Open Enrollment: Confusing Correspondence

What to ignore

  • Marketplace mailings, email, even phone calls saying you must enroll or pick a plan when you don't get your health insurance through the Marketplace or you have enrolled and picked a plan.*
  • Notices from Blue Cross telling you some information they sent earlier is incorrect but not giving any information about what plan they're talking about.

What to pay attention to

  • Marketplace requests for information from you regarding past or current transactions with them. Not doing so could result in loss of coverage and/or tax penalties
  • Invoices for 2017 premiums from your current insurance company. If you are not paid up for December, January 2018 will be applied to 2017. If you remain 30 days behind, your policy could be cancelled.
  • If you got your 2018 health insurance through the Exchange with assistance, the insurance company whose plan it is will notify you that they have received your application from the government. They’ll provide information on how to pay your portion.

*If you are not buying this year's health insurance through government sites, but bought last year's health insurance through the Marketplace, call 800-318-2596. Cancel your account. The government is assigning health insurance plans that may override your Off-exchange choice for 2018.

Open Enrollment ends December 15.
If you don't have your health insurance for 2018, call us. We're here to help. 847-362-8888.


Week One Open Enrollment

Open Enrollment for those folks under 65 who buy their own health insurance began November 1. It runs to December 15.

Despite confusion about cost-sharing and premium assistance, people who qualify are receiving help at proper levels. Call us to find out if you qualify and how to pick the plan that gets the best help. 847-362-8888. (Not all agents are certified to take you to the government for this help.)

  • As in previous years government sites (online and on-phone) had to pause from overload. The phone lines shut down last Sunday. They are expected to do so every Sunday except December 10.
  • Blue Cross 2018 renewal packets were expected to reach 98% of their policy holders by November 1, but we’re hearing from clients who still have not received them. Watch your USMail.
  • The link to open Blue Cross quotes generated through their site and agents was not working Tuesday. Try today. If you can’t open your quote, call us. 847-362-8888.
  • Provider-Finder sites online are proving inaccurate. Northwestern Hospitals have people to help at 312-926-8400, Northshore University Health System 847-570-4202. Better still, call the doctor you want to use to ask what insurance they take. Make sure they know you are on an individual plan. Group plans have different coverage.

Your best bet for getting the insurance plan you need for 2018 is to work with an Illinois licensed and CMS certified agent. They know the federal rules and, more important, the local situation. Their services are free.

It takes a conversation. Call today to get health insurance for 2018.


WHAT TO DO ABOUT YOUR CANCELLED BLUE CROSS PLAN

We know you’re concerned because you still haven’t received your Blue Cross Renewal Packets as of November 3rd.
We can see into our clients’ accounts that renewal packets have been sent. But we cannot see the content yet. (Technical glitch, being fixed, yadayada.)
While we don’t know the specific plans Blue Cross is offering to migrate you to, here’s what we do know.
1. All On-Exchange policies must go back to the Exchange before December 15 for 2018 coverage. We’re making appointments and will be calling you by Monday. You can help by sending us an email confirming the network you want to stay in or change to, if your 2018 income projection remains the same, if the people covered by the plan remain the same. rbloomfield@jpearlsteinltd.com.
2. Off-Exchange Renewal (Blue Cross’ only continuing plan is Blue Choice Preferred Silver PPO 102)
• If you want to keep your plan there is no need to re-enroll. Just keep your payments up to date and you may continue to use your coverage. You’ll be covered January 1, 2018. We will remain our agents.
• If you want to enroll in a different plan, (Silver to Bronze or to a different hospital network), we must submit a new application for you by December 15th. Call us 847-362-8888 or rbloomfield@jpearlstein@aol.com.

3. Off-Exchange Discontinued (This affects 98% of Blue Cross policy holders.)
• If you like the plan Blue Cross has selected for you there’s no need to re-enroll. Just keep your payments up to date and you may continue to use your coverage. You’ll be covered starting on January 1, 2018.
• If you want to enroll in a different plan let us know. We’ll discuss options, send quotes. We must submit a new application for you by December 31st.

Net Net: We will take care of everyone in a timely manner.
On-Exchange (those with premium assistance) must apply by December 15 for a January 1 start.
Off –Exchange accepting the plan Blue Cross offers should do nothing but be in good standing paying your premiums. Automatic start January 1.
Off-Exchange Discontinued wanting a plan other than what Blue Cross proposes, let us know immediately. We have until December 31st for a January 1 start.

We know there are others out there as perplexed as you. Please send them to us.

Thank you.


LATEST NEWS FROM BLUE CROSS

Blue Cross has released the 2018 plans.

Here's what's important for you to know at this time:

You'll get Renewal Packets by November 1.

They contain:

  • If your health plan is continued or not and what Blue Cross suggests
  • How to keep the current plan if you can, go to the suggested 2018 plan or get a new plan of your choice
  • Changes to coverage comparing what the current plan covers and what it costs
  • Dental plan renewal letter (if applicable)
  • Important updates to the pharmacy benefits

We were told we will be able to go into your account and see this correspondence. As of right now, we can look at plans and prices, but can't send them to you yet.

If you got your current plan at the Market Place (On Exchange) and you have any changes in plan or projected 2018 income, we must go to the Market Place.

If your plan is discontinued, Blue Cross is offering an application extension to December 31 for January 1 effective date.

Don't Panic. You don't need to call in. We're organized and ready to take care of everyone. We'll contact you by email and phone when all the information is there.

You're the best.

Jerry S. Pearlstein   Rebecca Bloomfield


AFFORDABLE CARE ACT OPEN ENROLLMENT FOR 2018

November 1-December 15

Who needs to act during these 45 days?

  • Individuals/families under 65 who buy their own health insurance
  • People who want to change their current plan.
  • People who may be notified their current plan is not available in 2018.
  • People who are receiving premium assistance and must re-certify with the government to continue it.
  • People who are receiving premium assistance but will not be eligible in 2018.
  • People who have not previously qualified for premium assistance but will in 2018.
  • People who may be eligible to form a small group

Blue Cross will notify you if your plan will automatically re-up for 2018. We expect their letters to get to you by October 1. We expect plan cancellations and premium increases. You must make the changes you want for 2018 within the Open Enrollment Period.

Except in clearly defined circumstances, 2018 Affordable Care Act health insurance cannot be bought or changed after December 15, 2017.

If you do not act between November 1 and December 15, you will be stuck with what you have for all of 2018.

We recommend that you do not go online or the Exchange yourself. Neither the system nor the navigators understand how to get you the plan that gives you access to the doctors and hospitals you want.

We have completed our re-certification for participation in the Affordable Care Act On Exchange and Off Exchange. We are up-to-date with what is available in our area. We have a 99% success rate in obtaining Premium Assistance and Cost Sharing.

Please watch our emails. Let us know when you get your letters. (847-362-8888) We'll be setting up appointments with those clients receiving premium assistance.

We're here to take care of you.

Jerry Pearlstein   Rebecca Bloomfield


SMALL GROUP HEALTH INSURANCE FOR 2018

SPECIAL ENROLLMENT NOVEMBER 15-DECEMBER 15

From November 15 to December 15 only, we can offer Small Group Health Insurance and waive two requirements:

  1. No required minimum percentage of participating employees
  2. No required employer contribution to employees’ premiums.

Groups are most advantageous because they offer a PPO that gives access to all Chicago area hospitals and doctors. Currently, individual/family Affordable Care Act compliant plans do not.

Blue Cross Small Group plans also offer features such as combined deductibles that their individual ACA compatible plans do not.

At least two entities are required to qualify for a small group.

  • A Partnership of at least 2 partners with a formal partnership agreement. They must be working partners putting in at least 30 hours per week. A group can be created even if only one of the partners takes the insurance.
  • Sole Proprietor or LLC, S or C Corp with an employer/owner plus a fulltime employee paid a salary (minimum $1000/month) for whom the owner files a state quarterly wage report (IL340). The FT employee cannot be the spouse of the owner or a child of the owner under 26. OR a part time employee of any age, working any number of hours. In both cases the employer must be filing IL340 Quarterly Wage Report.

    The insurance must be offered to all employees. Some may waive joining because they have insurance through their spouse, union, Medicare. Military or Medicaid.

    The owner (and family) can have one policy with group coverage even if the employee doesn’t take insurance.

**IMPORTANT** Establishing a small group is a multi-step process: You must request a Proposal to confirm that the business qualifies for Small Group, provide a census that includes genders and birthdates of all who will be offered the insurance so we can generate proposed plans and prices, return signed applications from each participant and the Binder Payment for the first month.

Start now to submit a completed application between November 15 and December 15 to take advantage of the Special Enrollment requirement waivers.
Call us at 847-362-8888.


MEDICARE OPEN ENROLLMENT OCTOBER 15 – DECEMBER 7

Who is affected?

  • Over 65, uninsured and have not yet signed up for Medicare Part A, B, C or D benefits. Read “Five Myths About Medicare“.
  • Want to change Part D plans
  • Want to switch from a Medicare Advantage plan to a Medicare Supplement (Medigap). Read about both.

You can sign up for Medicare if you turn 65 in 2018 3 months before or after the month of your birthday. Benefits can begin the first day of your birthday month. The Open Enrollment is only for those already over 65.

We’re happy to help you through the process. 847-362-8888


From the Society of Certified Senior Advisors

Busting the Top Five Medicare Myths

Provided by Francie Stavish, Francie Stavish Associates. Senior Move Manager and Estate Cleanout

Avoid becoming a victim of what you think you know about Medicare.

Nearly everyone over the age of 65 depends on it, but myths and misconceptions around Medicare persist. The government-funded health insurance program for seniors will provide more cumulative lifetime benefits to average earners than Social Security by 2055, according to a study by the Urban Institute, but its complexities inspire a host of misconceptions.

Whether you will be new to Medicare or have gone through the process many times before, here’s how to navigate around unnecessary penalties, bad timing and costly stays you only thought were covered.

Myth 1: I can enroll any time I want to.

If only it were that easy. While there are large windows of opportunity, if you miss them, you’ll hit a wall.

First time enrollees have three months both before and after their 65th birthday for their initial enrollment period (IEP). The annual enrollment period (AEP) is October 15 through December 7, when you can make changes to your Medicare coverage.

Participants in traditional Medicare can switch to a Medicare Advantage plan during the open enrollment period, and seniors with Medicare Advantage can return to a traditional Medicare plan or change to a different Medicare Advantage plan without getting hit with a penalty.

Retirees can also switch from one Part D prescription drug plan to another, or add Part D to their coverage (although a late enrollment penalty may apply).

What you can’t do during open enrollment is switch from Medicare Advantage to Medigap (see sidebar) or switch Medigap plans without answering medical questions. You also can’t join Part B, which covers outpatient care, preventive services, ambulance services, and durable medical equipment, unless you have a qualifying event.

Myth 2: Medicare pays for long-term care.

Many seniors are shocked to find out that Medicare is not going to pay for their golden years in a retirement home or assisted living facility. It will cover the first 20 days in a skilled nursing facility, if and only if the need is due to a hospital stay of at least three days. (Some Medicare Advantage plans will waive this requirement under certain circumstances). As of 2017, days 21 through 100 are no longer fully paid, and require a copay of $164.50 per day.

Why are so many seniors taken by surprise, given how common long-term care has become? Experts speculate that it’s because they confuse Medicare and Medicaid, a needs-based alternative that kicks in when assets are depleted. Even then, Medicaid probably won’t cover the swanky place you’ve got your eye on; it is only available for eligible facilities.

Myth 3: Medicare covers all my health expenses.

“People usually think Medicare will cover everything, and that doesn’t work out well for clients who aren’t healthy,” says Joanne Giardini-Russell, Medicare advisor with Financial Architects Inc.

Medicare generally covers 80 percent of costs, and that 20 percent that isn’t covered can add up faster than you can slip on a banana peel. Consider the additional financial burden of dental, vision and hearing coverage, and it explains why so many seniors get supplemental insurance.

It’s important to realize, however, that you have a choice in additional insurance. Don’t just roll from the insurer you had at work into the Medicare Advantage plan the same insurer offers. You can choose between any Medicare Advantage plan offered, as well as Medigap. (See our guide, right) However, you can’t enroll in both.

Myth 4: Medicare is free.

Most people get hospital insurance (Part A) for free, but are surprised that medical insurance (Part B) and prescription drug coverage (Part D) require a premium payment, which is dependent on their income. For 2017, the standard premium per month for Part B is $134, but most people with Social Security end up paying $109 a month on average, according to the U.S. Centers for Medicare and Medicaid Services.

Check if you may be eligible for the Limited Income Newly Eligible Transition (LINET) program, which is a temporary prescription drug plan for low-income Medicare beneficiaries who don’t have other prescription drug coverage. It helps get rid of gaps in coverage for those who aged into Medicare without getting a Part D plan.

The Affordable Care Act added coverage for an annual wellness exam, and covers 100 percent of most preventive services such as cancer and diabetes screens, mammograms, bone mass measurements and more. Many seniors don’t realize these services are now free.

Myth 5: I don’t need to enroll in Medicare.

Even if you have other insurance, it could be crucial to enroll – and timing matters.

If you work in a company that employs fewer than 20 workers, the employer-sponsored health plan automatically becomes secondary to Medicare at age 65, and the Part B penalty kicks in. That penalty means premiums can go up almost 10 percent for every month you are eligible for Medicare but not enrolled. In addition, you can get hit with a similar penalty for Part D that costs 1 percent of the base cost, multiplied by the number of complete months you’re not covered.

Seniors covered by COBRA have no longer than eight months to sign up for Part B without incurring a penalty, even though COBRA may provide secondary coverage for a year or more after retirement.

Likewise, small business owners and seniors who are self-employed have to enroll in Medicare during their IEP, regardless of whether or not they buy insurance privately.

If your employer has 20 or more employees, it’s usually a good idea to at least sign up for the free Medicare Part A as soon as you’re eligible. But before you do, find out whether that will trigger a change in your current coverage.


Should I Choose Medigap or Medicare Advantage?

Provided by Francie Stavish, Francie Stavish Associates. Senior Move Manager
From the Society of Certified Senior Advisors

One of the most confusing choices retirees must make is picking between supplemental Medigap and a Medicare Advantage health plan that covers Part A and B benefits.

Medigap (Medicare Supplement)

With a Medigap policy, seniors have more physicians to choose from. All Medicare providers participate in Medigap. Out-of-pocket costs are low to none, but average premiums run about $150 to $200 a month and vary by age and health history.

Medigap policies come in 10 variations, no matter where you live. But they don't include any coverage for Part D, so additional coverage for prescriptions is necessary. And while you'll have to tote three cards in your purse or wallet (one for Medicare, one for Medigap and one for Part D coverage), payment is a snap. Medigap almost always cuts a check directly to providers after Medicare pays its share.

Medicare Advantage

Medicare Advantage programs require the use of plan providers only (HMO) or charge you extra for out-of-network services (PPO). Plans charge copays and carry deductibles of several thousand dollars per year. Premiums run from negligible to more than $100 per month, but all enrollees pay the same regardless of health history or age.

Most Medicare Advantage plans cover prescription drugs, and they are rated with a five-star system. Seniors only have to carry around their Medicare Advantage card for services, but there's the additional hassle of paying copays and deductibles to providers.

The result: Medigap usually costs less for someone with major health problems. Despite higher premiums, out-of-pocket costs are typically much lower. However, if your prescription costs are high, you should factor in the additional cost of Part D coverage before making a decision. Healthier individuals can save money with Medicare Advantage's lower premiums.

Hint: It's important to review your choice every year at open enrollment, October 15 to December 7. At this time, Medicare Advantage and Part D plans can change or drop coverage for certain drugs or alter pricing on the same drug. Your Medicare Advantage plan can also change their network of doctors and facilities, adjust the way they cover a medical service, and/or drop additional benefits such as hearing, vision and dental.


ALERT: BlueCross leavingSHOP

WHAT DOES BLUE CROSS' EXIT FROM "SHOP" MEAN TO YOUR SMALL BUSINESS?

Our Blue Cross General Agent says: "Group health insurance sold directly through BCBS and its agents is still going strong."

There are even new opportunities for the self-employed and small business owner to choose health insurance plans for themselves and their employees:

  • during Group Special Enrollment (Nov. 15 – Dec. 15) enroll with no employer contribution, no minimum enrollment.
  • more network options including BCBS large PPO network
  • possible premium and tax savings including HSA plans

As individual/family policy premiums increase and access to hospital/doctor networks decrease, many very small businesses are looking to group health insurance.

Employers currently contributing to their employees' individual plans should consider forming a group during Group Special Enrollment. Group premiums are tax deductible for the group.

Click Here to learn more about qualifying for Small Group Health Insurance.

Or call us at 847-362-8888 to start a conversation about your situation and opportunities.