On January 28, 2021, President Biden signed an Executive Order directing the Department of Health and Human Services (HHS) to open healthcare.gov for a three month special enrollment period (SEP).
Usually, the Open Enrollment Period for new health insurance or changes to a current plan is from November 15-December 15 of every year for the following year’s coverage. In the past, if you needed new coverage or changes made outside of that time frame, you would have to qualify by having a life event such as marriage, divorce, birth, adoption, loss of employer-provided coverage, etc.
This Period for 2021 is from February 15-May 15 to provide an additional opportunity for uninsured and underinsured Americans to enroll in coverage in the face of the COVID-19 pandemic. Coverage would be available as soon as the 1st of the following month. This applies to both subsidized plans (with premium assistance based on income qualifications) in the Marketplace and non-subsidized plans that are considered Off-Marketplace.
According to Florida Blue, here are a few tips if you are in the market for new health insurance or to make changes to what you currently have:
- Starting February 15, consumers seeking to take advantage of this SEP can find out if they are eligible by visiting healthcare.gov or speak with an agent. The application process and plan selection can either be done online or through an agent as well.
- Consumers who are eligible and enroll under this SEP will be able to select a plan with coverage that starts prospectively the first of the month after plan selection. Consumers will have 30 days after they submit their application to choose a plan.
- Current enrollees will be able to change to any available plan in their area without restriction to the same level of coverage as their current plan. In order to use this SEP, current enrollees will need to go through their application and make any changes if needed to their current information and submit their application in order to receive an updated eligibility result that provides the SEP before continuing on to enrollment.
- Consumers won’t need to provide any documentation of a qualifying event (e.g., loss of a job or birth of a child), which is typically required for SEP eligibility.
HHS has published a fact sheet here: https://www.hhs.gov/about/news/2021/01/28/hhs-announces-marketplace-special-enrollment-period-for-covid-19-public-health-emergency.html providing additional details on implementing the healthcare.gov SEP as well as an CMS fact sheet here: https://www.cms.gov/newsroom/fact-sheets/2021-special-enrollment-period-response-covid-19-emergency with more technical details.
Health care is a hot topic of conversation lately in politics since the Affordable Care Act and now numerous methods of reform are being discussed. But also with regard to the economy since the cost of care seems astronomical lately. Many argue that one of the drivers behind a lot of that cost increase is prescription drugs.
According to data analyzed by 3 Axis Advisors (a health care research firm), retail prices for 460 prescription drugs are increasing by an average of 5.2% in 2020 – more than double the projected rate of inflation for the year. Many manufacturers are raising the prices on existing drugs as well, so it isn’t just new therapies being introduced.
While patients typically don’t have a say in the diagnosis or treatment plans they receive from medical professionals, they do have a choice (and a right) to look into where they get prescription medications from. You, as the patient, owe it to yourself to do a little bit of research and get your drugs at the lowest cost possible to you.
Here are a few ideas to explore so you can be sure you’re doing all that you can as an advocate for yourself:
• Sourcing for lower cost – A common misconception is that one drug will cost the same regardless of where you have the prescription filled… Publix, CVS, Walgreens, Winn Dixie, etc. There are tools such as GoodRx that allow you to search specific drug names and find the cost at different retailers in your area.
• Coupons – There are websites online, the manufacturer itself, and retailer coupons that can provide significant savings. Some pharmacists will check for coupons on your behalf but not always.
• Websites such as Drug Store Unlimited that get drugs from other countries can also save money.
• Patient assistance programs – Ask your doctor about programs available in your area that may offer advice and guidance, more so with Medicare but also for individual health plans.
Just a few minutes of your time before you fill your next prescription could be very beneficial to you.
There’s Medicare Part A, B, C and D. All we need is another acronym, right? Well here’s OEP! Open Enrollment Period. This is the time of the year that any and all changes must be made for the following year’s coverage. Individual insurance for those under 65 as well as employer-provided group plans have this as well. But for those 65 or older on Medicare, go time is from October 15-December 7.
During this time, you can enroll in Medicare for the first time if you missed your eligibility window around your 65th birthday as well as make changes to the plan you have if you’re already on Medicare.
There are a couple of different options when it comes to Medicare. Once you have Parts A and B, you’ll need either a Supplement or Advantage Plan. You can read about the differences between the two here.
Supplements don’t change much from year to year but the Advantage Plan does get slightly revised, similar to individual under 65 plans.
For example, the only changes to the Florida Blue Advantage Plan (also known as the BlueMedicare Choice PPO) for 2021 coverage are the following:
• Specialist Physician copays are now $50 instead of $45
• Inpatient hospital care copays are now $345/day for days 1-5 rather than $295
• Routine hearing exams are now $0 copay for one per year, when it used to be $45
Regarding prescription drug coverage on the Florida Blue Part D plan, there were very few changes as well. Here is a chart that shows the two plans we offer in our area for 2021: 2021 part D summary
Of course everyone’s situation is different so please reach out to us to discuss your Medicare needs and we are happy to help during this year’s open enrollment period.
Asking for a friend, right? Nah, don’t be silly. Hearing loss is a real thing! According to the National Institute on Deafness & Other Communication Disorders, 8.5% of adults age 55-64 experience significant hearing loss. Technology today has created some pretty incredible hearing aids to solve this problem, however they can be rather pricey. It may not seem possible to put a price tag on the sound of your grandchild’s voice that warms your heart, a honking horn in traffic that keeps you safe, a movie you’d like to enjoy with your spouse, or your favorite song… but the reality is that, given how far they’ve come, the average cost of hearing aids in 2020 is around $2,500 each.
Individual insurance policies do not typically cover hearing aids and neither does original Medicare (parts A&B). Therefore a Medicare Supplement, such as the most commonly known Plan F, does not cover them either. Supplements only extend coverage to what original Medicare covers first so if it’s excluded by parts A&B, it’s excluded by the Supplement as well.
Some Medicare Advantage plans will offer coverage for hearing aids with a copayment. Medicare Advantage plans, such as the Blue Medicare Choice PPO from Florida Blue, take the place of original Medicare. They function more like an individual under-65 health plan in that they have copays, coinsurance, deductibles, out of pocket maximums and prescription drug coverage built in. These plans usually have a lower monthly premium but more out of pocket expenses for medical services. The Florida Blue Advantage plan that we have and are most familiar with has a copay of $699-$999 per hearing aid (with up to two aids per year), depending on the details of the aid itself.
Hearing aids and any available insurance coverage for them varies from plan to plan and company to company. If you’re considering them, please talk with your doctor and your insurance advisor to fully understand what may be available to you. We’re happy to hear out any questions you may have.
Medicare has been so closely associated with the age of 65 for so long now that many people think they can wait until they actually turn 65 to address their health insurance needs and begin that transition. With regard to eligibility and actually enrolling in Medicare, that’s perfectly fine since you have a 7 month window surrounding your 65th birthday to do so. However, there are several things to consider as you approach 65 that make it really beneficial to do your research and get things moving in that direction in advance. This being said, we encourage that you start this process at 64.5.
If you are still working, there are things to consider such as comparing your employer provided group coverage to that of Medicare for both coverage and cost. Another important factor is if you are contributing to an HSA, you must stop at least 6 months before going on Medicare for tax purposes. Also, if you currently have a spouse and/or family members on your plan that will need to come off, you’ll want some time to quote that and make arrangements financially as it can be much more costly than what you’ve been used to.
Whether you are working with a financial advisor or not, you will want to plan for Medicare financially and weight out your options. Gathering all of the information on Advantage plans vs Supplements and those cost differences will help you decide what aligns with your budget. There are also many prescription drug plans you can shop in order to make the right decision for you.
All of this can take time and there is no need to wait, which will only add more stress to an already somewhat overwhelming process. We have a 64.5 checklist that may be helpful if you’d like to see the steps we advise taking at that time. And of course, we’re always ready and willing to hand out some high fives for being on top of your Medicare at 64.5!