Congrats! You’ve planned ahead, selected a plan that fits your needs, and enrolled in a new health insurance plan during Open Enrollment. Now what?

For most who enroll during Open Enrollment, coverage begins 1/1/23, but there are a few things you could do while you wait.

1. Be on the lookout for new ID cards

If you changed insurance providers, or made changes to your plan elections, a new ID Card is the first tangible proof of your membership with your carrier. You will likely receive your new ID card after all required documents are received and processed. Expect your new card a few weeks after the effective date of your new plan.

2. Set up your user account.

Registering through your carrier’s website might be one of the best things you can do. You can do this through your laptop, smartphone or tablet, and this can save you time when looking for specific information about your coverage throughout the year, and can make finding in-network providers a convenient click or tap away. Most carriers have smartphone apps that you can download, so all your information and all the resources you could possibly need (including cost of care for any procedures you may need in the upcoming year) are right in the palm of your hand.

3. Schedule your annual exams

Almost every healthcare plan now covers specific annual preventive care services without imposing cost-sharing requirements— this means no out-of-pocket expenses! You can go to your insurer’s website so see what is covered, and you can set your appointments early. A few things you can check off the list? Annual physicals, cancer screenings, dental cleanings, and vision check-ups.

4. Double-check your first payment

Be sure your payment amounts correctly match the total currently enrolled in the plan you (and your family members) selected. If you see any discrepancies, now is the best time to resolve any issues.

5. Consider tracking your health-related expenses

Try to pay attention to how much you spend on health-related expenses over the course of the coming year. This way, you’ll be better prepared for next year’s open enrollment period, and you can be sure to make an educated choice on any plan changes, like looking into an HSA, which is one of the easiest ways to put money back in your pocket.

6. Get dental or vision coverage

If for any reason you weren’t able to get a health plan that includes dental or vision coverage, good news: you can buy dental or vision insurance year round! A stand-alone dental or vision plan is a type of plan offered through the Marketplace that’s not included as part of a health plan.

Dental or vision plans that come with health plans generally offer less benefits and limited network than companies that offer dental and vision plans separately. You may opt to get a stand-alone plan if the health coverage you chose doesn’t include dental or vision, or if you want different dental or vision coverage.

On November 12, 2021, the Centers for Medicare & Medicaid Services released the 2022 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2022 Medicare Part D income related monthly adjustment amounts. Below is a summary of those numbers:

Please note the Part B premiums increase for individuals with earnings of more than $91,000 or joint tax filers with earnings of more than $182,000. The monthly Part B premium can be as much as $578.30 for high income earning individuals and families.

This is the amount of the out-of-pocket expense that must be paid for outpatient services (e.g., office visits) before the 80% coinsurance benefit under Part B begins. The deductible and/or coinsurance percentage may not be applicable to certain Medicare beneficiaries who are enrolled in a Medicare Supplement or Medicare Advantage plan.

Most individuals qualify for Part A without having to pay a monthly premium. Part A is premium free to individuals who paid Medicare taxes for 40 quarters (i.e., 10 years) or for individuals who were married to someone who paid Medicare taxes for 40 quarters.

Approximately 8% of Medicare beneficiaries pay a higher premium for Part D because of their income. These individuals will pay the base plan premium plus the additional amount in the table above. Part D covers prescription drugs.

For additional information about the 2022 Medicare adjustments, please refer to this CMS Fact Sheet.

We’ve created this checklist with the same intent you had when you downloaded it — to enroll in a health insurance plan that’s right for you and your family.

We get it. Everyone searching for health insurance is in a different stage of their life.

If you don’t currently get health insurance through your job, family, or another source, you might need to buy your own plan. We’re here to help you understand your options.

Before Enrollment

How much did you spend last year?

Review your medical activity and expenses during the past year, and think about anticipated medical expenses for next year.

Find out if you’ll qualify for Medicaid by estimating your household income.

Estimate your household income for 2021 if you think you’ll qualify for tax credits or Medicaid.

Identify your list of must-have doctors, drugs, and medical facilities.

Make sure these things are covered by any potential new plan, and be flexible with the rest. It could save you money!

Decide who needs to be on your plan.

Does it make financial sense for you and your spouse to get a family plan?

Do your kids need to be on your plan, or can they get coverage through another source (school, work, etc.)?

See which plan type works best for you.

Identify which plan types insurance companies offer (EPO, PPO, HMO, POS), and learn which plan type is the best for you and/or your family.

Choose a metal tier (Bronze, Silver, Gold, or catastrophic).

Select the metal tier based on your health and budgetary needs.

We’ve created this checklist with the same intent you had when you downloaded it — to enroll in a health insurance plan that’s right for you and your family.

We get it. Everyone searching for health insurance is in a different stage of their life.

If you don’t currently get health insurance through your job, family, or another source, you might need to buy your own plan. We’re here to help you understand your options.

During Enrollment

Enroll in a health insurance plan.

IXSolutions can help you enroll on Healthcare.gov or through a private carrier website so you can feel confident in your decision.

Choose your HSA contribution amount.

If you have an HSA-compatible plan, choose your HSA contribution amount for 2021. Remember: there is a limit on how much you can contribute to each year. In the 2021 tax year, you can contribute $3,600 for single-only coverage and $7,200 for family coverage.

After Enrollment

Congrats! You’ve planned ahead, selected a plan that fits your needs, and enrolled in a new health insurance plan. Here are a few things you could do while you wait for your coverage to begin:

Pay your first premium bill on time!

If you don’t, your plan won’t be active and your health care won’t be covered during the year.

Consider signing up for autopay.

If you can, sign up for autopay to make sure you don’t miss future payments and put your coverage at risk.

Know your plan’s benefits and perks!

Utilize your health plan by getting acquainted with your plan’s benefits and perks!

If you enrolled in Medicare on your 65th birthday and haven’t looked at your coverage since—you are not alone. Most individuals enroll during their Initial Enrollment Period and never think about changing plans.

The truth is, you may be spending more money than necessary.

✔️ Have your prescriptions changed?

Maybe you are no longer taking the same dosages or even medications you were prescribed back in 2010. Or perhaps a few new medications have been added to your list.

Each year, you should receive a complimentary drug analysis to make sure you enrolled in the most cost- effective prescription drug plan, also known as Part D.

✔️ Has your current health status changed?

You may have enrolled in the most comprehensive plan available because it was affordable at the time, however, premiums increase with age and now that you’ve been enrolled a few years it may be more cost-effective to make the switch. You could save thousands of dollars each year by switching plans.

If your current health status has changed or you simply find yourself calling the doctor more, it’s time re-evaluate your coverage.

✔️ Have you moved?

Medicare Advantage plans operate on state specific networks (like an HMO). If you move, you may need to purchase a new Medicare Advantage plan.

If you are enrolled in a Medicare Supplement plan, check to see if you have the Standard or Select network. The Standard networks gives you access ALL hospitals, nationwide.

Not sure what your current benefits include? Have your plan looked at more closely by a Licensed Medicare Consultant.

A Quick Overview

As you may know, on March 11, 2021, President Joseph Biden signed into law the American Rescue Plan Act (ARPA). ARPA is the third stimulus package signed into law in response to the COVID-19 pandemic.

Under ARPA, two significant provisions were included that will help more Americans obtain and pay for health insurance coverage:

1. COBRA Subsidies—ARPA provides a six-month subsidy for certain individuals who are eligible for health insurance coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).

2. Health Insurance Marketplace Subsidies—ARPA temporarily increases the amount of subsidies that can be obtained for coverage purchased on the Health Insurance Marketplace (Marketplace), and it increases the number of people who can qualify for a subsidy.

Let’s talk about some of the highlights of these two new provisions.

COBRA Subsidies

• ARPA provides federal funding to cover 100% of COBRA premiums for periods of coverage between April 1, 2021 and September 30, 2021.

• The subsidies are only available to individuals and their family members who became eligible for COBRA coverage because of an involuntary termination of employment or a reduction in hours.

• A second 60-day election period must be offered to certain individuals who did not elect COBRA coverage during their initial election period or who terminated their COBRA coverage prior to the maximum duration permitted under the law. The individuals who must be offered a second election period are those who would be eligible for one or more months of subsidized coverage had they originally elected COBRA coverage and/or continued making COBRA premium payments.

Health Insurance Marketplace Subsidies

• ARPA makes temporary changes to subsidy payments and eligibility for 2021 and 2022.

• During this time period, ARPA removes the requirement that household income must be within 400% of the Federal Poverty Level (FPL) to qualify for a subsidy.

• ARPA changes the maximum premium payment that an individual or family would have to pay for the benchmark plan (i.e., the second-lowest cost silver plan) to 8.5% (from 9.83%) of their household income.

• ARPA increases the amount of subsidy payable to an individual or family based on their household income.

Ensure Your Coverage

These changes will hopefully result in more individuals receiving coverage through COBRA and the Marketplace.

If you don’t currently get health insurance through your job, family, or another source, you might need to buy your own plan.

Ready to enroll in a health plan? Contact us at (855) 563-6993, and we’ll help you get started.

On Thursday, January 28, President Joseph Biden signed an executive order that reopened the marketplace from February 15, 2021 – May 15, 2021 for a special three-month enrollment period.

Those who lost their jobs, and therefore their healthcare, during the COVID-19 pandemic, can now get coverage. It will also give those who need coverage during the pandemic an extended chance to buy health plans.

On Thursday, January 28, President Joseph Biden signed an executive order that reopened the marketplace from February 15, 2021 – May 15, 2021 for a special three-month enrollment period.

Those who lost their jobs, and therefore their healthcare, during the COVID-19 pandemic, can now get coverage. It will also give those who need coverage during the pandemic an extended chance to buy health plans.

Please note, enrolling between February 15 and May 15 will guarantee you coverage first of the month following the date you apply. Retroactive effective dates will not be permitted.

Secure your 2021 coverage before the May 15 deadline.

Further Reading:
The Centers for Medicare & Medicaid Services (CMS), a division of the Department of Health and Human Services (HHS), put out a summary of what to expect in the coming weeks and months.

More employees than ever before are working beyond age 65, and this is the age when most people in America quality for Medicare. Employers and plan administrators need to understand their options and/or requirements when an employee is eligible for both a group health plan and Medicare. Before we get to that, let’s start with some basics.

The Medicare Alphabet

Medicare is comprised of four different parts, each of which is identified by a letter.

1. Part A covers hospitalization and inpatient care. Most people can enroll in Part A without having to pay any premium.
2. Part B covers office visits and outpatient care. Most people must pay a premium to enroll in Part B. In 2021, the premium starts at $148.50/month and increases for higher income earners.Parts A and B are referred to as Original Medicare, and the benefits are administered by the Centers for Medicare and Medicaid Services (CMS), a federal government agency.
3. Part C is more commonly called the Medicare Advantage program. Under the Medicare Advantage program, private insurance companies administer Part A and B benefits, and often provide more benefits than Original Medicare. There may be an additional premium charged by the private insurance company, although some plans have no additional premium.
4. Part D covers prescription drugs. Part D plans are also administered by private insurance companies. In addition, several Medicare Advantage plans include Part D coverage.

Although technically not a “part” of Medicare, there is one other plan to point out. Medicare Supplement plans, also known as Medigap plans, are available to people enrolled in Original Medicare. These plans cover some of the deductibles and out-of-pocket costs associated with Parts A and B.

Qualifying for Medicare

Most people qualify for Medicare on the first day of the month that they turn age 65. For example, if your birthday was on May 15th, your eligibility for Medicare will start on May 1st.

Some people qualify for Medicare under age 65 because of a disability. These people are eligible for Medicare on the first day of the 25th month of receiving Social Security Disability Income benefits. People under age 65 with end-stage renal disease (ESRD) or amyotropic lateral sclerosis (ALS) can qualify for Medicare earlier.

Coordination of Benefits

Employers and plan administrators should be prepared to answer questions from employees as they enroll or consider enrolling in Medicare while still working or having coverage through a spouse who is still working. The federal government has a set of rules in place, referred to as Medicare Secondary Payer rules (MSP rules), that determines which health plan is primary and secondary when an employee is enrolled in both a group health plan and Medicare. This is primarily based on the size of the employer, and when determining the size, employers should include full-time and part-time employees in the count.

• • Employers with fewer than 20 full-time and/or part-time employees for each working day in each of 20 or more calendar weeks in the current or preceding year.
    • Medicare will be the primary payer of coverage. The group health plan will be the secondary payer of coverage.

• • Employers with 20 or more full-time and/or part-time employees for each working day in each of 20 or more calendar weeks in the current or preceding year.
    • The group health plan will be the primary coverage for those people who qualify for Medicare based on turning age 65. Medicare will be the secondary payer of coverage.

• • Employers with 100 or more full-time and/or part-time employees on 50 percent or more of its business days during the previous calendar year.
    • The group health plan will be the primary coverage for those people who qualify for Medicare due to a disability. Medicare will be the secondary payer of coverage. Note: Special rules apply to individuals who qualify for Medicare based on a diagnosis of ESRD.

• Employers offering coverage to former employees, such as retirees.
  • Medicare will be the primary payer of coverage regardless of the employer’s size. The group health plan will be the secondary payer of coverage.

Options for Employers and Plan Administrators

Some employers or plan administrators may be interested in providing an alternative benefit to employees who are eligible for Medicare. This alternative benefit generally involves a financial incentive to disenroll in the group health plan and pursue coverage exclusively through Medicare. This could create savings to the employer, coverage under Medicare may be better than the group health plan, or it could be a combination of both.

The MSP rules that were discussed above also dictate when a financial incentive which may encourage disenrollment from the group health plan can be offered. These MSP rules are in place to protect the solvency of the Medicare Program.

• • When Medicare would be the primary coverage regardless of enrollment in the group health plan (usually, this will be employers with fewer than 20 employees), the employer may establish a Health Reimbursement Arrangement (HRA) which provides tax-free reimbursements to employees under the following circumstances:
    • The employee is offered a group major medical plan with minimum value; and
    • The employee is actually enrolled in Medicare Parts A & B; and
    • Premium reimbursements are only available to those employees enrolled in Parts A, B and/or D; and
    • Reimbursements are limited to Part B and D premiums, Medicare Supplement premiums, and excepted benefits (e.g. dental/vision).

• • When Medicare would be the secondary payer of coverage if the employee were enrolled in both the group health plan and Medicare, the employer cannot offer any incentive (financial, or otherwise) that would encourage disenrollment from the group health plan. Penalties of up to $5,000 for each violation may apply.  In addition, the Internal Revenue Service (IRS) may impose a penalty of up to 25% of the employer’s group health plan expenses for the relevant year.  It would not be advisable to pay or reimburse employees for Medicare premiums (with pre-tax or after-tax dollars) in situations where Medicare would be the secondary payer of coverage if the employee enrolled in the group health plan.

• Employers offering retiree coverage may establish an HRA that reimburses Medicare premiums and/or medical expenses without having to offer a traditional group health plan. These HRAs allow employers to fix their contributions and expenses while at the same time providing a generous benefit to retirees.

Medicare and COBRA

Medicare entitlement of the employee is listed as a COBRA qualifying event, however, it is rarely a qualifying event. In situations where it is a qualifying event, it is only a qualifying event for the spouse or children that are covered under the group health plan.

For Medicare entitlement of the employee to be a qualifying event, the terms of the group health plan must specify that the employee is no longer eligible for coverage under the group health plan once entitled to Medicare. This is prohibited in most instances by the MSP rules, and thus, Medicare entitlement of the employee is rarely a COBRA qualifying event. This is best illustrated by an example.

John works for XYZ Company which has 200 employees and is subject to COBRA and the MSP rules. John is enrolled in the group health plan offered by XYZ Company, and he also has elected to cover his spouse Jill under the plan. John just turned age 65 and has become eligible for Medicare, but Jill is only 62 years old and is not yet eligible for Medicare. John has decided to enroll in Medicare, and consequently, Jill will be losing coverage under the group health plan.

Does XYZ Company have to offer COBRA to Jill? No.

John voluntarily dropped coverage under the group health plan. XYZ Company did not, and is prohibited from, changing John’s eligibility for coverage under the group health plan because he enrolled in Medicare. John could have continued coverage under the group health plan even while enrolled in Medicare. As a result, John’s Medicare entitlement does not trigger a COBRA qualifying event for Jill.

Medicare Part D Notification and Reporting

As previously mentioned, Part D is the prescription drug program available to those individuals who are enrolled in Medicare Parts A and/or B.  Upon becoming eligible for Medicare, each person has the option to sign up for a Part D plan.  If a person delays enrollment in Part D, they will be charged a late enrollment penalty equal to 1% of the “national base beneficiary premium” multiplied by the number of months not enrolled in a Part D plan.  However, if a person delays enrollment in Part D and is enrolled in a plan from their employer which includes prescription drug coverage, they will most likely have that penalty waived if they sign up for Part D later.

The Medicare rules provide that employers or plan administrators must do two things:

1. Provide any Medicare eligible individuals with a notice annually prior to October 15^th.  The notice indicates whether the drug coverage you offer is at least as good as the standard Part D plan option, referred to as the creditable coverage notice.  There is a non-creditable coverage notice if the drug coverage isn’t at least as good as the standard Part D plan option.  The notice should also be provided at other times, such as when a person first joins the plan or if creditable coverage status changes.  The best practice is to give this notice to all eligible employees since you may not be aware if they and/or their dependents are eligible for Medicare.
2. You must report information about your drug coverage and its creditable or non-creditable status to CMS within 60 days of the start of each plan year.  You must also report to CMS within 30 days after termination of a plan with prescription drug coverage or a change in the plan’s creditable coverage status.

Model notices and access to the online site to complete the reporting can be found HERE.

Summary

Employers and plan administrators should educate themselves about the interaction between Medicare and group health plans. It’s important for compliance reasons, but it’s also important to help employees understand what does (or doesn’t) change upon becoming eligible or enrolled in Medicare.

Introducing Bright Health, a brand new carrier in Illinois offering a carefully curated network of doctors, clinics and hospitals to provide the best healthcare at the best possible price.

About Bright Health

Bright Health began offering consumer-focused health insurance plans in Minnesota in 2017, after raising over $80M in venture capital. They are currently in 13 states, with plans to expand to more, driven by deals with integrated health systems in metropolitan areas.

Bright Health’s model is anchored in exclusive Care Partnerships with leading health systems in each state, using three technology components: an intuitive user interface, a data analytics component, and a platform that works with electronic medical records and telemedicine companies. These allow Bright Health to suppress costs while improving patient outcomes and care coordination.

What makes Bright Health stand out?

No referrals, just open access. No Primary Care Physician selection required.

Bright Health’s Network is an HMO-PPO hybrid. Like an HMO, you are restricted to Bright Health’s Care Partners:

• NorthShore University Health System
• DuPage Medical Group
• AMITA Health
• Edward-Elmhurst Health
• Sinai Health System

But like a PPO, you do not need referrals to see specialists. (Contact us to find out if your specialist is part of the Bright Health Care Network!)

Coverage for a fraction of the cost.

Bright Health offers individual and family plans with lower premiums, including several options with a $0 Deductible, and HSA-compatible plans.

Pediatric Dental & Vision on all plans

All plans include pediatric dental and vision coverage for members under 19.

Mindfulness and Mental Health

Sometimes, you just need someone to talk to. Bright Health offers plans with low cost-sharing for mental health services, including behavioral health treatments.

Enhanced Telehealth

See your doctor anytime, anywhere with enhanced telehealth access – all from the comfort of your own home.

If you are tired of having to get referrals and want open access for a fraction of the cost, Bright Health is for you.

Save money on premiums while retaining access to the best hospital systems in Illinois.

Individual & family open enrollment period ends on December 15.

Have a doctor you love and trust? To find out if your specialist is part of Bright Health’s Care Partners in 2021, give us a call at (855) 563-6993.

Question:

Are health insurance rates different in every state? For example, is New York more expensive than Pennsylvania?

Answer:

Yes, health insurance rates vary in every state. In fact, rates vary in every county.

Rates are based on age, geographic location (zip code) and other factors such as tobacco use. And they are not negotiable.

That means your neighboring town may have access to different plan networks than your hometown.

For example, if you lived in Lake County this year, you would not have access to Blue Focus Care, a Blue Cross Blue Shield of Illinois network specific to Cook County only.

You can only visit hospitals and doctors that are in network. Regardless of the county they service patients in—the plan you purchase is specific to the county you reside in.

The Tax Cuts and Jobs Act signed into law last year wiped out the federal penalty for not having health insurance (a.k.a. the Individual Mandate) starting in 2019. Some state officials are concerned that the elimination of the penalty could destabilize their local insurance markets, and they have responded with their own Individual Mandate requirements.

1. The state of New Jersey passed an Individual Mandate law on May 30 which will be effective in 2019. The penalty will be calculated using a formula similar to the one used for the current federal mandate. In general, the penalty will be the greater of $695 per adult ($347.50 per child) or 2.5% of household income. The penalty will be capped at the lowest-priced bronze plan available on the state’s marketplace. Additional details may be found here.
2. The state of Vermont also passed an Individual Mandate law on May 28, but this won’t be effective until 2020. An interesting part with the Vermont mandate is that specific details are not yet known. The financial penalty and enforcement mechanisms will be determined during the state’s 2019 legislative sessions. Additional details may be found here.
3. The state of Massachusetts was actually the first state to implement an Individual Mandate, and they did this well before the passage of the Affordable Care Act (ACA). The mandate in Massachusetts was signed into law back in 2006. In general, the state’s Department of Revenue issues guidance each year with details on the penalty amounts which are tied to a predetermined formula. The penalty amount varies by income with the maximum penalty applying to those without insurance and earning more than 300% of the Federal Poverty Level (FPL). In 2018, the maximum penalty is $119 per month, or $1,428 per year. The state imposed penalty is reduced by any amount owed under the current federal penalty. Additional details may be found here.

Lawmakers in other states are also considering some type of Individual Mandate. States like California, Connecticut, Maryland and Minnesota are considering laws that would require their residents to have health insurance or pay a penalty, and these aren’t the only states considering a mandate. Other states may also follow suit. It’s unclear which additional states will pass mandate legislation, but it does seem like there is a good chance there will be more.