Paco Maribona, CSA, HCAO Lincoln city
Patience and persistence are the key watchwords. Despite much confusion, delays in Open Enrollments, especially for ACA (Affordable Care Act, aka ObamaCare) through Cover Oregon, we're ahead of most states. So there's plenty of time before mid December to enroll, let things get ironed out. Getting your benefits right is paramount; and remember, you can always change plans annually, if advisable.
Those on Medicare or Medicaid are exempted from, don't need to shop the Cover Oregon marketplace; it's mainly for folks under age 65 (& legal residents of any age who don't qualify for Medicare). Group or individual grandfathered plan members may either keep their plans, or shop the exchange.
Traditional Medicare Supplements with underwriting (health questions) are available year around. The new Open Enrollment period for Medigap or Supplements, as of 2013, the Oregon Birthday Rule, runs annually from 30 days before to 30-60 days after your birthday. You can then change to the same or lesser plan without any health questions, to save premium with another Company. Luckily, I took several clients with me last year to support the Birthday Rule at its Salem hearing; I was the only agent there, though some mailed in their support too.
Medicare Part C medical plans, HMOs Health Maintenance Organizations like Kaiser, PPOs Preferred Provider Organizations like Regence, & Part D Rx plans, the so called "advantage" plans have an Open Enrollment period annually from Oct 15 - Dec 7th, to change or drop plans. Besides premiums, they have varying deductibles & co-pays that can run several thousand dollars annually. They offer a limited list of preferred providers, some cover drugs, are easy to apply for, yet often only cover emergencies outside their areas. HMOs require primary doctor referrals to specialists, while PPOs don't; services cost less inside their networks, more outside them. A last dis-enrollment period runs from Jan 1 - Feb 14th annually.
Cover Oregon, Oregon's health insurance exchange, isn't yet fully functional, as to actually verifying subsidies or online enrollments, but should be soon, perhaps in days or weeks, before the December 15th enrollment deadline. Still, one can get a good idea of what's available online now, then sign up through your certified agent or navigator, or by yourself soon. Applications on paper are available, but they are long & cumbersome, as are applications via phone, due to privacy issues. Extended open enrollment runs until 3/31/2014.
Here's a few tips: eligibility for subsidies or tax credits is determined by tax filing status. If you're low income, under 100-138% of FPL Federal Poverty Level ($15,856/individual; $32,499/family of 4), especially if you get food stamps, you can sign up for OHP Oregon Health Plan via a 1 page fast track form. Folks with incomes above subsidy levels will soon have a short enrollment form option. The rest need to qualify via income, taxes, long form. Whatever plan you consider, be sure your doctors are in their network. Some plans like Moda & Lifewise have large, existing state networks; some are new, possibly without track records.
Here are the ways to get health plans: through your employer, or individually, either inside or outside the exchange; or stay with your grandfathered plan, if preferable. Tax credits are only available through the exchange; tax deductions, outside it. If qualified, tax credits can be advanced monthly to offset premiums. See your tax professional for details. Many people can be helped by these plans; fewer will face financial problems, like bankruptcy. Consider your choices carefully, and shop wisely.
Paco Maribona, Certified Senior Advisor, He may be reached at 541-764-5155.
Also putliched in the Lincoln City News Guard on 1-30-13