Autumn is a busy time for everyone, school has started, lots of sports are going on, Halloween, Thanksgiving, Christmas, you get the picture. For those of us with Medicare or ACA insurance plans, it's also Open Enrollment time. During this time, you can make changes to your coverage or select a new plan. Each September, I receive an update from my insurance plan that compares last years rates for premiums, co-pays, deductibles and other expenses with what I will can expect to pay next year. My insurance company makes it easy for me to decide if I want to continue with the plan or not. Sometimes patients may receive notice that their plans are being discontinued or changing plan types. Patients and their caregivers need to be aware of the changes in their plans so they don't lose coverage or pay more out of pocket than they had been.
Open Enrollment dates for 2019 are:
- Medicare - October 15 to December 7, coverage starts January 1, 2019.
- Healthcare.gov - November 1 through December 15, coverage starts January 1, 2019.
- Medicaid and Children's Health Insurance programs - open all year around
- Employer plans vary by company and it's best to check with your HR department for specific questions.
Insurance is confusing and there are many things to consider when looking at insurance:Do I want an HMO or PPO? What's the difference?
- Do I want to go with Original Medicare or an Advantage plan?
- What will my premiums, co-pays, deductibles and out of pocket maximums be?
- Are my physicians, hospitals, and other providers covered under the plan?
- Does the insurance cover Nutrition Support - TPN or Enteral?
Medicare.gov does a good job of allowing you to look for insurance plans in your area and telling you the basics from a financial perspective. However, if you want to find out if your provider is In-network with the plan, it's best to call the insurance plan or provider to inquire if your providers are in-network.
The Affordable Care Act plans (ACA) can be found on at healthcare.gov but their plans for 2019 are not available until Open Enrollment opens on November 1st. The ACA will ask you questions concerning your income to determine if you are eligible for premium assistance as well as co-pay and deductibles. If you are unable to get employer coverage through your own employer or your parents, this is a good place to start. However, you can always look at individual companies (Humana, Anthem, United Healthcare, etc) for plan options outside of the ACA.
I have always managed our families healthcare coverage. Now I need to look at Medicare for me and separate coverage for my boys. Several years ago, I leaned the hard way what happens when you don't pay attention to plan changes. The Medicare plan I had switched from an PPO to an HMO which I didn't pay much attention because all my providers were In-Network with the plan. Fast forward 2 years later and I received notification that the insurance company was dropping my Infusion Provider, ThriveRx, from their In-Network provider list in October 2016. Since my plan was now an HMO, I knew they weren't going to pay for ThriveRx services and had to switch providers for several months. ThriveRx had been my only infusion provider since I went on TPN 8 years ago and they know my history and me. Luckily Medicare Open Enrollment started on October 15th so I immediately started looking for a new plan with a different insurance company that wasn't an HMO. At the beginning of 2017, I was back with ThriveRx and my team.
The bottom line is don't delay in reviewing your insurance plans for next year. You don't want to find out in January that your favorite Doctor is no longer covered and are stuck with that plan until 2020. Feel free to reach out to me if you have any questions, I know a little and can try and help you. In a perfect world, everyone would be covered no questions asked so I am just trying to do my part in helping you stay covered so you can keep Living, Loving and Laughing through all the other insurance headaches!
Love to all,
Michelle
Don't be like this:
