Just a quick reminder. Open Enrollment Periods(OEP) for the ACA and Medicare are getting closer to the end than the beginning.
OEPs allow people to switch insurance carriers and plans for any reason at all. Coverage chosen in the next two weeks will start on January 1, 2023.
Medicare Annual Enrollment Period (what they call their OEP) ends on December 7th.
This is for Medicare Part D (drugs) and Medicare Advantage for people who are already in Medicare Advantage or want to switch to Medicare Advantage from Traditional Part A and Part B Medicare. Get in gear now!
The ACA OEP for Healthcare.gov goes through January 15th. However, for coverage that starts on January 1, 2023, plans need to be chosen by December 15th. A couple of state based marketplaces will give you a tiny bit of extra time, but don’t count on it. If you live in Idaho, ACA open enrollment ENDS on December 15th!
Get moving.
If you need help, drop the question in comments.
MomSense
Question for my kid. He needs to sign up for insurance but he is unsure of income. He left his job to buy an investment practice and I don’t think he knows exactly what his income will be. I told him that I thought he could estimate his income but that I would ask the insurance guru.
ETA: He also got married in September.
Quinerly
Good morning! Please excuse my ignorance on this. I was self employed for last 5 years of my law practice. Private insurance thru BCBS of Missouri. I have early retired and have moved to New Mexico (April, 2022). Still insured under BCBS. I am turning 62 in February. Have decided to go ahead and start taking Social Security at age 62. I have done no research re Medicare. Do I sign up for next year now? I am actually very embarrassed that I really know nothing about the mechanics and timeline re this. My excuse….and I am sticking to it….is I have never been sneaking up on 62 before. Many thanks for any advice.
Gin & Tonic
@Quinerly: I am not David, but one is not eligible for Medicare until one turns 65 (absent some very special circumstances.)
narya
I’m getting severanced out; last day is next week, but they’ll cover health insurance through January. I can apply in January, correct?
David Anderson
@MomSense: Congratulations to you, him and his partner.
If his partner has an affordable offer of insurance through work that also covers him, he is not subsidy eligible.
If his partner does not have an affordable offer of insurance through work that covers him (but may cover the partner affordably), then your son is ACA subsidy eligible.
The income estimate is expected to be a good faith estimate of how much he expects to make in 2023 once certain deductions and exclusions are applied (Modified Adjusted Gross Income). If there is a big difference between what he reports on his taxes for the current year (2021 is what the IRS can see today) and what he projects for 2023, he may be asked to provide justification. A new business is a reasonable justification. He can also buy a plan on the marketplace that is subsidy eligible, pay cash for it in 2023 and get a big tax refund in 2024 if he qualifies for subsidies.
The biggest thing is that as his income changes, he should update his account’s estimated income for 2023 as soon as possible if he elects to collect in-year subsidies at all.
narya
@Quinerly: I can answer that one, I think: you’re not eligible for Medicare until you turn 65. The Medicare dot gov website is quite good, if you want to do some reading on your own.
Quinerly
@Gin & Tonic: like I said…had done nothing to look into it
Thanks for piping in. Much appreciated. Never dreamed I would now be in my 60’s.
David Anderson
@Quinerly: Unless you have ALS or End Stage Renal Disease or qualify for SSI disability income, getting Medicare at Age 62 is nearly impossible.
If you still have coverage through BCBS-Missouri, you can sign up for an ACA plan once you get notice of coverage termination at any point during the year. If you are moving to New Mexico, the state based marketplace makes it so that if you earn over 200% FPL (~$28,000 for a single person) Gold or Bronze plans are massively superior choices to Silver plans from the same insurer/network.
Quinerly
@narya: the one time I wanted to jump the gun.
I just spent 2 months researching dishwashers. I usually never jump the gun. 😉Methodical. And obviously have given little thought to SS/Medicare until now.
Thanks!
Quinerly
@David Anderson: thanks! Much appreciated.
David Anderson
@narya: Correct, you will qualify for a Special Enrollment Period based on the loss of other health insurance coverage when your health insurance runs out at the end of January. I would recommend getting a letter saying that coverage terminates on January 31, 2023 so that you can shop on the marketplace by January 15, 2023 to get ACA coverage that starts on February 1, 2023.
If you are generically healthy, defer any appointments in January to February or later so you don’t get hit with more cost sharing if you have a bad year.
narya
@David Anderson: Great–thanks. I will defer my primary care wellness visit to July, when I’m eligible for Medicare. I’m in IL; any idea whether there’s a bronze/silver situation like you mentioned above? I’m gonna go PPO.
Ohio Mom
@narya: IIRC, you were looking forward to leaving your job — though maybe a month or two later than your employer decided on?
Congrats on this wonderful milestone!
Mike E
I just signed up here in NC for an Aetna silver plan on an estimated income based on what I made when I quit my job in 2022, I am still looking for work…my 59 1/2 day is coming up this April and I will most likely have to take out my Roth savings then (if not sooner in 2023). That will be counted as income when they calculate my ACA subsidy/tax bill for the year, yes?
narya
@Ohio Mom: Yeah, I was! this wasn’t the planned schedule, but it actually works out for me–alone of everyone on The List.
Ohio Mom
@Quinerly: Sounds like you have a few years off before you have to start researching traditional Medicare vs. an Advantage plan. Enjoy them.
There are pluses and minuses to either choice but be forewarned that it can sometimes be hard to undo your original choice between these two pathways.
The trick is, you will be choosing for the rest of your life — who knows what your medical needs will be in twenty years? Who knows how the terms of the insurance will change?
For a small, not very consequential example, I chose a traditional plan, along with a Part D drug plan. Which worked fine for two years until the insurance company decided they would stop covering my eye drops next year. We could not find a plan which covered the eye drops for an affordable price but fortunately my opthamologist okayed my switching to a different eye drop, which has led me to choosing a new Part D insurer for next year. I only hope the new eye drops work as well as the old ones did.
Anyway, as I’ve said before, the slogan should be MedicAID for all because it provides hassle-free comprehensive coverage, which I can’t say is true of MediCARE.
Enjoy your retirement!
StringOnAStick
My husband starts Medicare January 1 and I was secondary on the ACA plan we had, so yesterday the insurance office we set up his stuff for two months ago got me signed up on the same ACA plan, starting January 1 but now I’m the primary since I’m the only one needing an ACA plan now. At least until July, when I’ll start on Medicare. It was hassle free, but it sure helps to have a Medicare focused insurance broker who can explain all the steps and choices for you.
Thanks to reading David for all these years, I feel like I have a pretty good understanding of how the while complicated, multi part US system works, and doesn’t work. Thanks again David!
MomSense
@David Anderson:
Awesome thank you! His wife is also a musician (like both brothers) so literally the OG Gig Economy. She’s crushing it BTW and already playing with Portland Symphony Orchestra but no insurance coverage.
BruceFromOhio
Thanks for the nudge on open enrollment dates. My older TeenFromOhio (not a teen anymore, btw, the name just kind of stuck) admitted to planning on going naked after leaving a toxic workplace to work as a free-lance contractor. After some fretting, MrsFromOhio and I proposed covering the monthly ACA premium as risk mitigation until she finds full-time employment that provides healthcare benefits. She’s already had a run in with unplanned events happening in the blink of an eye (hit & run accident that totaled her car – she was fine, but the uninsured other driver went to jail for drug-related circumstances)
Because of the splendid knowledge base available from these many posts, we were able to settle quickly on a course of action tailored to her circumstances. After my employer announced that employee premiums were being held to current level (i.e. no annual increase) I figured that alone would cover a good chunk of TFO’s monthly premium, so the whole thing may actually be a wash of sorts.
Long way of saying Thank You, David Anderson. I really appreciate the time and detail you put into these, my family is better off for it. And my daughter won’t end up in lifetime financial ruin if something traumatic were to occur.
BruceFromOhio
@MomSense:
That’s great! Such hard work, dedication and talent to achieve that kind of accomplishment is admirable. Best of luck to both!
AJ of the Mustard Search and Rescue Team
Are there still ‘navigators/helpers?’ I find the whole thing overwhelming and paralyzing.
58, self-employed, above subsidy thresholds, have gone naked the last five years but getting sicker. Colorado.
Rand Careaga
“CaesarCare,” my longtime HMO, has been ceaselessly pitching us to switch over to Medicare Advantage, which, as I understand it, would lock us indissolubly in to their system. As it happens, my wife has developed a life-threatening illness (of a flavor uncommon and all-but invariably fatal) this year, and we found, in the crunch, CaesarCare to be dilatory, uncommunicative, bureaucratic, inefficient and inflexible. We have accordingly taken our custom to a well-regarded hospital 350 miles away, driving there half a dozen times since mid-year, and not only has the difference in services delivered been night-and-day, but they have also treated the spousette with a new-ish procedure that is almost certainly her only hope for survival—a procedure that CaesarCare adamantly refused to consider. For what it’s worth, in our followup consultation this week, the surgeon who operated on her a month ago was very bullish on her chances.
Between Medicare Parts A and B, and a supplemental plan, our principal out-of-pocket expenses have been for gasoline and lodging. I am grateful that we never fell for the Medicare Advantage come-ons.
(I should add in fairness that when I needed my cardiac plumbing reamed out six years ago, the HMO did right by me, and I had no complaints at the time. It’s a shame that since then they appear to have stacked the board of directors with Enron alumni.)
David Anderson
@narya: There is not a massive Silver-Gold pricing flip in Illinois. If you earn over 200% FPL, take a hard look at Gold as the extra premium likely buys meaningfully more protection
David Anderson
@Mike E: Talk to a tax professional, but I would be inclined to think yes.
David Anderson
@AJ of the Mustard Search and Rescue Team: Yes, there are navigators.
And due to both the American Rescue Plan and then the Inflation Reduction Act, there is no longer an income ceiling for subsidies…. check to see what you qualify for.