selection. There was an annual fine for anyone who had access to affordable health insurance and didn’t enroll. The federal fine was removed in 2018 though. However, California, Massachusetts, New Jersey, and Rhode Island all have their own health insurance laws that penalize people that don’t have health insurance. They only get fined if they don’t qualify for an exemption on their state or district tax returns. These states keep this fine in place not to be harsh, but because they believe it’s a useful tool in preventing adverse selection in the health insurance market. In turn it keeps these state’s insurance premiums lower for their population.
Find Health Insurance With EZ
Because there are so many factors to take into account when organizing your own health insurance, it can be frustrating. No one enjoys reading hours of different plan benefits and premiums, so why not let a professional do all of the hard work for you- for free! There is a way to get affordable health insurance without all the hassle. A licensed EZ insurance agent can outline the benefits and drawbacks of each plan and assist in creating the plan that will work best for you.
Working with an agent saves you time and stress, no more trying to decode legal jargon or reading fine print. Agents do all the heavy lifting while you rest easy knowing that your coverage will be the best fit for your financial and medical needs.
Not to mention EZ agents can save you hundreds of dollars every year on health insurance premiums. We do this by having the ability to search both on and off the market for the most affordable plans. We’re also able to find and apply any discounts you may qualify for. Furthermore, we don’t stop at just finding you a plan, we help maintain your plan after the fact too! We can help you file claims with your provider and even help renew your policy when the time comes. To get started, simply put your zip code into the box below or give one of our licensed agents a call at 877-670-3557.
Medicare’s Annual Enrollment Period (AEP) is here, so don’t worry if you missed your initial enrollment period, you’ve got time! You’ve probably seen all the ads urging anyone eligible to enroll or make changes, but what is the AEP, and how can you make sure you’re enrolling in the right plan? Well, you’re in the right place for those answers. This guide will show you how, when, and what changes you can make to your current Medicare health plan or prescription drug plan for 2024. You’ll get answers to all the important Medicare AEP questions so you can make the best choices.
What Is The Annual Enrollment Period?
For Medicare, this happens every year from October 15 to December 7. People might also call AEP “Open Enrollment” or “Fall Enrollment Period.” All people who are eligible for Medicare can sign up or make changes during this time, and your new coverage will start on January 1 of the next year.
What Can I Do During The Annual Enrollment Period?
You can use the AEP to initially enroll in Medicare. You can also use the AEP to sign up for a Medicare Supplement Plan or Advantage Plan if you already have Medicare Parts A and B. On the other hand, you can also drop your current Medicare Supplement Plan or drop your Medicare Advantage Plan and go back to Original Medicare if you choose.
Enrolling in Medicare
Medicare is a government program that helps pay for health care for people 65 and older or younger people with certain disabilities or health problems. The 4 Different parts of Medicare cover different kinds of medical treatments.
Medicare Part A – Medicare Part A pays for short-term inpatient care in a hospital, skilled nursing center, or nursing home, as well as hospice care and some home healthcare.
Medicare Part B – Medicare Part B pays for doctor visits and other outpatient services, as well as mental health care, ambulance transfers, durable medical equipment, lab tests, and preventive screenings. Parts A and B are sometimes called “original Medicare” to set them apart from Medicare Advantage plans that are run by private companies.
Medicare Advantage (Part C) – Medicare Advantage plans are an option to replace original Medicare. They are offered by private insurance companies in accordance with Medicare rules. Participants usually pay less out of pocket, but service is usually limited to providers in the network.
Medicare Part D – Coverage for prescription drugs. To sign up for Medicare Part D, you need to have either standard Medicare or a Medicare Advantage plan.
Medicare Supplement – Medicare Supplement Insurance is sold by private companies. It pays for some of the costs that original Medicare doesn’t cover, like deductibles, coinsurance, and copays.
Comparing
During the Annual Enrollment Period, one of your biggest decisions is whether it’s better to go with Original Medicare with a Medicare Supplement plan or a Medicare Advantage plan. Knowing the different types of coverage can help you decide which one makes the most sense for you. Here’s a look at how they compare.
Original Medicare
Allows you to use any doctor, hospital, or other health care provider who accepts Medicare and is taking on new patients.
Coverage for Parts A and B of Medicare.
There’s no need to pick a primary care doctor, and most of the time, you don’t need a referral to see a specialist.
Most of the time, you pay a deductible, co-pays or co-insurance, and Part B premiums.
Medicare Part D is not included.
Most people who have Medicare Part A benefits do not have to pay a premium. In 2024, the standard monthly premium for Medicare Part B is $179.80, but if you make more, your payment may be higher. The Part B deductible in 2023 was $226 and should be close to the same for 2024. There are deductibles and charges for both Parts A and B. The 2024 prices have not been announced yet but they should be close to the 2023 amounts. Part A charges in 2023:
Benefit period deductible was $1,600.
Hospital stay days 1-60 had no coinsurance per benefit period.
Days 61-90 has a $400 per day coinsurance per benefit period.
Days 91 and over had $800 coinsurance per lifetime reserve day used (up to 60)
Once you’ve used all of your lifetime reserve days the patient pays all costs
Medicare Supplement
Fills in the coverage gaps left by Original Medicare
Medicare is billed first for health care services, and the Supplement Plan is billed second.
Out-of-pocket costs will be based on what’s left after Medicare and the Supplement Plan pay their share.
Medicare Supplement plans vary based on the insurer and the plan you choose and where you live. To find out more about Medicare Supplement costs click here for our state-by-state Medicare Supplement Guide.
Medicare Advantage
Usually, you have to use doctors, hospitals, or other health care workers that are part of the plan’s network. There may be a fee if you go to a service that is not in your network.
Required to cover the same essential services Original Medicare does.
Depending on plan and provider, you may need a referral for specialists.
Plans have different out-of-pocket costs, but some may limit how much you have to pay each year.
Most plans cover medications through Medicare Part D.
How much you pay for a Medicare Advantage plan (Medicare Part C) depends on the plan you choose. Members of Medicare Advantage are still responsible for paying their Medicare Part B payments, but some plans may pay some or all of them on their behalf. This is called a “Medicare giveback benefit” in the insurance world. Some Medicare Advantage plans may have a monthly fee on top of what you already pay, but most don’t. Deductibles, copayments, and coinsurance costs can also be different.
AEP Tips
Your Medicare plan will automatically continue at the start of each year unless you change it, but you might not get the same benefits. Every year, insurance companies look at the perks of their Medicare plans and make changes. Instead of just letting your plan keep going, you should make sure it still meets your wants. During the Medicare Annual Enrollment Period (AEP), you can change your plan if you want. Here are some tips to help you make decisions about your Medicare coverage during AEP that are based on accurate information.
Check Your Current Plan Changes
Each year, your Medicare Advantage plan (Part C) or Medicare prescription drug plan (Part D) may change how much it covers or how much it costs. Changes go into action on January 1, so you need to be aware of them when making decisions during AEP. Changes to a plan may include adding new benefits, taking away benefits that were previously offered, updating the list of drugs that are covered, and lowering or raising prices. Plans will send you a letter called an Annual Notice of Change (ANOC) that explains any changes to your benefits or costs for the next year. Plan members usually get ANOC letters in September. Read it carefully and get in touch with your plan provider if you don’t get one.
Review Your Handbook
“Medicare & You” is the government’s official guide to Medicare. It covers coverage, costs, enrollment, and more. Every year, it’s changed. The guide shows what’s new with Medicare and what, if any, big changes are coming in the next year. Changes to Medicare rules or policies could affect your benefits, costs, or other parts of your health care, so it’s important to stay up to date.
Review Your Plan
Now that you’ve looked at plan changes and gone over what your plan covers it’s time to look at your present plan more closely. Start by figuring out how well your current Medicare plan will work for you in the coming year. If your plan still seems like the right choice, you don’t have to do anything during AEP to keep it. You’ll stay on the plan as long as you keep paying your fees and other costs.
Shop Around
If you think your plan won’t meet your requirements anymore, you should look for one that will. Even if you think your current plan will still meet your needs, you may want to look around to see if you can find one with better features or lower costs. Every year, on October 1, insurance companies release new information about their Medicare plans. They are competing for your business, so don’t be afraid to look at all of your choices.
What If I Miss The Annual Enrollment Period?
During the Medicare Annual Enrollment, you can change your Medicare Parts A or B coverage. From October 15 to December 7, anyone can sign up. People who have private Medicare Advantage plans have their own open enrollment time, which runs from January 1 to March 31. If you miss your open enrollment time, you usually have to wait until the next year to make changes. However, there are some cases where you can make changes before the next year. Special Enrollment Periods (SEPs) are times when you can make changes to your benefits. You might be able to get an SEP if you:
Move to a place that isn’t in the service area of your present plan.
Move to a new area that gives your current plan new coverage choices
Are let out of prison
Move into or out of a nursing home with skilled care
Move back to the United States after living abroad
Leave coverage through a company or COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage
Stop being covered by the Program of All-Inclusive Care for the Elderly.
Used to be able to get Medicaid, but now you’re not.
Are registered in a Medicare Advantage plan or Part D plan that hasn’t been renewed
Both Medicaid and Medicare are available to you.
These are just some of the times when you might be able to change your Medicare plan outside of the Annual Enrollment Period. On the Medicare page, you can find out more about these times.
Getting Medicare With EZ
EZ can assist you in enrolling in Medicare, purchasing a Medicare Supplement Plan, or simply weighing your options. Our agents work with the best insurance companies in the country. They can provide you with a free comparison of all available plans in your area. We will go over your medical and financial needs and help you find a plan that meets your needs. To get started, simply enter your zip code in the bar below or give one of our licensed agents a call at 877-670-3602.
The health insurance Open Enrollment Period (OEP) is coming, and you might feel a little lost. It can be hard to sort through all of the different health insurance options in your area, but you know that you and your family need health insurance to stay healthy. Don’t worry though. You can always work with a licensed EZ agent, who will help you find a plan that fits your budget and your needs. Before you do that, let’s look at everything you need to know about the OEP.
What Is The OEP?
The Open Enrollment Period (OEP) is the only time of the year when you can change, cancel, or buy a new health insurance plan. Depending on which state you live in, it starts on November 1st and goes until mid-to late-January. Now is a good time to look at your current health insurance plan, see if it will change in the new year, and decide if it will meet your needs in the future or if you need a new plan.
When Is The OEP?
The open enrollment period for Obamacare plans is from November 1, 2023 to January 15, 2024. Any plan you buy by December 15 will cover you starting on January 1, 2024. If you buy a plan during open enrollment, which is between Dec. 15 and Jan. 1, it should take effect by Jan. 15, 2024, as long as you pay your first premium on time. Also, if you buy a plan between Jan. 1 and Jan. 15, your plan should start on Feb. 1, 2024. Some states’ open enrollment periods are longer than others, but this can change. At the moment, these states have longer periods for signing up:
California – November 1st, 2023, to January 31st, 2024
Idaho – October 15th, 2023, to December 15th, 2023
Maryland – November 1st, 2023, to December 15th, 2023
Massachusetts – November 1st, 2023, to January 23rd, 2024
New Jersey – November 1st, 2023, to January 31st, 2024
New York – November 16th, 2023, to January 31st, 2024
Rhode Island – November 1st, 2023, to December 31st, 2023
If you get your health insurance through your job, your employer can choose when your open enrollment period is.
Marketplace Plan Tiers
Since the Affordable Care Act (ACA) went into effect in 2010, most people buy traditional health insurance plans on the insurance marketplace during the OEP. When you buy plans this way, they come in four levels called “metal tiers.” Bronze, Silver, Gold, and Platinum are the tiers. The plans in these tiers are different in terms of price and how much you’ll have to pay out of pocket, not in terms of the quality of care you’ll get.
Bronze
The monthly premiums for bronze plans are the cheapest, but you have to pay the most out of pocket. With these plans, your insurance company will pay 60% of each of your medical bills. The other 40% will be your responsibility. Also, the deductibles for these plans, which are the amount you have to pay out of pocket for medical costs before your insurance plan starts to pay for them, can be in the thousands of dollars each year. Bronze plans are a good choice if you don’t use medical services very often but need a low-cost plan to protect yourself against the worst-case medical scenarios, like getting sick or hurt badly. Your monthly premium will be low, but since the deductible and cost-sharing percentage are both so high, you will have to pay for most of your routine care.
Silver
The monthly premiums and out-of-pocket costs for silver-tier plans aren’t too high or too low. These plans cover 70% of the cost of your medical care. You pay the other 30%. The deductibles for this tier are often lower than those for Bronze plans, so if you’re willing to spend a little more to have more of your routine care covered, these plans are a great choice. When you qualify for cost-sharing discounts, you have to choose a Silver plan to get the extra savings. If you are on the Silver plan and stop getting cost-sharing reductions, you will have a Special Enrollment Period. If you want to switch plans, you can sign up for the Bronze, Silver, or Gold plan that fits your needs and budget the best.
Gold
Even though the premiums for Gold plans are high, the out-of-pocket costs of care are lower than for the plans above it. These plans have low deductibles, and your plan will pay for 80% of your care while you only pay 20%. If you need a lot of medical care, a Gold plan might be a good choice for you because it will cover more of your care.
Platinum
Platinum has the highest monthly premiums of all the tiers. While the premiums will be high, your out-of-pocket costs will be the lowest of any type of plan, and since the deductibles are so low, your insurance company will pay more of your costs throughout the year. Since these plans cover 90% of all your medical costs, they can be a good deal for people who need a lot of medical services.
In addition to the different types of metal tiers, there are also different types of plans to choose from during the OEP. Some plans only let you choose from a small number of doctors, hospitals, pharmacies, and other health care providers, or they force you to use only those in their network. On the other hand, some plans will pay a bigger share of the bill for healthcare providers outside of the plan’s network. Depending on where you live, you might find plans in any or all of these categories at each metal tier level:
Health Maintenance Organization (HMO) – A type of health insurance plan that usually only pays for medical services from doctors who work for the plan or have contracts with it. Most of the time, out-of-network care is not covered, unless it is an emergency.
Preferred Provider Organization (PPO) – A type of health plan that has a network of providers but doesn’t force you to only see those providers. But your out-of-pocket costs will be lower if you use providers in the network. You can use medical professionals, facilities, and suppliers outside the network if you pay extra and don’t have a referral.
Exclusive Provider Organization (EPO) – A managed care plan is one in which treatments are only covered if you go to doctors, hospitals, or other healthcare providers in the network, unless it’s an emergency.
Point of Service (POS) – A type of plan where you pay less if you go to hospitals, doctors, and other healthcare providers in the plan’s network. To see a specialist, you need to get a referral from your primary care doctor.
How To Buy Health Insurance During The OEP
If your employer gives you health insurance, they should tell you when and how to choose coverage for the next year. If you don’t get health insurance through your job, you can use the marketplace to look for and buy a plan. Another way to buy health insurance during this time is to work with an EZ agent who can help you shop through all of the plans available and help you enroll. Most states use the federal marketplace, healthcare.gov, but 17 states and Washington, D.C., have their own state-based marketplaces where people can buy coverage. States that run their own health insurance exchanges may also offer longer sign-up periods. These are the states that have their own insurance markets where people can buy plans for 2024:
Residents of all other states should shop for and sign up for their next health insurance plan on the federal exchange.
Things To Consider During The OEP
As Open Enrollment for Individual and Family Health Insurance in 2024 gets closer, there are a few important steps to take when choosing your plan.
Review Your Current Plan
If you already have health insurance, look it over to see if it still meets your needs. Think about any changes in your health, finances, or lifestyle recently that might mean you need a different health insurance.
Explore Options
During Open Enrollment, it’s important to look at different plan options to find one that fits your healthcare needs and budget. Look for plans that have a network of doctors and hospitals that fit your needs and preferences.
Consider Subsidies
As you look at and compare insurance plans on the Marketplace, make sure to update your personal information, especially your financial information. If you make less than a certain amount of money, you may be able to get health insurance subsidies that can lower your monthly premium by a lot. Also, Silver Marketplace plans offer cost-sharing reductions, which can lower your out-of-pocket costs by lowering your deductible, copays, and coinsurance.
Consider Additional Coverages
Even though Marketplace health insurance plans cover a wide range of medical services and include prescription drug coverage, you may want to think about getting more coverage, like dental and vision plans, to make sure your health is well-rounded.
What If I Miss The OEP?
If you miss the Marketplace’s Open Enrollment Period, you might not be able to sign up for an ACA health insurance plan unless you qualify for a Special Enrollment Period. With a Special Enrollment Period, you can sign up for a plan outside of the Open Enrollment if you have a qualifying life event. This is an event that affects your current coverage, like losing your job or getting divorced. You might also be able to sign up for a health plan through your employer. Some plans offered by employers have their own enrollment periods that may differ from the Marketplace. Also, if you change jobs, you may be able to sign up for your new job’s health plan outside of the normal enrollment period.
Need Help?
The best way to find a cheap plan with the right level of coverage for you is to compare plans. Come to EZ first before you start comparing things on your own. We’ll make the process faster and easier by letting you compare plans in your area in just a few minutes. Our licensed insurance agents work with all of the best insurance companies in the country. They can talk to you about your budget, needs, and help you choose the best plan for you and your family. We compare plans and give you advice for free. Enter your zip code in the bar above to get free quotes or call 877-670-3557 to talk to a real person.
Medicare is the federal health insurance program for people who are 65 or older. When you enroll in Medicare, it is important to understand how it works and whether or not you will need a Medicare Supplement plan to go with it. Once you pay your deductible, Medicare covers only 80% of your Part B expenses, leaving you to pay the rest. Medicare Supplement is an insurance plan that is sold by private companies. Medicare Supplements plans help pay for the 20% of the Medicare Part B costs which is left for you to pay. Original Medicare, and Medicare Supplement plans cover different healthcare. It is important to go over each program, and what they offer in order to determine if a Medicare Supplement plan will benefit you.
How Medicare Works:
Every year, you must pay a set amount, a deductible, for your health care before Medicare pays its share. You can sign up for Part A and/or Part B insurance, but most people have both. You pay a monthly premium for Part B. Medicare only covers 80 percent of Part B services, leaving you with the other 20 percent to be paid out of pocket. Depending on your medical needs in a given year, that 20 percent gap can become a large financial burden.
For 2017, the Medicare Part A deductible is $1,316 a year, while Medicare Part B’s yearly deductible is $183. Once you have paid your deductible in health bills such as physician visits, outpatient hospital services, and covered medical equipment, then Medicare will pay cover the rest up to 80% for Part B, and 100% for Part A.
What Medicare covers
Medicare benefits are divided into two parts, Part A and Part B.
Medicare Part A (Hospital Insurance) — covers inpatient hospital care, skilled nursing facility care, short-term nursing home care, hospice care, and some home health care. (100% of your costs for up to 60 days in a hospital or up to 20 days in a skilled nursing facility.)
Medicare Part B (Medical Insurance) — covers annual wellness visits every month, ambulance services, orthotics and prosthetics, medical equipment, and mental health care. (80% of costs covered by Medicare.)
What Medicare does not cover
Annual physical exams except other than one annual wellness visit
Health care you get while traveling outside of the United States (Very limited exceptions)
Hearing aids, and most hearing exams
Long-term nursing home care for more than 100 days
Acupuncture, naturopathy, etc.
Most eyeglasses
Most dental care
Prescription drugs are not covered under Parts A and B, but it will cover some drugs in certain cases like immunosuppressive drugs for transplant patients, and oral anti-cancer drugs. For prescription drug coverage, you should consider signing up for stand-alone Medicare Part D plan.
How Medicare Supplement Works:
There is a monthly premium for your Medicare supplement plan, and in return, the plan pays most of your expenses not covered by Medicare parts A & B. For example, if you have a $4,000 ambulance bill and have already met the yearly Medicare Part B deductible, Medicare Part B will pay 80% of the bill. This leaves you to pay the 20% that us left, $800, out of pocket. But if you have a Medicare Supplement plan that covers Part B copayments and coinsurance costs, then it will pay the $800 remaining.
The Medicare Supplement Open Enrollment period is the six-month period that starts on first day of the month that you are 65 and enrolled in Medicare Part B. During the open enrollment period, you can enroll in any Medicare Supplement plan offered in your service area with guaranteed issue. This means that insurance companies are not allowed to deny you or charge you more due to pre-existing conditions. There are many different types of Medicare Supplement plans to choose from, and they vary in levels of coverage and cost.
What Medicare Supplement covers
In general, all Medicare Supplement plans cover at least part of:
Medicare Part A and Part B deductibles
Skilled nursing facility costs after you run out of Medicare-covered days
Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used)
Medicare Part B coinsurance or copayment
Part B excess charges
Part A hospice care coinsurance or copayment
Blood (first 3 pints)
Some will cover:
Foreign travel emergency (up to plan limits)
Part B deductible
Two Medicare Supplement plans (Plan K and L) include an out-of-pocket limit. Once you have reached a certain amount spent on Medicare-covered services, the Medicare Supplement plan will cover 100% of the costs for the rest of the year.
What Medicare Supplement does not cover
Medicare Supplement policies generally do not cover:
Long-term care (care in a nursing home)
Routine vision or dental care,
Hearing aids
Eyeglasses
Private-duty nursing.
Prescription drugs
Looking for more details or help?
There are roughly 10 different types of medicare supplement plans on the market, and they all vary in coverage and cost. Figuring out which plans are best for you can be hard, but we are here to help. If you would like to gather more information on Medicare and Medicare Supplement plans, one or our highly trained agents are ready to help. You can start by simply entering your zip code in the bar above to get a quote, or you can contact us by email at [email protected] or call 855-220-1144. There is no hassle and no obligation. We will help you answer any questions, go over all of your plan options, find the Medicare Supplement plan most suited for your needs and budget, and even help you sign up if you’re ready. No hassle necessary! We work on your time and do not hound you with calls like the other guys.
The Federal Government has extended the time to sign up for Medicare, mainly the relief period, also known as the Special Enrollment Period (SEP), for people through September 30.
Normally the annual open enrollment for Medicare is January 1st through March 31st. This time is when people who missed signing up for Medicare Part B at the time they were supposed to. Generally the time to sign up is three months before you turn 65, the month of when you turn 65 and the 3 months after that month. For example, if your 65th birthday falls in February, you can sign up November through May. If you miss this period you must enroll during the Special Enrollment Period.
During the January 1-May 31st Special Enrollment, people will have to pay a late fee based on how many years you delayed signing up from your eligibility. Also, your coverage will not start until July 1st.
The federal government expanded the special enrollment period until September 30th. The time expansion is mainly for those who enrolled in marketplace insurance when they could have enrolled in Medicare after losing their spouse’s job-based insurance or their own plan. The fees that would normally be charged for late enrollment will be waived through this relief process. There will also be no gaps in coverage when enrolling late.
“CMS’ decision to expand equitable relief will help even more people hampered by costly penalties and those going without needed health care,” said Joe Baker, president of Medicare Rights. “We applaud CMS for doing right by people new to Medicare, and we look forward to working with our agency partners, State Health Insurance Assistance Programs (SHIPs), local Social Security Offices, and others to help people access this critical relief.
If you qualify for the time-limited equitable relief, or have questions, you can go online and even apply atwww.medicareinteractive.org.
The Centers for Medicare and Medicaid Services, CMS, has announced that beginning in 2019, there will be a continuous Medicare Open Enrollment Period which will now be January 1- March 31st. During this time, Medicare beneficiaries will be able to to make a one time change of plans.
In 2011, the Affordable Care Act changed the Annual Election Period (AEP) to October 15 through December 7 every year and changed the Open Enrollment Period (OEP) into a Medicare Advantage Disenrollment Period (MADP) which was January 1-February 14. During the Disenrollment Period, you can drop your current Medicare Advantage plan and can return to Medicare and purchase Medicare Supplement. You can purchase Part D plan but only if you drop your Medicare Advantage Prescription Drug Plan, MAPD.
The 21st Century Cure Act that just passed and signed into law is bringing back the Open Enrollment Period dates. During the AEP, beneficiaries can change switch as much as they want but a final decision will be by December 7. The AEP will still during October 15- December 7 every year where beneficiaries can:
Switch from Original Medicare to Medicare Advantage Plan
Switch from Medicare Advantage Plan back to Original Medicare
Change Medicare Advantage Plans
Enroll in a Part D plan
Drop prescription drug coverage
Switch or purchase Medicare Supplement Plan
During the 2019 OEP, January 1-March 31st, beneficiaries can make a one time change to:
Medicare Advantage Prescription Drug Plan to another MAPD
Switch a MAPD to Original Medicare and a Part D
Switch Original Medicare and Part D to a MAPD.
Change Medicare Advantage Plans
Switch from Original Medicare to Medicare Advantage Plan
Switch Medicare Advantage Plan to Original Medicare
Purchase Medicare Supplement Plan when switching to Original Medicare*
*When purchasing a Medicare Supplement Plan during OEP, you will not have guaranteed issue and subject to underwriting.
The AEP can be a hectic time for many Medicare beneficiaries because it falls during the holidays. Some people will wait until the holidays are over to try and change plans and find out they cannot do it until the next AEP in a year. Now, with this new OEP, from January 1-March 31st, beneficiaries can help those that missed the deadline to have another chance to make changes.
What Medicare covers
What Medicare Supplement does not cover
In 2011, the Affordable Care Act changed the Annual Election Period (AEP) to October 15 through December 7 every year and changed the Open Enrollment Period (OEP) into a Medicare Advantage Disenrollment Period (MADP) which was January 1-February 14. During the Disenrollment Period, you can drop your current Medicare Advantage plan and can return to Medicare and purchase Medicare Supplement. You can purchase Part D plan but only if you drop your Medicare Advantage Prescription Drug Plan, MAPD.