Author: Janet Trautwein

It’s Medicare Open Enrollment Season. Here’s What You Need To Know:

Medicare’s Annual Election Period is here. Beginning October 15, seniors will choose their Medicare plans for 2019. They’ll have to make their selections by December 7 for coverage that takes effect January 1.

The enrollment process will be different than previous years. This time, seniors will have the chance to “test-drive” plans at the beginning of the year— and select a different plan if their initial choice doesn’t meet their budgetary or healthcare needs.

That flexibility will ensure that Medicare meets the needs of its beneficiaries better than ever before.

Medicare covers about 60 million Americans. Seniors become eligible for all of the program’s components— Parts A, B, C and D— when they turn 65.

Part A pays for hospital stays. Part B covers doctor visits, same-day surgeries, and potent medications administered in physicians’ offices. Part D is Medicare’s optional prescription drug benefit.

Part C, also known as Medicare Advantage is administered by private insurance carriers and places a cap on the out-of-pocket expenses not available on Parts A and B of Original Medicare. Part C typically includes the prescription drug benefit at no additional cost.

More than 20 million Americans are enrolled in 2,300 different Medicare Advantage plans, each with its own mix of benefits, monthly premiums, copays and out-of-pocket spending.

Deciding on a plan can be tricky. Beneficiaries must consider lifestyle factors, how much they can afford to spend, and what their future health needs may be.

In recent years, Congress didn’t make those decisions easier. Since 2011, seniors who chose a Medicare Advantage plan had 45 days to “disenroll” if it wasn’t right for them. But their only alternative was enrolling in traditional Medicare.

Thankfully, that won’t be the case anymore. Next year, beneficiaries who enroll in a Medicare Advantage plan will have the ability to switch to another Advantage plan at any point within the first three months of 2019. The change gives seniors much more flexibility and can make open enrollment less stressful.

Seniors may find all these options empowering— and overwhelming. Fortunately, help is available.

Medicare.gov contains a wealth of information that can offer assistance to beneficiaries.

Seniors can consult licensed health insurance agents and brokers. Many have decades of experience and are specially trained to educate consumers. Nearly three-quarters of agents and brokers spend a significant portion of their time explaining coverage to clients and investigating consumer insurance options.

Agents and brokers can help seniors determine which Medicare Advantage plan would be best for them— or whether they’d be better off enrolling in traditional Medicare.

Those who live in a FEMA-declared disaster area during the Annual Election Period may qualify for a Special Election Period outside of the normal enrollment window. Seniors can ask an insurance professional if a Special Election Period has been announced.

Medicare covers nearly one in five Americans. This open enrollment season, that population will find that they have more choices— and more flexibility. Savvy seniors should take advantage.

Janet Trautwein is CEO of the National Association of Health Underwriters. For more information, visit the website: www.nahu.org.

Confusion shouldn’t stop patients from buying health insurance

This year’s Affordable Care Act open enrollment period started on November 1. Millions of Americans will soon visit HealthCare.gov or the online insurance exchange run by their state to shop for 2018 health plans. Many will be confused by what they find.

Premiums have increased significantly. The most popular “silver” exchange plans cost 34 percent more on average, than they did in 2017. Skimpier bronze plans cost 18 percent more. Generous gold plan premiums have risen 16 percent. Many insurers won’t offer exchange plans at all. There will be just a single exchange insurer in nearly half of all counties.

Luckily, Americans don’t have to settle for exchange plans. They can also buy coverage “off-exchange.” And they may want to consider consulting a certified health insurance agent or broker to determine whether exchange or off-exchange plans are right for them.

Exchange plans are generally more attractive for individuals and families who earn less than 400 percent of the poverty level. That’s because these folks— individuals taking home less than $48,240 or families of four bringing in less than $98,400— qualify for subsidized coverage. But they can only claim those subsidies through the exchanges. Off-exchange plans aren’t subsidized. So they may be a better fit for the roughly 40 percent of Americans who earn too much to qualify for subsidies. Some of these plans also generally allow enrollees to visit a wider range of doctors and hospitals. About 5.4 million people purchased off-exchange plans in 2017.

Most people could use assistance when picking a plan. Less than four in 10 Americans are “very confident” that they can select the health insurance plan that’s right for them. Only four percent of people can define common insurance terms like “deductible,” “co-pay,” “coinsurance,” and “out-of-pocket maximum.”

Health insurance agents and brokers can help these folks understand the benefits and drawbacks of various plans. Most of these professionals have 10 or more years of experience in the industry. Three out of four spend “most” or “a lot of” their time explaining options to clients.

Consumers who have sought assistance from agents and brokers in the past have been extremely satisfied. Nearly 84 percent of people who requested assistance when shopping for plans in 2014 said insurance agents and brokers were helpful. That’s a higher satisfaction ranking than any other source of help.

It’s easy to see why agents and brokers are popular. They’re often able to find better deals than consumers would have found on their own. Premiums are 13 percent lower in counties with the most brokers. Plus, agents and brokers generally don’t charge for advice.

These professionals play a pivotal role in helping people sign up for coverage. In California, for instance, agents and brokers signed up 525,000 people for exchange plans in 2014. That represented 40 percent of the state’s total exchange enrollees.

Their services will be even more important this year, given some recent changes to the Affordable Care Act. This year’s open enrollment period in HealthCare.gov only runs 45 days, until December 15. In past years, it ran until late January, and will run longer this year in some state exchanges. The federal Department of Health and Human Services is also not spending as much on advertising open enrollment this year. So fewer people may even be aware that they need to sign up.

By helping people sign up for either exchange or off-exchange plans, brokers and agents can ensure a larger, more representative pool of enrollees. That will help stabilize the individual market and reduce future premium spikes. Americans only have a few weeks to decide on a 2018 health plan. They can ensure they make the right choice by calling in some professional help.

Janet Trautwein is the CEO of the National Association of Health Underwriters.