- Medicare Advantage & Medigap Plans are Private Insurance Offerings
- ACA Marketplace Plans Can Change in Your Zip Code Each Year
- Everyone Without Employer-Provided Health Insurance Needs to Shop Each Year
Halloween candy is on clearance and Christmas decorations are front and center, but aren’t we forgetting an important holiday? No, not Thanksgiving; we are in Open Enrollment Season. Medicare open enrollment runs from Oct 15-Dec 7 and Affordable Care Act Marketplace enrollment is Nov 1-Dec 15. In the rapidly changing landscape that is the US healthcare system, it has never been more important to evaluate your healthcare options on an annual basis. Let’s discuss the decision points that need your focus.
Medicare: Ages 65+
Medicare is the federal health insurance program for those 65 and older. In most cases*, everyone should sign up for Part A (Hospital) and Part B (Medical) starting three months before their 65th birthday. Medicare participants seeking additional coverage need to review their options during open enrollment. Medicare Advantage, also known as Part C, are plans that bundle coverage such as dental, vision, and prescription drugs in an “all-in-one” alternative to Original Medicare. A separate alternative is a Medigap plan, a supplemental policy that sits on top of Original Medicare to cover costs like copayments, coinsurance, and deductibles.
ACA Marketplace: If You Don’t Get Employee Health Insurance
The ACA Marketplace is also known as the exchange, Obamacare, or by its website Healthcare.gov. Since 2014, private insurers have offered plans on the platform, priced by plan type and zip code. Premiums, deductibles, and out of pockets maximums have changed over time and are almost always more expensive to the participant than any employee-provided health plan. Shopping your plan is important not only to confirm you have the best plan each year, but for budgeting purposes; premiums have experienced double digit percentage increases and decreases annually.
Which Policy Is Right For Me?
Just refer back to the title above: Healthcare is Now an Annual Decision. Medicare Advantage and Medigap plans, while conforming to federal requirements of these plans, are offered by private insurers. The same is true for Bronze, Silver, and Gold plans on the ACA Marketplace at Healthcare.gov. Two insurers can and do charge different prices for identical coverage. And one insurer can alter their offering over time in a specific market. The best practice is to shop each year based on your individual needs. This means using available tools to estimate your particular costs based on which doctors you see and which prescription drugs you take.
For Medicare participants, we have referred clients to independent health plan advisory professionals who stay abreast of the market and can help you shop. They can find your best option at no cost to you, since they are compensated by the private insurers offering the plans; premiums are the same whether you buy direct or through an advisory service. We are happy to make these introductions and would encourage anyone who is not shopping on an annual basis to start this year.
ACA Marketplace participants should follow the same process at https://www.healthcare.gov/see-plans/. It is important to examine your plan annually, as insurers have entered and exited various geographic regions in the first few years of the program. Your current plan may not be your best option for next year.
To reiterate one piece of advice for everyone: if you have thawed out your Thanksgiving turkey and not yet shopped your health insurance, get on it!
*Medicare Parts A&B have late enrollment penalties. The most common exception is a 65 yr old still working for a company with 20+ employees that provides an eligible health plan. https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b/should-i-get-parts-a-b