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Health Insurance Special Enrollment Is Open Now: Here’s What You Need to Know

In response to widespread unemployment and the associated loss of health insurance benefits, President Biden opened the health insurance marketplaces on February 15. Until May 15, anyone who needs a health insurance plan for any reason can enroll. Normally, enrollment is only open in the fall, and individuals or families must experience certain qualifying life events in order to gain access to a special enrollment period.

During this time, you can enroll in an ACA-qualified health insurance plan, possibly with a tax credit or subsidy to help cover the cost of your premiums. Here’s what you need to know about this enrollment period.

You can decide between a tax credit or a subsidy. If you qualify for a subsidy, it reduces the cost of your monthly premiums. However, because these subsidies are based upon your income, regaining employment or a significant boost of income later in the year could render you ineligible. You might end up owing some of the subsidy back to the government. If you suspect that might be the case for you, opting for the tax credit instead might be a good idea.

Consider premiums versus out-of-pocket expenses. Lower-premium plans look more affordable on the surface, but come with higher out-of-pocket expenses such as the deductible. These can be acceptable plans for those who seldom utilize healthcare services, but can become expensive for those who are likely to seek more care. As you weigh your options, consider how likely you are to incur out-of-pocket expenses, and whether a higher-premium plan might help you better manage your budget.

Consider whether a short-term plan is best for your situation. Short-term healthcare plans can bridge the gap when you’re temporarily unemployed, retire a few months before Medicare eligibility, and in certain other temporary situations. If you expect your employment or insurance options to change drastically in the near future, this could be an option for you.

Consider your COBRA options. Typically, staying on your employer’s plan via COBRA can be expensive, since the laid-off worker must pay for the entire cost of premiums. But if you’ve already reached your deductible for the year, it could be a wise choice. Also, the American Rescue Plan provides coverage for COBRA premiums until September 30, making this a viable option for many.

It’s free to consult with a health insurance broker. Premiums are the same whether you consult a health insurance broker or not, so you might as well take advantage of their expertise. Give us a call to discuss your health insurance needs at this time, and we can help you learn more about the options available to you.

You Need These Forms Before Filing Your Tax Return

As Spring approaches, so does tax season. Most of you are gathering your documents and preparing to file your 2020 federal income tax return, along with your state return. But before you get started, we wanted to remind you to watch your mail for two important forms that you will need to complete your taxes: Forms 1095-A and 1095-B.

Not only do you need to document your earnings for the year; you must also provide proof of health insurance coverage. The Affordable Care Act already required that most Americans maintain healthcare coverage for each tax year, and now the state of California also imposes an Individual Mandate. While the federal penalty for failing to maintain coverage is currently set at zero, the state law does impose a fee upon those who did not enroll in a policy. Therefore, it is vitally important to retain proof of your health insurance coverage for the year, which is provided to you by your health insurance company. They will send you Form 1095-B in the mail.

In addition, those who receive a subsidy to help with the cost of health insurance premiums also need to reconcile that amount. Each year, subsidies are estimated based upon expected earnings, but underpayments and overpayments can occur. You must use Form 1095, which you will also receive in the mail, to demonstrate the correct amount of your subsidy. You should also receive this form in the mail soon, if you have not already.

Covered California will send Form FTB 3895 California Health Insurance Marketplace Statement to all enrolled members. It is used to fill out Form FTB 3849, Premium Assistance Subsidy, as part of your state tax return. Use the California Franchise Tax Board forms finder to view these forms.

You are not required to submit these forms with your tax returns, but you must use them to correctly compute your taxes. You should also keep these forms in your files, so that you can provide proof in the event your return is ever audited.

If you need more help understanding how to use Forms 1095-A and 1095-B, please give us a call and we will be happy to assist you.

The Benefits of an Insurance Broker When Shopping for Health Insurance

Whether you’re a business owner shopping for a group health insurance plan, or an individual searching for the right individual, family, or Medicare plan, this decision carries a lot of weight. You’re looking for a plan that meets your needs and fits your budget. You also hope to enroll in a plan that is easy to understand, that provides customer support, and that helps prevent any billing surprises.  A few bells and whistles wouldn’t hurt, either.

Those are all reasonable objectives, but it can become difficult to balance them all during the comparison shopping process. Working with a health insurance broker can simplify that process in a number of ways, and help you locate the right plan for your needs.

What a health insurance broker does. Brokers are licensed health insurance agents who do not work for one particular insurance provider. Instead, they work independently to match their customers – either businesses or individuals – with the health insurance plan that best suits their needs and budgets.

What a health insurance broker does not do. Because brokers work independently, they have no interest in steering you toward a particular plan or “selling” you on “their” company. Instead, they work with a variety of insurance providers and are biased toward none of them. These companies pay a commission to brokers that is already worked into their premium structures, so that you aren’t charged any more for using a broker to locate your plan. In fact, you might as well utilize this service because it is free!

What you can gain by working with a health insurance broker. Aside from helping you compare and choose the right health insurance policy, brokers provide other benefits to their customers. This professional will remain available to answer your coverage questions, provide customer support, help you solve billing issues, and remind you of important deadlines or changes to your plan. If you’re a business owner, your broker will also assist you in explaining plan benefits to your employees.

Working with a health insurance broker will also save you time, because these professionals are already familiar with all the health insurance options on the market. Simply describe your priorities and needs, and your broker will know where to begin the search for the right health insurance plan.

Working with a health insurance broker doesn’t cost you anything!  Brokers get paid by the insurance companies, and they can offer you the same rates that you would get if you went directly to the insurance company.  So you get the assistance and support of a broker with no added cost!

If you’re interested in individual, family, Medicare, or group health plans, give us a call and we will put our experience to work for you.

Understanding Medicare Advantage Plans and Open Enrollment

Once you become eligible for Medicare at age 65, you might discover that the options aren’t as simple as you had imagined.

If you sign up for Original Medicare, you will enroll in both Parts A and B (which serve as hospital insurance and medical insurance). Part A is usually free to most beneficiaries, and Part B charges a premium. You might also wish to add Medicare Part D (for prescription drug coverage). Even still, you will owe copays and deductibles.

Medicare Advantage combines Parts A and B, and often Part D. For some beneficiaries, this feels like a lot to juggle. Some prefer a comprehensive plan that bundles the above services, plus others in many cases, for one monthly premium. In that case you can opt for a Medicare Advantage plan, also called Part C. These plans are packaged and provided by private insurance carriers, and must adhere to Medicare standards.

Many Advantage plans include additional services, such as limited vision or hearing services, dental care, fitness programs and more. Each Advantage plan is quite unique, so it pays to evaluate each plan carefully.

In many cases, you will receive care from a network of providers in your area. You might still be billed for services received outside of your network. So, while Medicare Advantage can be a convenient way to manage expenses, it is not a guarantee that you won’t ever incur out-of-pocket expenses.

Medicare Advantage Enrollment is open now. If you do opt for an Advantage plan, the most important thing to remember is that you are subject to a different open enrollment period. While you can also partake in certain aspects of the general Medicare Annual Election Period in the fall, Open Enrollment for Medicare Advantage runs between January 1 and March 31 each year.

During this time, you can evaluate your current Medicare Advantage plan and enroll in a different one. You can also drop Advantage and go back to Original Medicare if you choose.

If you’re feeling uncertain of your Medicare Advantage plan, and would like to evaluate your other options, give us a call during Open Enrollment. We can help you narrow down your options and select a plan that is right for you.

“Oops! I Missed Medicare Annual Enrollment!”

Each year, Medicare beneficiaries have the opportunity to make changes to their plans during Annual Enrollment from October 15 to December 7. Now that December 7 has passed, we occasionally hear from clients who are wondering what to do. “Oops, I missed Medicare Annual Enrollment,” they tell us. “What do I do now?”

Fortunately, you’re not necessarily stuck in a plan that isn’t just right for you. There are several courses of action you can take now, depending upon your circumstances.

Make changes during Medicare Advantage Open Enrollment. Annual Enrollment and Open Enrollment are often confused for one another, but they serve two different purposes. If you’re enrolled in a Medicare Advantage plan, you can participate in the Open Enrollment period between January 1 and March 31. During this time, you can switch from one Advantage plan to another Advantage plan, or drop Advantage and go back to Original Medicare.

Unfortunately, you can’t switch from Original Medicare to an Advantage plan at this time.

But before you drop your Advantage plan, consider your network of providers (which you might lose if you drop Advantage). You also won’t benefit from the out-of-pocket spending cap anymore, because Original Medicare does not have that feature.

Enroll in a five-star Medicare plan. Each fall, Medicare plans are reviewed and rated. If you’re not currently enrolled in a five-star plan, you can switch to one between December 8 and November 30. But you can only switch once, and you must choose a five-star Medicare Advantage plan, Medicare Cost plan, or Medicare Prescription Drug plan.

Take advantage of the Medicare Special Enrollment Period. If you experience certain life changes, such as a move or contract change, you can take advantage of a Special Enrollment Period and change your plan. A list of qualifying events can be found here.

Any time you find yourself dissatisfied with your Medicare plan, please do give us a call. We can assess your situation and help you determine whether you are eligible for any of the above opportunities to make changes to your plan.

 

 

Understanding Medicare AEP and Medicare Advantage OEP

Medicare beneficiaries are offered different opportunities to examine their Medicare plans and make necessary changes… But these opportunities can be confusing at times. Depending upon your plan participation, you will hear about Medicare Annual Enrollment Period (AEP) and the Medicare Open Enrollment Period (OEP). Each of these events occur annually, and serve similar but somewhat different purposes for beneficiaries.

Medicare Annual Enrollment Period. From October 15 to December 7 each year, you will have the opportunity to review any upcoming alterations to your plan. You should receive notice of changes to drug formularies, premiums, coverage, and so on. And, if necessary or desired, you can respond by making the following changes:

  • Drop Medicare Advantage and return to Original Medicare
  • Move from Original Medicare to a Medicare Advantage plan
  • Switch from one Medicare Advantage plan to another
  • Make changes to Part D enrollment, such as enrolling for the first time, dropping coverage, or changing plans

Changes that you make during this time will take effect for the following plan year, on January 1. Those who don’t make changes will simply be re-enrolled into their current plan selections.

Medicare Open Enrollment Period. Those enrolled in a Medicare Advantage plan also have the opportunity to make changes, during the OEP which runs from January 1 to March 31 each year.

During this time, Medicare Advantage participants can:

  • Drop your Advantage plan and return to Original Medicare
  • Switch from one Advantage plan to another
  • Add, drop, or change your Part D plan, if you’re enrolled in a separate plan (many Advantage plans include Part D coverage automatically)

The OEP only applies to Medicare beneficiaries who are enrolled in an Advantage plan on January 1, and only one change can be made during this time. Any changes made will become permanent for the duration of the plan year.

With January 1 rapidly approaching, we urge you to contact us if you have questions about your Medicare Advantage plan. We can help you assess your options and make changes during the OEP, if necessary.

 

 

 

Medicare’s Annual Election Period Ends Soon

If you’re a Medicare beneficiary, take note of this important date: December 7 is the closing date of Medicare’s Annual Election Period. Unless you make desired changes to your Medicare plan by that date, your current plan will automatically renew for next year.

Why is this important? Even if you like your current Medicare plan just fine, plan administrators can and do make changes each year. Sometime prior to October 15, you should have received a notice called either Evidence of Change (EOC) or Annual Notice of Change (ANOC). These notices detail any changes to the upcoming plan year, regarding costs or coverage limits. It is important to review these notices when they arrive, so that you don’t receive any unpleasant surprises during the next plan year. Never just assume that your current plan will remain the same.

If it looks like your plan might be changing, contact us right away to determine your next action. We can help you compare different plans and select one that fits your needs.

Even if your plan is remaining relatively the same, your needs could be changing. Speak with your primary care physician about your personal risks, medications that you might need in the near future, upcoming treatments, and more. If it looks like you might face increased or different healthcare needs in the near future, you should also reevaluate your Medicare plan to be sure it’s a good fit for you.

  • During the Annual Election Period, you can take the following actions:
  • Switch from one Medicare Advantage plan to another
  • Drop Medicare Advantage and go back to Original Medicare
  • Switch from Original Medicare into an Advantage plan
  • Add, change, or drop Prescription (Part D) coverage

Any changes you make to your plan(s) will take effect on January 1, 2021. Again, the deadline to make these changes is rapidly approaching on December 7. If you haven’t already contacted us to discuss your options, now is the time to do so.

Take Advantage of the Small Group Special Enrollment Period Now

Many small business owners wish they could provide group health benefits to their workers, but several obstacles stand in their way. First, premiums can seem unmanageable to smaller businesses. Second, the required participation rate of 70 percent of employees might be unattainable for numerous reasons. Still, small business owners don’t deny the potential benefits of a group health plan to both themselves and employers.

If that sounds familiar, we have good news: The Small Group Special Enrollment Period was designed to allow employees of small businesses to enroll in a group health plan, while sidestepping the rules that would normally prevent their participation.

Under the Small Group Special Enrollment rules, employers are not subject to participation minimums. This means as long as one – yes, just one – employee signs up, they can enjoy a group health plan.

As for the cost of premiums, business owners are not subject to any requirement to contribute. They can pay for part, all, or none of the plan as their budget allows, passing on any difference to employees who choose to participate. Workers are happy because they can access a plan of their liking, and business owners are happy with the flexibility of their contributions. Everyone wins!

In addition, if the employer establishes a cafeteria plan, employees can access valuable tax savings. By paying for premiums through pre-tax payroll deductions, they can earn a significant deduction on their income tax obligation.

Finally, the healthcare plans offered under Small Group Special Enrollment are subject to the same underwriting guidelines required by law. Employees can access quality healthcare plans even though their employers won’t be subject to strict regulation of their contribution.

There’s just one drawback of this special enrollment period: It only lasts for one month, between November 15 and December 15 (with coverage beginning January 1). Give us a call now to begin weighing your options, so that employees have time to make a decision about group health plans.

Covered California Update: Open Enrollment Begins Soon!

For those of you who are enrolled in a Covered California healthcare plan, Open Enrollment will soon begin. During this time, you will be able to enroll in a new plan or make changes to your current plan. With 2020 bringing so many changes to our lifestyles and budgets, we should all pay close attention to Open Enrollment this year.

Here’s what you need to know:

Open Enrollment begins November 1 and runs through January 31, 2021. However, if you want your new plan to begin on January 1, you need to complete your application by December 15.

Even though you have until January 31 to enroll, we do recommend getting started early. Your healthcare plan is a big decision, and one that can bring many financial consequences. Begin to evaluate your current spending now and anticipate next year’s healthcare needs. Did you meet this year’s deductible? Would you prefer lower premiums? Ask yourself these questions now, to begin narrowing your focus.

If your financial information has changed, be sure to update it in the system. Your subsidy, if you receive one, is based upon your financial information. Submitting accurate data is the best way to ensure that you receive the correct subsidy. If your income has dropped this year, you might qualify for help even if you have not qualified in the past.

Outside of Open Enrollment, there are other times you can make changes to your plan. If you have a baby, adopt a child, move, experience a change of employment, or experience certain other qualifying life events, you can make changes to your Covered California plan within 60 days.

Medi-Cal enrollment is year-round. If you have experienced a qualifying life event, and you believe you might now be eligible for Medi-Cal, you do not have to wait on Open Enrollment. You can apply now.

You can receive help with your application. If you need help evaluating plans, submitting your application, or anything else regarding Covered California Open Enrollment, contact us right away. We can help get the ball rolling. Remember, Open Enrollment begins November 1 but you should start getting ready as soon as possible.

 

Medicare Annual Election Period Starts Today: Here’s What to Do Now

How are you liking your Medicare plan? Do you ever wonder if you could achieve better coverage or lower out-of-pocket costs with a different plan? Would you like to compare plans, and try to identify a better fit for your healthcare needs?

That’s the point behind the Annual Election Period, which runs from October 15 to December 7 each year. During this time, beneficiaries can make changes to Medicare Advantage plans and Part D plans. Now is the time to compare coverage, premiums, and potential out-of-pocket costs among different plans. If you decide that another plan is a better fit for you, you can change your enrollment during this time period.

Plans can and do change each year. Each year, Medicare plan administrators can make certain changes to their costs, benefits, coverage, or the network of providers and participating pharmacies. By this point, you should have received either an Evidence of Change (EOC) notice and/or an Annual Notice of Change (ANOC) from your plan administrator. If you haven’t already, now is the time to review these materials and determine whether the plan’s coverage and cost still meets your needs. If it doesn’t, or if you’re not sure, we can help you review these materials and make a decision about your healthcare plan.

Comparison shopping is always wise. In some cases, your plan might not be changing much, but you still wonder if another plan would be a better fit. Comparison shopping might save you money or help you identify a better deal. Give us a call and we can help with that too.

Here’s what you’re able to do during the Annual Election Period:

  • Change from Original Medicare to a Medicare Advantage plan
  • Change from a Medicare Advantage plan back to Original Medicare
  • Change from one Medicare Advantage plan to another
  • Enroll in a supplemental Part D plan (for prescription drugs)
  • Change from your current Part D plan to a different one
  • Drop Part D coverage altogether

If you decide to make a change, your new plan will take effect on January 1, 2021.

Healthcare is one of the most important decisions you will make each year. Let’s discuss your current plan, and then compare it to other options. Together we can make sure you’re enrolled in the best plan for you.

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