Tips for Medicare and ACA Open Enrollment

For many people, fall is a time to think about enrolling in or updating health insurance coverage.

For those who are beyond age 65 and already on Medicare, open enrollment runs from October 15 to December 7, and is a time when current Medicare beneficiaries can adjust their coverage for the coming year. (Please note, if you have yet to sign up for Medicare, your period to do so runs between the three months before and the three months after you turn 65.)

For those who are pre-65 and not covered by an employer plan, open enrollment for 2022 Marketplace health insurance coverage (medical insurance created by the 2010 Affordable Care Act) began on November 1 and ends on Saturday, January 15, 2022, however, Wednesday, December 15 is the last day to enroll for coverage beginning on January 1, 2022.

In light of this timing, below are Charter Oak’s tips for choosing a health insurance plan– whether you are looking at Medicare coverage or through the Marketplace.

Tip #1: Assess Your Current Costs

When thinking about changing your health insurance plan, it’s important to review your healthcare-related expenses. Take a look at how much you are currently paying per month for your plan as well any out-of-pocket expenses over the past 12 months, including routine doctor visits, specialist visits, prescriptions and emergency room or urgent care visits.

Unless you foresee any major changes in the coming year (such as surgery, a recent diagnosis or pregnancy), past expenses are a helpful indicator for determining coverage that will be cost-effective and appropriate for you.

If your out-of-pocket expenses have been too high, open enrollment is an opportunity to search for a plan with lower deductibles. Lower deductible plans will likely mean higher monthly premiums, but the higher monthly premiums can be offset by the peace of mind from having fixed monthly medical expenses.

Tip #2: Search for Plan Options

For Medicare beneficiaries, you should receive information from the government related to your current Medicare coverage each year. Your current coverage summary is a helpful starting point in comparing options. And there are many online tools for learning more, including Medicare’s Plan Finder tool or by calling 1-800-MEDICARE. You can also check the State Health Insurance Assistance Program website to find help in your state.

Below are the Medicare coverage options you can choose. One of the biggest questions is whether to choose Original Medicare (and buy a Medigap policy) or a Medicare Advantage plan (often viewed as an all-in-one alternative to Original Medicare).

Medigap is a supplemental insurance policy designed to help cover the costs of certain medical expenses that Original Medicare doesn’t cover. A Medigap policy may cover expenses such as: Copayments, Coinsurance, Deductibles and Medical care when traveling abroad. Whether you’ve had Medigap coverage in the past or you’d find it beneficial moving forward, you can adjust, add or drop your Medigap coverage during open enrollment.

Medicare Advantage (or Part C) is a type of healthcare plan offered by private companies contracted through Medicare. It’s designed to combine Part A (hospital insurance) and Part B (medical insurance) and in some instances it offers a prescription drug plan or other additional coverage. Medigap policies cannot work with a Medicare Advantage Plan. If you sign up for Medicare Advantage and aren’t happy with it, you can switch back to original Medicare during the first year in a Medicare Advantage plan. If you don’t drop your Medicare Advantage plan and return to Original Medicare within that first 12 months, you generally must keep your Medicare Advantage Plan for the rest of the year, disenrolling or changing during the next Open Enrollment Period or if you qualify for a Special Enrollment Period.

Medicare Part D (Prescription Drug Plan) is for those who have an Original Medicare plan. It’s important to check for changes to your Part D coverage every year. Prescription coverage can change yearly, and your prescription needs may change as well.

For most Marketplace participants, Healthcare.gov is your starting point. For Maine residents, a new state-based marketplace just launched, and can be found at Coverme.gov.

Tip #3: Account for Your Current Providers

Some plans require you to visit in-network providers or offer lower out-of-pocket costs for visiting an in-network specialist. If you already have preferred providers on your current plan, switching plans could jeopardize your ability to visit them in the future.

When comparing plans, make sure to check whether or not your current healthcare providers are in-network. If they are, you should have no problem continuing to see them as you did before. If they’re out-of-network, you’ll either have to find a new provider or prepare to pay more for every visit. Also be sure that your existing medications are covered. Some plans may require generic versions of your medications, and some medications like chemotherapy drugs may not be covered at all.

Charter Oak’s advisors understand that picking the right health insurance plan for you and your family can be daunting. We hope the above helps clarify these decisions and welcome your further questions on the subject. It is a pleasure and privilege to serve you -- and to help you take care of both your physical and financial wellness. Wishing you a relaxing and peaceful Thanksgiving holiday.