Tidbits from the Medicare & Individual Healthcare (Under Age 65) markets
Here are some thoughts you may not know, but you may find useful–either for yourself or for someone you know.
On the healthcare front:
If you find yourself or someone you know who did not apply for health insurance before the end of annual enrollment for Illinois residents, there is a box on their Illinois State Tax Return that can be checked stating that they don’t have insurance. This will trigger a Special Enrollment Period (SEP) providing 60 days to create an account at Get Covered Illinois (getcoveredillinois.gov) and select a plan. I can help with selecting a plan, as it can be pretty confusing.
Other events that trigger a SEP are life events like marriage, divorce, pregnancy, or job change, prompting loss of health insurance or loss of Medicaid benefits.
On the Medicare front:
Many insurance carriers are raising the prices for Medicare Supplement Plans. This typically occurs in the company’s fiscal year. Letters indicating an increase must be mailed within 60 days of the increase. If you receive such a letter, you have the option to select a new plan, subject to underwriting. You are allowed to change carriers anytime throughout the year as long as you are getting either more benefits or a better price.
Each carrier has its own criteria for underwriting–but generally will ask for information regarding the history of cancer, HIV, autoimmune disease, and respiratory or cardiac issues. Insulin-dependent diabetics also can have issues with underwriting. Depending on your health challenges, many clients have been able to change plans.
What happens if you are prescribed a new medication throughout the year that is not on the formulary (list of approved meds) for the Part D (drug) plan you are on? First, each plan, by law, must have two medications from each therapeutic category of meds. When you are prescribed a med that is not on the formulary, the company that offers the plan would prefer you try the two that are offered on the plan. Discuss this with your doctor. If one of them will meet your needs, then you will have plan pricing. If, however, the only med that will solve your particular issue is not on the formulary, the doctor must file an appeal with the carrier. Then, the price you get through your plan will be full price for the remainder of the year. You can change plans each year during Annual Open Enrollment from October 15–December 7. You should also always consider GoodRX or SingleCare to see if there is a coupon that will reduce your cost. Using either of these will not count toward your drug plan deductible, but if the cost savings are great enough, then you are still ahead.
If there are topics of interest to you, let me know by sending a note through my website.
Attend a free Medicare Workshop on Tuesday, March 10, at 6 p.m. at Town & Country Public Library in Elburn.
Mary Hansen is a licensed insurance consultant (broker) with American Republic Insurance Services. She looks forward to answering your questions. You can submit them to her website: maryhansenmedicare.com Phone: 630.286.9160 You can also find her on Facebook: https://www.facebook.com/foxvalleymedicarehelp/ Look for her daily posts!
