As the year comes to a close, MSAA would like to remind everyone about two important upcoming deadlines. The open enrollment period for Medicare and the Health Insurance Marketplace is quickly coming to an end. Continue reading
Medicare Open Enrollment ends on December 7th for coverage that begins on January 1, 2018.
Health Insurance Marketplace
Private insurance through the Affordable Care Act’s Health Insurance Marketplace has a December 15th deadline in order to receive coverage that begins on January 1, 2018. If you do not enroll in a marketplace plan by December 15th, you cannot enroll in a plan for the rest of 2018 unless you qualify for a Special Enrollment Period.
Ensuring that you have health insurance coverage to manage the many medical expenses that can accompany MS is crucial. You can visit these sites in order to enroll or re-enroll in a health insurance plan that meets your needs.
To help you better understand the complexities of health insurance coverage, you can also visit our website section My Health Insurance Guide or call the MSAA Helpline at (800) 532-7667, ext. 154. This is an important time, so please be sure to enroll in a health insurance plan that is right for you!
Dealing with insurance of any kind can be a stressful experience for anyone if you aren’t familiar with the language and jargon used on the forms. Health insurance is no different – particularly when you are trying to make sure that the health insurance you have covers all of your health needs, including any regular therapies, durable medical equipment, specialist visits, and regular tests.
Navigating the world of health insurance can be daunting, but our Client Services team here at MSAA has a couple of resources that can help get you started on resolving your questions and issues:
- Patient Advocate Foundation – The PAF provides case management for patients who are dealing with insurance, employment, or other legal issues related to their medical condition.
- State Insurance Departments – This link will take you to a map of the United States with a link to each individual state’s insurance web page that can offer more information about the insurance laws and the insurance marketplaces available in your home state.
- Life Happens – This non-profit provides information and resources to find life insurance, disability, and long-term care insurance policies/plans, and they can help you find a local agent to assist you with those plans.
This is just a short list of resources that you have at your disposal to help you work your way through your insurance questions. For more information about your particular question or issue, please feel free to reach out to our Client Services Specialists at (800) 532-7667, ext. 154 or at MSquestions@mymsaa.org.
Making my way through the medical insurance nightmare has been a challenge since being diagnosed with multiple sclerosis. It wasn’t something I thought much about before MS came along. I never really got sick so health insurance and my own well-being just wasn’t a priority. Talk about a learning curve. I was thrown into things head first and then bounced around a few times before landing hard with a thud.
My life was suddenly filled with doctor appointments, medications, unpredictable symptoms and massive medical bills. I found myself in this new world of the chronically ill and I didn’t like it one bit. To be honest with you, it scared me more than anything I had ever been through.
I think the first year after I was diagnosed, I spent much of my days in a mind numbing fog. I became overwhelmed with the vast amounts of information I found online about MS and the high costs associated with it. The more questions I asked, the more questions I had.
I became more concerned with being able to afford my co-pays and medical insurance premiums than with the latest phone apps or music downloads. I found myself searching for insurance plans that made MRI’s and durable medical equipment more affordable. I researched Medicare, SSDI and early retirement. I looked for ways to afford home modifications and accessibility aids.
I discovered that no one can look out for me better than me.
When I was searching for a supplemental insurance plan that would cover all the things Medicare doesn’t, the monthly cost was too high for me to be able to afford. So, what did I do? I got online and through asking tons of questions came across a foundation that helps people with MS pay their monthly insurance premiums. That was something I would have never known about if I didn’t dig around for answers myself.
I found that asking questions is the best thing anyone can do for themselves.
When the cost of my pain medication went up, again I got online and found that my Medicare drug plan had an exception form that can be submitted to request a lower co-pay. I had my doctor help me fill it out, sent it in and the cost of that one medication went from $45 a month to $3. The insurance company won’t tell you about that option in bold print on their home page. It’s something you have to ask questions about and search for yourself to find.
Then there was the time a few years ago when my powerchair was damaged in a car accident. I was okay but my chair got banged up a bit. I discovered that my homeowners insurance covers things like that. I was able to get a new chair to replace the broken one. Who knew homeowners insurance (or renters insurance) worked that way? I sure didn’t. Another lesson learned by again asking lots and lots of questions.
I don’t think I will ever understand insurance or how they calculate the costs associated with their services, but through asking tons of questions and digging around for answers I have been able to ease much of the costs associated with MS and living with a disability.
You have to be your own advocate, do your own research and never stop asking questions! You may not be able to control the progression of your MS but that should never stop you from taking control of your own health care.
*Penelope Conway was diagnosed with Multiple Sclerosis in November 2011. She is the author and founder of Positive Living with MS (positivelivingwithms.com) where she uses humor and her own life experiences with MS to help others navigate this unpredictable journey. She believes that staying positive and holding onto hope is the key to waking up each morning with the strength to get through the day.
A week from now Medicare’s open enrollment insurance period will begin, running from October 15th until December 7th. This is the time when you can review your current Medicare plan and make changes if needed. You do not need to sign up for Medicare each year, but you can review your coverage and make adjustments if necessary to ensure your health insurance needs are being met.
Medicare beneficiaries who have a Medicare Advantage plan or Part D plan should receive documents such as ‘Evidence of Coverage’ or ‘Annual Notice of Change’ letters from your health plan showing coverage outlines and any changes that will occur. It’s very important to review these materials to make sure of any changes in the plan’s costs, providers, benefits, drug formularies, etc. so that if something is changing with your plan, you are aware of it and can make changes to your coverage if needed. These plans can change their benefits so it’s crucial to review your policy and any upcoming changes.
What can you do during the open enrollment period? According to Medicare’s website you can:
- Switch from Original Medicare to a Medicare Advantage Plan and vice versa.
- Switch from one Medicare Advantage Plan to another Medicare Advantage Plan or from one Part D prescription plan to another.
- Join a Medicare Prescription Drug Plan (Part D Plan) if you haven’t done so.
The Medicare website offers a Medicare Plan Finder where you can search for and compare health plans, benefits, coverage and estimated costs. You can also contact Medicare directly at 1-800-MEDICARE (1-800-633-4227) for additional information and questions.
For additional help, you can receive individualized assistance and guidance in choosing coverage through your State Health Insurance Assistance Program (SHIP). This resource provides one-on-one insurance counseling and support, visit https://www.shiptacenter.org/ to find your local office.
MSAA’s My Health Insurance Guide is another helpful source for the MS community to find more information about insurance options and resources. This is an important time, so be sure to review your plan’s coverage and make changes if needed to make sure it’s right for you!
This year marks the 50th anniversary of President Lyndon B. Johnson signing into law the Medicare program. Since its inception July 30, 1965 the program has seen many changes. Medicare and Medicaid started as basic insurance programs for Americans who didn’t have health insurance, the programs have changed over the years to provide more and more Americans with access to quality and affordable health care.
You don’t need to sign up for Medicare each year. However, each year you have a chance to review your coverage and make changes. Most Medicare beneficiaries should receive an Annual Notice of Change (ANOC) and Evidence of Coverage (EOC) from their existing Medicare Advantage and Medicare Part D plan providers by September 30th.
Individual Medicare plans can change each year—things like cost, coverage, and which providers and pharmacies are in network. So it is important, that each year during the open enrollment period you dedicate some time to review your plan.
During this open enrollment period you can make changes to various aspects of your coverage.
- You can switch from Original Medicare to Medicare Advantage, or vice versa.
- You can also switch from one Medicare Advantage plan to another; or from one Medicare Part D (prescription drug) plan to another.
- And if you didn’t enroll in a Medicare Part D plan when you were first eligible, you can do so during the general open enrollment.
Visit the Medicare Plan Finder at Medicare.gov/find-a-plan. With the Medicare Plan Finder, you can compare plans and learn about the coverage, benefits, and estimated costs for each plan. For further information and questions, contact Medicare directly at 1-800-MEDICARE (1-800-633-4227).
Want to learn more about Medicare, or the different types of coverage options available? MSAA’s My Health Insurance Guide provides comprehensive, easy-to-follow information and resources for the MS community about Medicare and Medicare Advantage plans.
Need additional help?
Get personalized counseling and assistance in choosing coverage. State Health Insurance Assistance Program (SHIP) provide free, in depth, one-on-one insurance counseling and assistance. Visit https://www.shiptacenter.org/ to locate the office nearest you.
While the 2014 year slowly comes to an end and individuals start to make their end of year plans, there are still two important dates to keep in mind in regards to open enrollment for health insurance. For those who are uninsured, or who possibly want to make some changes to a pre-existing Medicare plan, open enrollment allows individuals to make changes without penalty.
Medicare open enrollment ends Sunday, December 7th. Up until this date, changes can be made allowing an individual to switch from Original Medicare to a Medicare Advantage Plan, or vice versa. A switch from one Medicare Advantage Plan to another Medicare Advantage Plan or to a plan that offers different drug coverage can be made as well. This is especially important to the MS community as medications can often change. If the doctor prescribes a medication that is not covered under a drug formulary, other drug coverage options can be explored that may be more suited to your prescription needs. To explore options, contact Medicare directly at (800) 633-4227 or visit www.medicare.gov.
For more complex issues with Medicare, the Medicare Rights Center offers a helpline to answer your questions about insurance choices as well as Medicare rights and protections. You can reach the Medicare Rights Center at 1-800-333-4114 or visit www.medicarerights.org.
The Open Enrollment Period for individuals eligible to enroll in the Marketplace for a Qualified Health Plan for coverage starting in 2015 is now through February 15, 2015. Individuals can enroll in a plan in the Marketplace by visiting www.healthcare.gov, or by calling (800) 318-2596. These plans are available to those who are uninsured, losing insurance, or who would like to make a change to their existing plan. If you purchased a plan in the previous Open Enrollment period and were not happy with that plan, now is the time to review other options and make a switch if available.
For more information regarding insurance, MSAA’s My Health Insurance Guide is aimed at assisting the MS community with understanding the many details surrounding today’s health insurance options.
Tomorrow, October 15th, is the first day of Medicare Open Enrollment for plan year 2014. The plan that you select now will impact your medical coverage and costs for an entire year. Don’t forget to tune in to our live Webinar tomorrow evening from 8-9PM EST for important information on Medicare Open Enrollment and specific tips for people living with MS.
To register for the Webinar, go to the following link: support.mymsaa.org/aca1
If you cannot attend the live program, don’t worry, you will be able to watch the archive and download the presentation slides from our MSi page after the live program: https://mymsaa.org/manage-your-ms/videos/.
This year, be prepared. Learn from Medicare experts who can try to help you understand what questions to ask and how to select your best options.
The Patient Protection and Affordable Care Act (PPACA or ACA for short) passed in Congress as a landmark piece of legislation with the intent of securing more accessible healthcare for all Americans. At MSAA, we often receive calls with clients curious and/or concerned about what these changes to the healthcare landscape may entail for them. The Affordable Care Act has enacted numerous changes to both private and public health care coverage (this includes Medicare and Medicaid).
On the private insurance side, here is a short list of just a few reforms that will be enacted starting October 1st:
1. Pre-existing condition exclusions have been eliminated, and insurers can no longer deny applicants based on their MS disease status.
2. Insurers must justify any monthly premium increase of 10% or more before it can take effect.
3. No consumer will be subject to yearly or lifetime benefit caps, which was a major issue for those with MS.
4. If you need to purchase a private plan insurance, it will now be offered through an Enrollment Marketplace in each state.
For Medicare and Medicaid:
1. The percentage for what you pay inside the Medicare Donut Hole will be decreasing every year until it is closed in 2020 and the out of pocket expense will be 25% of the plan’s medication cost.
2. Medicare beneficiaries will receive free wellness exams every year to ensure adequate preventative care.
3. As for Medicaid, for those states that elected to participate, the eligibility criteria will expand to 138% of the Federal Poverty Level or $32,499 for a household of four, for example.
These are just a few of the major reforms that will be taking place under the provisions of the ACA. MSAA has enacted a new initiative to expand education on this topic, including webinars that will focus individually on the changes to Medicare and private insurance.
The first webinar, “Understanding Medicare in the New Era” will take place on October 15th at 8 pm and will be presented by Katherine Fitzpatrick of the Medicare Rights Center and MSAA Client Services Manager, Margaret Weisser and registration is currently open. Registration information for the second webinar on the new State Marketplaces and Private Insurance is forthcoming.
You can register for the Medicare Webinar at: support.mymsaa.org/aca1
We look forward to “seeing” you there!