By Ulla-Undine Merritt (Dee) National Producer Number (NPN) 8853366
HEALTH INSURANCE is more important than ever! There is no way to determine when something will happen or when you could be diagnosed with a serious medical condition. So, saying I am healthy, so I don’t need health insurance makes no sense. Insurance is moving the financial risk from you to the insurance company. There are always options for about every budget. Work with a professional that is contracted with many carriers and offers multiple options. Many plans are available year-round, the government plans such as the Marketplace and Medicare have specific times that you can enroll unless you have a Special Enrollment Period due to, as an example loss of coverage, marriage, moving out of the plans service area, etc.
MEDICARE – Annual Enrollment Period October 15-December 7th, 2023, for January 1st, 2024, effective. Medicare Advantage – Part C & Part D Prescription Plans
Most of the plans in your area have made many changes and things you might not notice, especially important, are your doctors still in network, what tier are your medications and maybe the tier changed, copays, coinsurance. What extras are the plans offering? Maybe you need extra dental, vision, hearing aids. Many plans include some wonderful extra benefits, but it is also particularly important to know how to use the benefit and if they work for you. If the insurance company, you are with comes up with a better plan they will NOT switch you to it automatically. Your insurance agent should be making you aware of a better option. It is illegal for a insurance person to call you regarding Medicare, do not talk to someone you have not given permission to call. Ask them for their National Producer number and report them to Medicare for a unsolicited call.
CMS has made many rules for 2024 Medicare season. If you want to enroll or review your plan over the phone, you need to agree to be recorded and Medicare requires us to keep the recording for 10 years. In person appointments do not have that requirement, but you need to sign a scope of appointment that authorizes us to talk to you about Medicare Advantage or a Drug Plan it does not allow us to do anything but talk to you about these topics. Many plans have decreased the cost of Insulin which will be a huge savings for so many in 2024. Part D after you, the plan and the pharmaceutical company paid $8,000 you no longer have a cost for your medications for the rest of the year.
When you turn 65 you are eligible for Medicare, once you have worked 40 quarters roughly 10 years there is no cost for Medicare Part “A”. Part A covers Hospitals, Skilled Nursing, Home Health & Hospice. Medicare Part B you can choose to take at 65 or you can hold off if you are still working and have credible coverage. If you do not have group health insurance that is considered qualified, and then you want it you would have a late enrollment penalty for each month you did not have Part B & Part D and that penalty will last for the rest of your life. Part B covers, doctors, imaging, blood work, ambulance, durable medical equipment, etc. Part D is a Medicare Drug Plan and covers medications. During your initial enrollment period it is especially important to understand your options! Medicare Supplements/Medigap Plans are NOT guarantee issue you may need to medically qualify. You can purchase a Medigap Plan during your 1st 6-month on Medicare Part B without medical underwriting. There are a lot of things you need to know. Again, work with an agent you can trust! Especially important: when you move you need to know your options. Can you keep the same plan? Do you need to make a change and what does that look like?
We offer Free Medicare Seminars in Lee & Collier County please e-mail info@logicalinsurance.com to register or call 239-362-0855 for dates. Medicare’s website is www.Medicare.gov.
MARKETPLACE – Obama Care/Affordable Care Act – open enrollment starts November 1st- December 15th for January 1st effective. December 16th to January 15th will have February 1st, 2024, effective. The website is HealthCare.gov, your local insurance agent can help you through the maze. The government also changes each year what how much you can earn to receive subsidy to help lower your cost for insurance. Many people are not aware that they do not need to forgo having health insurance and there are affordable options for them. Insurance is not just about the price of the premium but particularly important the network of doctors, hospital, etc. that you can have access to. Be careful carriers that are selling in your area might not have a good network, so the price might be right but if your hospital and your doctors are not in their network that is a problem. So always check the network!
Understanding deductibles, out-of-pocket maximums, what applies to the deductible? Do I have to pay the deductible before the plan pays? This differs by each plan, Copays vs. coinsurance if you do not understand ask, become informed about what you are buying and how it works.
Individual/Family Health Insurance – Being young and healthy does not mean you do not need health insurance. Do you know anyone that knew when they were going to be diagnosed with cancer, or when they were going to have a heart attack or even a serious accident? I do not, it happens, and insurance is there to help you get the care you need and limit your financial exposure. What are your insurance options, and what is best for you? Employer Group Coverage, Individual Medically Underwritten Health Insurance, Medicaid, or the Government Market Place Guaranteed Issue Health Insurance. There is a lot to know about the differences, as well as the cost. The monthly premium should not be your only consideration. You do not know what you do not know so ask the experts, which do know about all of plans and can help educate and guide you thru the enrollment process. When it comes to medically underwritten plans, most of them you can enroll all year long, but you can also be denied based on medical underwriting.
Logical Insurance Solutions is a SWFL Insurance Broker that works with most of the carriers, we are happy to help you through the maze. This is what we do daily, it is second nature to us. We offer virtual seminars, one on one WebEx, phone and in person appointments.
To learn more about your options call to schedule an appointment contact: Logical Insurance
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