I know many seniors are alarmed, confused, and downright annoyed with the daily barrage of phone calls and the inundation of unsolicited mailings they receive daily. Various solicitors with mainly foreign accents call seniors early in the morning, late in the evening, or any other time of day they feel like, speaking in over-familiar tones, calling seniors by their first names, or pretending to be family or friends to get you to commit to changing insurances. The more you block the calls and put them on the national do not call list, the more they seem to call.
Open enrollment for consumers on November 1, 2024 and will continue until January 15, 2025. Selecting the right health insurance can be an overwhelming process for many individuals. Yet it’s and essential decision to protect from unexpected high medical costs and to ensure access to quality care when needed.
Two of IBX’s executives have provided us valuable Insurance 101 tips and insights on key factors consumers should consider when selecting a health plan for 2025.
Consumer Open Enrollment Period (OEP)
Koleen Cavanaugh, Senior Vice President and Chief Marketing Officer at IBX Foundation, provided answers to the following questions:
How do I know the best insurance for my particular situation?
Everyone has unique needs and preferences when it comes to healthcare coverage, and we understand that price is an important factor. You should also consider the cost to buy and use your health insurance. Lower premiums (each month) may come with higher out-of-pocket costs when you need to use your plan. Consider the deductible, the amount you will pay before insurance benefits kick in; co-insurance, the percentage of the cost you will pay each time you receive care; co-pay, a flat fee each time you receive health care services.
To help pay for insurance, the federal government offers tax credits to all eligible consumers. You can visit ibx.com/calculator to see if you are eligible for tax credits to lower what you pay every month–and potentially what you pay when you need care. If you are eligible, you will need to enroll on pennie.com, the state-based health insurance marketplace, to take advantage of those tax credits.
Understanding the features of a health plan, including verifying that your preferred doctors and hospitals are a part of your health plan’s network, can help you pick the right plan for you and your family.
What should I do if I don’t have health insurance?
Enrollment and changes to health plans can occur during Consumer Open Enrollment Period (OEP). Consumer open enrollment runs from now until December 15, 2024, for coverage starting January 1, 2025, and through January 15, 2025, for coverage beginning February 1, 2025. If you’re outside the OEP, you’ll have to wait until next year to make changes to your plan unless you have a qualifying life event. Qualifying life events include birth, marriage, adoption/foster care, losing coverage, change of income, moving, or becoming a U.S. Citizen.
You can enroll in a plan through Independence Blue Cross at ibx.com or through Pennsylvania’s state-based health insurance exchange, Pennie, at pennie.com.
Will I be able to continue seeing the same doctors?
If you want to access the doctors and hospitals of your choice, check to ensure they are part of your health plan’s network. In-network services are offered at a lower cost. Some health plans do not include health care coverage for doctors and hospitals outside their network unless it’s an emergency. Also, check which plans provide virtual visits and the cost to members.
Are the companies that advertise finding the best insurance for you legitimate?
In Pennsylvania, you can purchase trustworthy plans on the state-based Health Insurance Exchange, Pennie, through an insurance broker or directly through a private health insurance provider like Independence Blue Cross (IBX).
Consumer Annual Enrollment Period (AEP)
Kortney Cruz, Senior Vice President of Government Markets at IBX, provided answers to the following questions:
How easy is it to return to regular Medicare once you sign onto a Medicare Advantage Plan?
It’s possible. If you start a Medicare Advantage Plan when you first qualify for Medicare, you have 12 months to go back to your original Medicare with any Medigap plan. If you’ve had a Medicare Advantage plan for some time and want to go back to your original Medicare, you have two annual opportunities to do so: the Annual Enrollment Period (October 15 – December 7) and the Open Enrollment Period (January 1 -March 31). If you want to return to your original Medicare and have health issues, you may not qualify for Medigap.
Is there any one plan that offers better coverage than others, and is a Medicare Advantage Plan better than a Medigap Plan?
No one can tell you what the best plan is. When choosing a Medicare plan, you need to look at your individual needs and circumstances. Every plan is different and varies in levels of coverage, cost, and network restrictions.
Medicare Advantage and Medigap are both options for people with Medicare. The biggest difference is that Medigap policies supplement original Medicare, while Medicare Advantage is a private insurance alternative to federally-run Medicare.
Is it best to change Medicare Advantage Plans each Open Enrollment Period?
No one can dictate when it’s best to change your Medicare Advantage Plan. Only you can decide that. Generally, you only want to change plans if there’s a significant reason to, such as a major change to your health needs, moving out of your plan’s service area, if the cost of the plan becomes unmanageable, etc.
What happens if you have both Medicare and Medicaid?
If you have both Medicare and full Medicaid, you are what’s considered “dually eligible.” That means:
You can choose if you want your Medicare coverage through Original Medicare or Medicare Advantage. If you choose to join a Medicare Advantage plan, there are special plans for dual eligibles that make it easier to get the services you need.
Medicare will pay first, and you get Medicare-covered services. Medicaid pays after Medicare and any other insurance you have.
You’ll be enrolled in a Medicare plan that will cover your drug costs instead of Medicaid. Medicaid may still cover some drugs Medicare doesn’t cover.
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