Open Enrollment for Obamacare and Medicare —By Jacques Chambers

Open Enrollment for Obamacare and Medicare
—By Jacques Chambers

Medicare Open Enrollment starts October 15, 2015 and ends December 7, 2015.
All changes made during this time are effective January 1, 2016.

Affordable Care Act Open Enrollment runs from November 1, 2015 through January 31, 2016.
The effective date will be based on when the changes are requested;

• If made on or before 12/15/2015 – Changes effective on January 1, 2016
• If made 12/16/2015 through 01/15/2016 – Changes effective on February 1, 2016
• If made 01/16/2016 through 01/31/2016 – Changes effective on March 1, 2016 

Employer-Provided Benefit Programs also frequently provide an Open Enrollment Period for employees, allowing them to make changes in their employee benefits choices. Although employers can select other times of the year, most employers who offer one have their Open Enrollment in November and/or December for a January 1, 2016 effective date.

Medicare

Medicare beneficiaries have the opportunity to switch their coverage from any to any of several choices:

Original Fee For Service Medicare – Parts A and B of original Medicare are the same for everyone; however, each beneficiary can elect the prescription drug plan in which to enroll. The best way to do this is to compare plans using your own current prescriptions, since your medications may have changed and plan formularies and prices also change.

There is a program on line at www.medicare.gov that allows you to enter your medications, which pharmacy your prefer, and where you live; it will then show you what each plan would cost you out of your pocket based on your medications.  Click on “Find Health and Drug Plans” and follow from there. I recommend the “General Search” rather than the personal one; it is much quicker and just as accurate. If you are on particularly expensive medications, once you find a drug plan, you should confirm the coverage and what you will pay directly with the insurance company as errors sometimes occur.

Even if your current Drug Plan has been serving you well, it is still advisable to run the program. The plans for 2016 are already up on the website.

For persons who are not comfortable with computers, Medicare’s toll-free number (800-MEDICARE) will do the same calculation.  However, I recommend you find a friend or relative who will do it for you on a computer because the results are too long and involved for a telephone operator to spend much time reviewing the options based on your specific needs.  

Medicare Supplement (also called Medigap) Plans – This open enrollment period does NOT apply to the Medigap Plans sold to people with Original Medicare to “fill the coverage gaps” left by Medicare Parts A & B.  To find out when you can purchase them, go to www.medicare.gov and search for “When Can I Buy a Medigap Policy”. It will list the Open Enrollment opportunities for them. They may also be purchased at other times, but the insurance company may require proof of good health.

Medicare Advantage Plans – These are plans offered by insurance companies and health service providers and are an alternative to Fee-for-Service Medicare.  Many of these plans are run by Health Maintenance Organizations (HMOs), but there are also Preferred Provider Organization Plans (PPOs), Exclusive Provider Organizations (EPOs), Special Needs Programs, and Private Fee-For-Service plans, although all types are not available in all areas. All Medicare Advantage Plans must offer all of regular Medicare’s benefits and may add more.  Some plans may also charge an additional premium, usually relatively small.  These plans frequently include the prescription drug coverage in their plan so you don’t have the additional task of finding a Part D drug plan.

During this Open Enrollment Period, persons may switch from one Medicare Advantage Plan to another or move back to or away from Fee-For Service Medicare.

NOTE: If you move from a Medicare Advantage Plan to Original Fee-for-Service Medicare, you have until February 14, 2016 to enroll in a Part D Drug Plan.


Affordable Care Act (Obamacare)
Persons enrolled in coverage, as well as those who have not yet joined, have the opportunity to enroll into or change health plans under the Affordable Care Act.

Many plans are making changes in coverage as well as cost, so I do recommend you go to your state’s health exchange, or to www.healthcare.gov for people in those states that do no operate their own exchange, and search to see if there is better coverage for you.

Since most of these plans use network providers, you should confirm directly with the insurance company that the doctors and hospitals you prefer are part of the network. Also, make sure your medications are on the plan’s formulary.

Employer Provided Benefit Plans 
Employers offering an Open Enrollment period for their employees will publish (or offer online) an Open Enrollment Guide that spells out each employee’s current benefits plus the available options, opportunities, and costs that may be chosen during this period. For persons dealing with a serious medical condition like HCV, it can be an opportunity to alter benefits and, in some cases, actually increase benefits since these programs usually offer more than just health insurance.

Life Insurance. Persons dealing with HBV/HCV are generally unable to purchase life insurance in the individual market. An employer may give all employees a base benefit from $10,000 to $50,000, and a few will allow employees to purchase additional coverage. If your employer offers supplemental life insurance above what he or she offers; see if there is an amount you can purchase that will not require evidence of good health. If it is available, it is an excellent way for an otherwise “uninsurable” person to obtain additional life insurance.

Long Term Disability.  Less common, but still occasionally available, is the opportunity to increase the benefit of your LTD plan.  Some employers will provide a basic benefit for LTD, such as 50% or 60% of your monthly earnings, and allow employees to purchase an additional 10% or 15% to raise the benefit they would receive in the event of disability.

Some employers may allow you to add this benefit if you did not elect it originally. Again, it is important to read your Open Enrollment material to see if your employer offers this and if proof of good health is required.

Revising LTD Premium Payment. One additional possibility to explore is the payment of LTD premiums. Some employers will allow you to have the premium they pay for your LTD coverage added to your W-2 making the premiums taxable rather than receiving it as a tax-free gift. If this is possible you may want to jump at the chance, the reason being tax-free disability benefits should you become disabled.

If you pay for the LTD coverage with money that is taxed as income, then the benefits you receive if you become disabled will be income tax free, substantially increasing the spendable dollars you would receive as a disability benefit. The rule is the IRS will tax either the premium paying for the coverage or the disability benefits being paid out, but not both.

Health Related Benefits.  Many employers, especially larger ones, offer a variety of health, dental, and vision plans from which employees can choose.  At Open Enrollment, you have the opportunity to change your coverage from one plan to another regardless of your medical condition, and sometimes have the opportunity to make choices within your plan, such as increase or decrease the size of the deductible.

For someone dealing with HCV, this can be an important choice, especially if this is the first Open Enrollment since diagnosis.  There is no one type of health plan that is best for everyone. There are two main kinds of plans that employers offer most often:

Preferred Provider Organization (PPO) – These plans provide some coverage for all physicians, but pay more if you choose a physician that has contracted with the insurance company, a Participating Provider.  This plan will give you the greatest flexibility in medical providers; however, it will often cost you more out of pocket for both your portion of the monthly premium as well as the plan co-pays and co-insurance.

Health Maintenance Organizations (HMO) – These plans usually offer the lowest out-of-pocket expenses, but limit your choice of physician. Coverage is only provided when using one of their contracting doctors and hospitals.  Also, a Primary Care Physician (also called a Gatekeeper) oversees all your medical care and must refer you to a specialist before the HMO will cover the specialist’s charge.

Exclusive Provider Organization (EPO) – These plans are exactly like an HMO except, there is no Gatekeeper physician. You decide if you need to see a specialist and make the appointment directly.

Which plan is better for you will depend on which doctors you wish to retain and what HMOs or PPO plans they are part of, as well as the cost to you.

Disability & Benefits: COBRA Continuation Coverage and Obamacare —Jacques Chambers, CLU

COBRA (Consolidated Omnibus Budget and Reconciliation Act) Continuation Coverage has been a very helpful federal law that allows persons covered under a group health insurance plan to continue on the coverage after regular eligibility for the coverage is lost, e.g., an employee ceasing to be employed; a spouse who divorces the employee; a child reaches the age when she is no longer eligible for dependent coverage. It was an important law when passed, as health coverage was otherwise lost when employment stopped, and to buy individual health insurance before Obamacare, a person had to prove they were in good health with no medical problems or serious medical history.

Now, with the implementation of the Affordable Care Act (Obamacare), COBRA may still be beneficial although it is no longer the only way for a person with a medical condition to continue to have health insurance coverage.

However, COBRA Continuation Coverage has serious drawbacks:

• Coverage only lasts a brief period of time, and before Obamacare the choices of coverage after COBRA were greatly restricted.
• Coverage is expensive. Although the benefits were often broad, the COBRA Continuee is expected to pay the full premium including the portion the prior employer paid plus a 2% “administrative” charge. If a disabled COBRA Continuee qualifies for the disability extension, the premium becomes 50% more than the employer pays.
• The Continuee’s coverage remains at the mercy of the former employer. If the employer changes carriers or drops health insurance altogether, the coverage and cost may change or be lost completely.

Now, however, Obamacare offers a choice for people being moved to COBRA coverage. Loss of the regular employer based coverage creates a Special Enrollment Period which allows a person to purchase a plan on the health exchange as long as they do it within 60 days of the coverage ending, according to the termination date given in the COBRA Notice letter from the employer or its administrator.

Under Obamacare, based on your income, tax credits may be available to assist with the premium payments, which would not happen if you remain with COBRA. Also, there is a wide variety of plans, coverages, and prices to choose from.

 

NOTE: Federal law gives you 60 days from the date your coverage terminates to accept COBRA coverage, and it must be reinstated back to the date the regular coverage stops. It may also take 30 to 60 days after applying for an Obamacare policy to go into effect, depending on the exchange used in your state. To be safe, many people accept COBRA coverage, then drop it once the Obamacare policy is in force.

Be aware, also, that once the 60 days of the Special Enrollment Period for Obamacare has passed, you will not be able to enroll in an Obamacare plan until the next open enrollment or at the expiration of the COBRA coverage. 

COBRA as an Alternative
For those who may want to consider COBRA, below is a brief summary of the law. Since Obamacare is an excellent, as well as a usually less costly, alternative for many, this will focus on those undergoing treatment who have a special need or desire to maintain their current coverage and medical team.

COBRA coverage is limited, usually to 18 months for terminating employees, and to 36 months for dependents losing eligibility, either through divorce, dependent child aging out of coverage, or death of the employee.

In 1989 COBRA was amended under a law called OBRA (Omnibus Budget and Reconciliation Act) to allow people who had to stop work due to disability to extend the time they could keep COBRA Continuation. Under this law, someone who qualifies may stay on their employer’s COBRA Continuation until they become eligible for Medicare, which is normally 29 months after they leave work due to disability. This is because Social Security Disability Insurance (SSDI) benefits are not payable until you have been disabled for five full calendar months. Those five months plus the twenty-four months of SSDI benefits required to become eligible for Medicare add up to 29 months.

However, to qualify for this disability extension of COBRA you must meet several requirements:

• You must apply for Social Security Disability Insurance (SSDI) benefits.
• Social Security must approve your claim for disability benefits AND notify you during your initial 18 month COBRA period.
• The Onset Date of your disability must be no later than 60 days after the start of your COBRA coverage.
• Finally, you must provide a copy of your Social Security Notice of Award letter to your COBRA administrator within 60 days of receiving it AND within the 18 month COBRA period.

Now, for a practical look at each of these requirements:

1. COBRA is letting Social Security decide who was disabled when they stopped working. If you didn’t pay into Social Security because you were a public school teacher or government employee and are therefore not “financially eligible,” Social Security will still review your medical records to see if you are disabled enough to have qualified for benefits if you had been eligible. Such persons will need to tell Social Security that they are applying to extend COBRA to have such a claim reviewed.
   
   
2. The SSDI claim must be approved during the original 18 months of COBRA. If there is a denial and you have to wait to appeal before an Administrative Law Judge, and it goes beyond 18 months, you lose your chance to extend COBRA even if your claim is later approved.
   
   
3. Social Security will determine the onset date of your disability. That is the date they believe you became disabled and the first of the following month is the date they start counting the five calendar months waiting period. Even if the approval letter comes in the last few months of your COBRA Continuation, you can still qualify for the extension if the Onset Date given in your approval letter is within 60 days of the COBRA Qualifying Event, usually the last day of the month in which you stopped working.
   
   
4. The COBRA administrator MUST be informed of your approval for Social Security within 60 days of the receipt of the Notice of Award letter. It is assumed that the letter was received by you within five days of the date of the letter.
   
   Unfortunately, ignorance or misunderstanding of this rule has cost many people their right to stay on COBRA. Too many people don’t think about extending their COBRA until it is almost over, and that can be too late to get the extension.
   
   The COBRA administrator is usually your old employer or they may have contracted with an outside firm to administer their COBRA people. A good rule of thumb is that the copy of the Social Security Notice of Award letter should go to the same place that you send your COBRA premiums. Follow up to confirm the notice was received and ask for written confirmation of eligibility for the extension.

COBRA can be a good way to stay insured since it allows you to stay on your employer’s health insurance plan until you become eligible for Medicare. The primary drawback is that during the months after the first 18 months of COBRA, the employer can (and will) charge you the actual premium PLUS 50%. If you were paying $500 per month on COBRA, the extended months will cost $750 per month.
 
Thanks to the Affordable Care Act (Obamacare), there is now a good alternative to the high cost of continuing the employer’s coverage through COBRA for persons dealing with HCV who lose their employer coverage.


http://hcvadvocate.org/news/newsLetter/2015/advocate0315_mid.html#4