Just a couple of quick reminders.
Open enrollment for the health insurance Exchanges (HIX) starts tomorrow morning at midnight. Open enrollment will run through February 15th. If you want coverage to start for January 1, 2015, you need to have selected your plan and acknowledged the right of the insurance company to bill you by December 15, 2014.
Open enrollment for Medicare is ongoing right now. It closes out on December 7th. Traditionally the busiest day of open enrollment for Medicare Advantage and Medicare Part D prescription drugs is the Monday after Thanksgiving.
Enrollment is always open for CHIP and Medicaid.
Enrollment is open at the discretion of your employer if you are covered through work.
Now onto the reminders for HIX open enrollment.
I would strongly recommend that everyone who has a current HIX/individual Obamacare policy to go online over the next week or two to look at their choices. They are scheduled to be automatically renewed in the same plan or a near analogue of the same plan if that plan is cancelled by the insurer for 2015. This could be bad news for a variety of reasons. It could be bad because the plan itself could have been the wrong plan for the family. It could be bad because circumstances changed and changing metal bands could be a reasonable response. It could be bad because the post-subsidy costs could change.
Post-subsidy costs will change for a lot of plans. This will happen for a number of reasons. Plan prices will change in and of themselves. Some will go up, some will go down. More importantly, the market mix within a county is often changing. In my region the Silver market went from four insurers and eleven plans last year to six insurers and twenty nine plans this year. The company that had both the cheapest and second cheapest Silver this year issued the same basic plan design as its low cost options. They were a bit aggressive on their 2014 pricing and raised rates by 9% for 2015. The three other insurers from last year (including Mayhew Insurance) massively undercut the 2014 2nd Silver by embracing very narrow networks and HMOs. So the 2014 2nd Silver which sets the benchmark subsidy level is now the 9th Silver. The subsidy benchmark in my region is 3% lower than it was in 2014. That type of undercutting will mean that the people who auto-renew their 2014 2nd Silver plan which had them paying $99/month will now see $200/month premiums in January.
For people who are buying insurance on the Exchanges for the first time this year, I recommend that you spend a couple of hours this week looking at the plans available on the Exchange and ask yourself the following questions:
- How much can I afford to spend every month
- How much can I come up with at once to cover a medium size emergency (say a broken wrist)
- Do I have any pre-exisiting conditions that dictate me seeing a doctor every month/quarter/year with expensive testing etc.
- How comfortable am I with taking medium to large size financial risks?
- Who are the doctors and hospitals that I want to use? Does it matter, or will any doc be good enough?
- How often do I travel out of region so do I want a national network or a local network with national emergency room coverage?
- Am I on the borderline between Medicaid and Cost Sharing Silver and should I manage my finances to land in one of those categories?
- Do I have major life events coming up in the next year (birth of a child, retirement, moving to France for six months etc) and how do I deal with those changes
If I was buying insurance on the Exchange for the first time, I would not buy this week. I would look to find answers to the questions above and figure out what set of plans meet enough of the minimal qualifications and then intensely shop from that short list. I would probably seek to buy right around Thanksgiving for January 1st coverage to give me enough time to make a good decision while getting rid of the stress of making the decision.
Finally, ask for help. There are tons of navigators who will help you. They can lay out choices and options but they can not recommend plans. Brokers can recommend plans but they will often try to enroll people off exchange. That could be fine if you know you are not subsidy eligible, but you must go on the Exchange for subsidy. Ask for help, and people will want to give you good assistance.
raven
It ends for us today
raven
But now I know that we have private insurance even though we are a public entity.
MomSense
Thanks for this post, Richard. My health situation has changed (not dramatically so) a bit requiring lab work every 6 weeks/2 months and a regular prescription. When I chose my plan last time I didn’t think I would have to worry about co-pays for diagnostics so I am going to look for a better fit for my new circumstances.
On the whole, I have been really pleased with Maine Community Health (co-op).
Joy in FL
Richard,
I really appreciate the information you take time to lay out.
You mention navigators in your last paragraph. Would you name an example or two of navigators, please? I have no idea what those are.
I assume brokers are entities such as my local Humana office (I went there in August when I retired and gave up my sweet employer-sponsored health benefit. I had studied health plans online but saw that I needed help knowing what I was looking at). Are there other kinds of brokers?
I will just barely not qualify for a subsidy, so in that sense, my decision is simplified. I need something less costly for the upcoming year, and as you have pointed out, the multitude of choices is not helping me have a clear idea what to select.
The list of questions you provided is very helpful. I’m going to print it and mull my answers.
Again, thanks for all your help.
Violet
@raven: You’re a public entity? Do we start calling you Raven, Inc?
raven
@Violet: I work for you.
Violet
@raven: If you’re working for me, I need some help with the laundry.
Richard Mayhew
@Joy in FL: Navigators are people employed by non-profits who assist people with enrolling in government medical programs. The relevant ones for you are PPACA naviagotors who will help you with Exchange enrollment.
Here is a story on some:
And from the Miami Herald:
Xantar
In Maryland, if you have an Exchange plan, you need to re-apply in order to get monthly subsidies for 2015. Otherwise, you’ll get your subsidies as a lump sum when you pay your taxes in 2016. I’m not sure if that’s the case nationwide, but it’s definitely true in Maryland (I heard it from the exchange director). The Maryland Health Connection should be sending you notices and calling you about this anyway, but since MarylandHealthConnection.gov is open for browsing now (and actually works!), you owe it to yourself to check out your options.
eldorado
fyi: in my state, tribal members are not subject to open enrollment deadlines.
Kristine
The deadline for changing/renewing the plan from my employer (subsidized retirement plan) falls next week. I am going to check out the Illinois exchange to see what they offer, and am almost hoping that I don’t find anything that might make me consider switching coverage. We’ll see.
Violet
Are there Navigators in red states?
dance around in your bones
I thank Obama that I live in California and am a poor who qualifies for MediCal. I have had so many health issues since I came back from Baja that I’d be bankrupt right now, if I had any money to bankrupt :)
Once I get my hip replacement surgery and heal from that I will be a productive member of society again, AKA a worker bee. You would not believe the subtle hostility I get from people who find out I am (currently) on public assistance.
Joy in FL
@Richard Mayhew:
Thank you so much. I will be using this information!
Ruckus
@Violet:
LOL
Thanks! I needed that.
Mike E
If the Supremes strip my affordable health insurance, and I don’t find fulltime employment to continue my health coverage, I’ll be saying sayonara to NC and moving to a blue state. Oh well.
Ruckus
@dance around in your bones:
Don’t you know that you are just sucking the financial life out of those people, at the rate of what. 1/2000% of their income tax?
/snark
Real question, can be taken as rhetorical, why tell them? I tell people who ask that I won several million in the lottery and that’s why I’m still working at 65 and drive a 17 yr old POS van.
dance around in your bones
@Ruckus: I don’t know – because I am honest about how I get my medical care?
I obviously don’t have a job (well, since the fiasco last month) and had been taking care of my grandkids and doing laundry and cleaning and etc to pay my way for my daughter’s very generous support of me after my husband died.
So, when people ask me how I paid for a (probably) $80,000 hip operation, I have to tell them something! And now I am having a total hip replacement, which probably costs even more, paid for by MediCal.
I should probably keep my big mouth shut. I swear, I do get the ‘sucking off the taxpayers’ vibe once in a while, and that makes me feel bad.
Richard Mayhew
@Violet: yep, they are federally funded
Marina
If I understand correctly (based on a conversation with a Medicare rep), new Medicare enrollees–I enrolled last summer, and I think that still qualifies as new–have one chance, and one chance only, to switch to a different supplement plan. After the window closes, when the next open enrollment comes around, Medicare supplement plans can turn you down. Medicare Advantage plans will take you on during any open enrollment. Are supplement plans better than Medicare Advantage plans?
I will try again to find a navigator. So far, no luck, other than people who work for a particular plan, and will only try to sell you on that plan.
Thank you for whatever clarity you or other commentators might be able to shed on this weird situation.
Richard Mayhew
@Marina: I’m not sure. I don’t have great knowledge on Medicare procedures… just something that I never had to do much about.
VFX Lurker
@dance around in your bones:
Don’t. No one (except for maybe Scrooge) begrudges a cancer patient’s $1.5 million treatment, even though the money to pay for that treatment clearly comes from pooled employee resources and not from the patient’s personal savings. No one begrudges a Medicare patient’s heart transplant. No one’s going to give a vet grief for getting his stroke treated at a VA hospital. MediCal patients get the exact same deal as everyone else: the lucky pay for the treatment of the unlucky.
I swear, our society needs an attitude adjustment.
Wishing you an uneventful surgery and a full recovery.
VFX Lurker
I have an offbeat question for Richard. If someone enrolls in an Enhanced Silver plan for 2015, but they get an income increase later in the year, I would expect a premium subsidy adjustment. That part is clear.
However, does their Enhanced Silver plan then convert to a Silver plan for the rest of the year, or does the change in income count as a “qualifying life event” that lets them enroll in a different plan on the Exchange?
dance around in your bones
@VFX Lurker:
I thank you for that reply, because some of the subtle grief I get is from Family, doncha know – son-in-law makes a shit ton of money but they manage it badly ….. so it pains me to think that the tiny percentage of their tax $$$ is going to keep me healthy.
What, I should just die or something?
parsimon
@Xantar: Thanks for this, Xantar. I didn’t realize this about the new Maryland exchange.
Piquoiseau
@Richard Mayhew
I would be interested to see your take on this: nytimes.com/interactive/2014/11/14/us/Where-Federal-Health-Exchange-Rates-Will-Rise.html
It looks like states that set up their own exchanges and/or took the Medicaid expansion are less affected by rate increases, but then some states (Louisiana?) defy that interpretation. Upward or downward movements also seem to cluster geographically, but there are some very similar states (MN/WS; TN/KY) going opposite directions. What’s going on?
Also: the map shows the price for second-most-affordable Silver plans. There is supposed to have been a downward movement here in CA, but I checked today and Bronze plans are priced exactly as they were last year. You’ve written before about how competition for second-most-affordable Silver is higher due to the way the subsidies are figured; I wonder how that piece fits in with the story.
HeartlandLiberal
Also, for those of you retired and on Medicare, carefully review your Part D coverage for prescription drugs. You can input all your drugs at the Medicare online web site, and compare companies offering plans, see if your medications are in their formulary (hey, spell check thinks that is misspelled!)
We had been with Wellcare for three years, then they flat rejected a claim for 30 day extension of a life sustaining refill of a blood thinner which had been covered the first 30 days after wife’s major surgery. Claiming we had not tried two cheaper alternatives. Like, duh,this was for someone with afib and a pacemaker recovering from hip replacement and a continuation of medication specified by surgical team’s heart specialist. This is not time to play games, but approve what her heart specialist of 10 years has specified, and risk stroking out. (Perhaps you are sensing my contempt for Wellcare at the moment,)
So we used the web site, and found that by switching to a different provider the site identified after comparing the meds entered, ALL my wife’s prescriptions are now covered (Wellcare had already refused coverage on two ongoing expensive meds), plus the estimated annual cost is going to be over $1,000 less, and we can stay at our current pharmacy which is closest to our neighborhood. Wellcare was forcing us to move to Sams Club or Walmart next year, or pay a lot of extra copay on all tier levels. And I know what you are thinking, as soon as they said ‘we negotiated, and Sams Club and Walmart responded’, that should have been a clue to run screaming away right then.
Here is the Medicare web site. Review your coverage and costs. Don’t just sit and assume all is OK. All the providers change their plans every year, and you as a consumer should take advantage of the market driven competition for Part D coverage.You should do this review every November. (Or at least until you succeed in electing enough Republicans they destroy the Medicare program you and I paid into ever since 1965 or so. After all, we need to end these “entitlement” welfare program. Hmmm. I never knew insurance was a welfare entitlement. The things I learn as I age.)
medicare.gov/part-d/coverage/part-d-coverage.html