Are you struggling with what to do with facing a health insurance plan change for you and your family. You can work with a broker to help remove the stress out of making a health plan change by leveraging our expertise. We can help you compare options like Cobra vs the other choices you have for coverage. Call us today for your consultation. We can make this simple for you.
Individual Health Insurance Open Enrollment Period this year is only 45-days – November 1st through December 15th. This is your only time to purchase or make changes to your coverage. To purchase it any other time in the year, you need to have a SEP -Special Enrollment Period. Make it a priority to review your coverage and check your current plan’s network and ensure your doctors are still in the network. As a result of the network changes, do not assume because last year the provider was in network, they will be in their network the next policy year.
Carriers to Consider
The insurance carrier Oscar is a new company serving the Austin health insurance market. They are an EPO-Exclusive Provider Organization. An Exclusive Provider Organization (EPO) health insurance plan requires you to use the doctors and hospitals within its own network. As an EPO member, you cannot go outside your plan’s network for care. Also, note that there are no out-of-network benefits under an EPO health insurance plan. Oscar plan does allow for self-referral within the network. They as well have a Telemedicine included at no cost to allow you consult with an online doctor and they can prescribe for routine needs. You can check out Oscars product offerings and sign up with them using this link: Oscar 2018 Plans and Enrollment. They have Scott and White and Austin Regional Clinic (ARC) in the network.
Vista 360 Health
Vista 360 Health is another carrier worth checking out in the Austin market. headquartered in Austin, Vista has been growing their network of doctors. They have just added Austin Diagnostic Clinic (ADC) to their list of in-network doctors. Being a local carrier Vista 360 was familiar with and focused on their network of doctors starting with the two big groups ARC (Austin Regional Clinic) and ADC (Austin Diagnostic Clinic). All of Vista 360 plans have Telemedicine included at no extra cost, it can really save you a trip to the urgent care or the primary care office. They leverage the ARC Telemedicine, so the doctors are Austin doctors who support the service for Vista 360 Health. You can check out their 2018 plan using this link: Vista 360 Health Plans and Enrollment.
Now is a time to enroll in health coverage, or make changes to your plan selection. Take advantage to review all your options before the Individual Health Insurance Open Enrollment Period ends on December 15th, 2018. If you are confused, frustrated or need assistance in finding a plan, please work with a broker or agent. There is no charge to working with an agent to help you find the best options. We may even have suggestions you may not have thought about.
RF Insurance Masters, Ray Freer was included this month in the Advisors Magazine September 2017 issue page 38 with our view on the current situation of health insurance choices. As an insurance agent, it has been a difficult time trying to help our clients find the best coverage for their needs with the limited number of choices of carriers and plan designs. The largest challenges are the finding their doctors participating in the carriers Health Maintenance Organization (HMO) networks. In Texas we are limited to the HMO plans only not allow members to choose doctors outside of the network and have their visit covered. The other large challenge is how to keep the premiums affordable with the benefits the client is hoping to have. Sometimes it will force a client to give up some of their current doctors to make the premiums lower by choosing another carrier that does not have their doctor in network. For an agent, it has been a hard couple of years assisting clients and finding that the best choice for them falls far below their expectations. We hope that we will see more choices in health insurance and better networks as this affordable care act continues to evolve.
2018 Individual Health Insurance OEP – Open Enrollment Period
This year for the first time they will not have an extended enrollment period for the 2018 Individual Health Insurance OEP. To make changes or to enroll in a health plan
for 2018, you will have a 45-day window to make plan changes – November 1st, 2017 through December 15th, 2017. If you miss Open Enrollment Period (OEP) you can only enroll in a plan is you have a Special Enrollment Period (SEP). Make sure you take advantage of this time to evaluation the many new options you may have in your area. You do not want to let the opportunity to change plans be missed, otherwise you will be stuck with your current plan for another year.
Special Enrollment Period (SEP)
You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child. If you qualify for an SEP, you usually have up to 60 days following the event to enroll in a plan. If you do not have one of these SEPs, you will not be able to enroll in a individual health plan. As long as you are healthy, you can enroll in a short term health plan, that will cover you for 90-days. When you apply for these short term plans they do look at your medical history or if you have any pending medical needs. They can deny offering you coverage because of those conditions.
Association Health Plans
There are Association Health Plans that allow you to enroll any time during the year, but they do underwriting as well and will only let healthy people join the group. These Association Plans are true group insurance run by an Association. They allow you to join the group, you will get a full Affordable Care Act (ACA) Compliant Group coverage. These plans can really help clients that have missed the Open Enrollment and do not have a Special Enrollment Period.
Health Share Plans
Health Share Plans – these are not health insurance, but they can provide an Affordable Care Act exception from penalty. You can join these plans year round, they do have waiting periods on plans before they cover pre-existing conditions. These plans are as well a lower cost approach to protection and we have seen many people gravitate to this type of coverage. These are not health insurance though, so do you research on the various plans and make sure you know what you are purchasing.
Agents Assist You to Find the Best Coverage during 2018 Individual Health Insurance OEP
Finally, if you are having trouble trying to figure out which options would be best for you, work with an independent agent. Agents are familiar with the many health plan options that are on the market. The agent-broker can help you answer any questions or concerns you may have before selecting a plan. Independent agents can as well help you verify if your doctor is part of the plans network. With all the HMO plans we have in Texas, this has become the biggest challenge for our clients to find out if they can continue to go to their doctor. The agent can help you navigate the best options for you and your specific situation. You do not need to go it alone, contact an agent to assist you during 2018 Individual Health Insurance OEP.
Recheck your doctors are in network/accepting your 2016 Individual Health Policy, before enrollment period ends on 1/31/2016. Some directory errors can leave you without your doctor accepting
Shopping for individual insurance for 2016 has been quite different than in the past year. During the initial enrollment period starting in November 2015 there was mostly HMO (Health Maintenance Organization) and EPO (Exclusive Provider Organization) plans on the market. These are closed network plans that does not allow members to go out of the provider’s network for any medical services. All the major insurance companies Aetna, BCBS, Humana and United Health Care removed their PPO (Preferred Provider Network) plans from the market removing the flexibility to go to any doctor (in or out of network) while allowing self-referring to any specialist and smaller networks of providers that require referrals to specialists from the Primary Care Doctor. HMOs and EPOs do not allow out of network coverage.
The biggest challenge for people shopping for insurance is finding plans that will allow members to keep their doctors in 2016 on the available plans. This has been a challenge for many of our customers to find the plan that works. We have had a client that had seven doctors and they were forced to change all of them because no plan offered any of their doctors in network. The end result for this client was she had to accept changing all of her doctors. They as well needed to change from the flexibility of a PPO plan to a HMO or EPO.
We have as well found that the systems on the carrier’s website we used to check if your doctor was participating in a company’s network to select a plan may have been outdated or incorrect. This makes it very important to take the time to confirm that your doctors accept the plan you selected for 2016. We have had numerous clients contact us that they found out that their doctor does not take their insurance.
We have also discovered that some doctors will not accept any individual insurance, so that leaves loyal patients in a situation to decide if they should pay cash outside of their insurance to keep their doctor. Some of our clients do not have the means to do that so they will be forced to change to a new doctor.
If you are not satisfied with your health insurance choices and you own an LLC or small business a group insurance plan may be the answer to be able to get a PPO/POS plan that you were used to before this year. Ask an insurance agent broker about details to see if you can put a group together with your company.
For others take a few minutes to confirm with your doctor they really do accept the insurance plan you signed up for. You want to do this before the annual enrollment window closes. Once you miss the January 31 2016 date to select a plan, you will be stuck with this insurance for the entire year.
If you are not happy about the state of individual health insurance and the offerings, this is a good time to let your elected officials know what you are going through with your health insurance. I really do not think they know what the American people are having to deal with.
We want to ensure that when we help our clients select the best Medicare Prescription Drug Plan (PDP) for their specific prescription needs. As the annual enrollment period begins our clients are provide through the U.S. Mail a large number of advertisements to select the particular carrier’s prescription drug plans. They have great advertising literature that say some great claims of saving 80% on your prescriptions.
I can see how this can be very overwhelming as a person looking to help save on their prescriptions. The truth is the claims may be true for certain prescriptions, but how will the carriers plan do with your set of prescriptions? You cannot believe the information provided without doing additional research on what your prescriptions will cost. In some cases, you may find that that prescription plan advertisement you got in the mail may be 80% more expensive than another plan.
There is a tool out there I use as an agent to remove emotion and help select the best prescription plan for my clients. This tool is provided on Medicare.gov. I never though the tool from the government can be so useful to objectively look at the coverage from all the various options available in your area. The tool will let you select your prescriptions, your pharmacy, and show you your prescription costs monthly throughout the year. The site will show you when you fall into the Coverage Gap and estimate when you will reach the catastrophic coverage. The tool can give you piece of mind that you are actually going to find the best plan for your particular set of medicines.
To check you set of prescriptions is very easy to do with the help of your insurance broker, but you can do this by yourself. The Medicare.gov system will be able to save your prescriptions and zip code to allow you to visit again. This is great especially if you have many prescriptions. Once you are on Medicare.gov, you can select “Find Health and Drug Plans”.
Once the new page opens you will enter your zip code.
Next you will answer the questions “How do you get your Medicare coverage?“And “Do you get help from Medicare or your state to pay your Medicare prescription drug costs?” then click the “Continue to Plan Results”.
The next step is to enter your prescription drugs. Be very specific on your prescriptions, dosage and number of times a day that you take them. They will even ask how often you refill your prescription (monthly, 90-day or other).
Once you enter your first prescription, you will be able to save a couple of numbers that will allow you to retrieve your drug list.
Drug List ID: 3484910016
Password Date: 10/3/2015 (change date)
Zip Code: 78732
As shown below in the screen shot from Medicare.gov. If you have these 3 numbers you can return to the list at a later date.
Once your drug list is complete, click “My Drug List is Complete”. You will then be able to select up to two pharmacies, your favorite one and one additional pharmacy.
When you are done here, you select “Continue to Plan Results” Then you will be able to select if you want to look at Medicare Health Plans with Prescription drug coverage (MAPD) or Prescription Drug Plans (with Original Medicare) – the top two options.
Next for this example I selected the Prescription Drug Plans. Original Medicare costs are always shown at the top of the list, but if you scroll down you will see the plans sorted by annual cost. The annual cost is the cost of your prescriptions at your first pharmacy and this includes the annual premium as well.
We can drill down even more on the plan by clicking the “SilveScript Choice (PDP) title and see further details on your cost.
Two things are very clear on this top part of the details – the plans Star Ratings, how well the plan is rated by a variety of factors, the plan monthly premium, and the annual drug deductible. As you move further down the page, you can see the annual costs for premium and drugs at each pharmacy option and through the mail order program included with the prescription drug plan.
In the above chart there is a lot of information to help you review the costs for this plan on your prescription drugs. They show you the Full Cost of the Drugs, this is the retail cost for each drug on the plan. The Initial Coverage Level, this is the cost for the prescriptions you would expect to pay at the pharmacy for each prescription (shown in Green on the bar graph). The cost you will expect in the Coverage Gap (Donut Hole), shown in brown in the bar graph. The cost of your drugs in the Catastrophic Coverage, shown in Blue on the bar graph. The monthly premium is shown in grey on the bar graph. This graph can help you plan when you hit the Coverage Gap.
As you get close to the bottom of the plan details, they tell you what tier each medication is on the plans Formulary. They will as well tell you if your prescription is not covered on the Formulary.
When I help my clients we walk them through this level of detail to do the best job we can at estimating costs for them. We have found this Medicare.gov site is a great resource that can be very objective with the clients specific set of medicines. This is a free tool and gives you the most comprehensive estimate of your RX costs and plan costs throughout the year.
If you do have questions visit with a local broker to help you through the process. There is no extra cost for having someone help you find the best options. Don’t miss your change to make a change of plans if there may be a better option out there for you. The Annual Enrollment Period is October 15th through December 7th each year. Plan evaluation is an important part of your annual review of your coverage.
Loosing Group Coverage – COBRA or Individual Health Plan
The Affordable Care Act and changes for COBRA that you need to be aware of before you take the easy route and make your first COBRA payment. The laws have changes some with respect to COBRA. If you do make your first months COBRA payment, then they expect you to stay on that plan until you exhaust COBRA or hit an annual enrollment period. A loss of group coverage does give you a “Qualifying Life Event” that will allow you to enroll in an individual plan. My advice to my customers is to compare your COBRA options to the Individual Plan options either on the Healthcare.gov website or just direct from the carriers. There is no reason to enroll through Healthcare.gov unless you have a need for subsidized plan or you are getting additional benefits from them for being a Native American.
We would suggest working with a broker who will be able to advise you and help you compare coverages. Depending on your needs in a health plan and cost I have advised some of my customers that COBRA may be the best option. Other customers who have less needs can find ways to save on premiums with other individual options. Brokers will be able to guide you to find the best options for your health plan and RX needs.
Just know that if you pay one payment to COBRA you are stuck with it until the next open enrollment period. This is much different than it was in the past as we could drop COBRA at any time and enroll in an individual plan. So if you in the situation of looking at COBRA it is a good thing to compare your options before the commitment. The Affordable Care Act has added some twists to how health insurance works. Let a broker help you find the best solution for your particular needs.
We are now able to make changes to our individual health insurance plans under Obamacare open enrollment period begins on November 15th. We help people with updating and purchasing their individual health insurance on the marketplace (www.healthcare.gov) when you are looking to get a subsidy to help pay for the health insurance coverage for you and your family.
You can enroll with an licensed agent that will be your advocate to assist you with selecting a plan, and supporting you for any issues you have with your policy. Enrollment period for 2014 is from November 15 to February 15th. If you want to have a January 1st effective date, you must submit your application by December 15th.
Do you think you are eligible for a subsidy, below is a table to help you determine if you should look at going through the healthcare.gov with the help of an agent. Below is simplified table to assist you in determining your particular situation. Remember you are estimating your 2015 income.
My suggestion for health insurance subsidies is that you should be cautious on your income levels, if anything estimate on the high side as you may have to pay back subsidies if you underestimate your earning for 2015. If you estimate too low and your income comes in much higher, you may need to pay back thousands of dollars on your 2015 taxes.
We definitely help our clients find the best plan for their situation if they are enrolling with Healthcare.gov or if they are enrolling direct with the carriers. If you are looking at enrolling and you are eligible for subsidies, you can select the Silver Plans first. If you subsidy is enough you end up in the cost sharing band. When you are in this band, you will received lower deductible and max out of pocket with the premium subsidies. You could end up with a Silver plan with a $500 deductible with $750 annual max out of pocket. I did run into some people who did enroll with the plan Bronze plan, because they did not notice the plan deductible savings on the Silver plans. I did talk with them as they were disappointed in the choice that had made when they did it by them self.
The bottom line is that you should work with an agent who can best advise you for coverage either on or off of the Healthcare.gov site. There is no charge for the help and you would have an agent that will assist you with any questions or problems you may have. Don’t miss the enrollment window for Obamacare as to have a January 1st effective date you must submit an application by December 15th. For 2014 the Open Enrollment Period is from November 15th to February 15th 2015. If you do not make changes during this time, you can not purchase health insurance unless you have a valid qualifying event.
Starting on November 15th, the 2015 Open Enrollment Period Health Insurance begins for changes for all individual insurance plans. We expect all carriers to release their rates just before the 15th of November for the 2015. This is for both on the Healthcare.gov or through the various insurance providers. The Open Enrollment period for 2015 is from November 15, 2014 – February 15, 2014. To get coverage for January 1, 2015, you must have your application submitted by December 15, 2014. If you apply by the 15th of the month you can get coverage the first of the following month through the Open Enrollment Period.
Last year we saw many issues with the Healthcare.gov site, this year should be smoother. We have seen many clients who tried to enroll on the Healthcare.gov to help get subsidies that did not know that a local insurance agent can assist with the enrollment process. An agent has a strong understanding of the plans on the market and know how to guide you to find the best plan for your specific situation. The agent can be your advocate should their be any issues with your coverage either on or off the Healthcare.gov site.
We did see people who did make mistakes when they enrolled without assistance purchasing a Platinum, Gold, Silver or Bronze plan. If you are getting a subsidy, it makes sense to check out the Silver plans because they do offer cost sharing for some who are eligible for a subsidy. Cost sharing does lower your deductible and out of pocket costs automatically. When you work with an agent we can help you see the savings on those plans to ensure you maximize your benefits.
If you are not receiving a subsidy, there is no reason to enroll through HealthCare.gov unless you are looking for a multi-state coverage. You can purchase these plans without HealthCare.gov. Your local agent can help you enroll.
There are three advantages for you to work with a local independent broker to help you sign up for your health plan on or off healthcare.gov. First is a personal advice and guidance to find the best plan for your needs, an advocate to assist you with issues once your policy is issued, and lastly helping others in your community by supporting their local business. If you buy direct, the insurance company will take the commissions that the agent would have made, and the money does not stay in your community.