by Paco Maribona, Lincoln City
Certified Senior Advisor and Independent Insurance Agent
The two different Insurance Open Enrollment (OE) periods bring some questions. Should you make changes to your health insurance plans, or not? I can help, and I suggest calm and patience throughout the process. If you or a family member is on Medicare, VA, or group insurance, you don't need to do anything, nor sign up for ACA (Affordable Care Act) or Cover Oregon.
The Medicare Advantage plans' (HMO, PPO, Rx) annual OE (Open Enrollment) goes from Oct. 15-Dec. 7, but it does not affect Medicare Supplements, which can be changed year around, and whose OE is within 30 days of one's birthday. If you're happy with your current medical and Rx plans, you likely won't need to change; but if you want to change, OE is the time to do so. Medicare Advantage dis-enrollment period runs from Jan.1-Feb. 14, 2015, during which beneficiaries may dis-enroll from Advantage plans to Medicare Supplements and stand-alone Rx plans only.
Medicare Supplements (Medigap) cover any provider (doctor, hospital, etc.) anywhere in the USA who accepts Medicare, while the “Advantage” plans cover limited areas and charge co-pays for services. Generally, you may see providers outside their areas for emergencies only.
Folks under age 65 and not covered by Medicare or VA generally qualify for ACA or Cover Oregon. Their 2015 OE runs from Nov. 15-Feb. 15. If you have OHP (Oregon Health Plan) or Medicaid, contact local navigators or OHP directly about re-certification. Accountants can help with tax questions or possible penalties. Of course, certified agents can help you through either OE period; and your acceptance is guaranteed, regardless of health, during these OE periods only.
If you got your insurance directly from Insurers or agents and didn't get a subsidy, you don't have to change plans unless you wish to. Carriers will automatically enroll you into the same or similar plan you have now, if available. If you got a plan and subsidy through Cover Oregon, you will need to re-apply through the FFM (Federally Facilitated Marketplace) either through a certified agent or via the federal website: healthcare.gov . 2015 brings some changes in plan coverage and premiums..
Please read and consider carefully the information sent by your current Insurer. If you decide to keep your plan, fine; if not, then use the OE period to compare and decide which changes fit you best. We hope the Federal Exchange and website are easier to navigate than Cover Oregon. Be sure to get the affordable coverage you need.
Paco Maribona. 541-764-5155