It’s Time to Evaluate Your Options and Choose the Insurance Plan That’s Best for You
by TERESA SCIHFFER
It’s open enrollment season for Medicare and the Affordable Care Act (ACA) plans. If having health insurance that covers your actual medical needs, as well as your preferred doctors and necessary medications, is important to you, then you might want to pay attention. This is the time of year to review your plan and make note of any changes that will affect you, and potentially switch to a more suitable or affordable plan.
We talked to Keith Sumner, an insurance broker with HealthMarkets Insurance Agency in Lakeland, to gain some insight into what people need to be aware of as they navigate their health insurance options. The biggest takeaway from the conversation? The advice of an insurance agent is priceless during this time. Sorting through the myriad of available plans can be a daunting task, and it is wise to consult someone familiar with the details.
First of all, if you qualify for Medicare, you need to know that the open enrollment period began October 15 and ends December 7. In Polk County, there are 47 different Medicare Advantage plans available to consumers through private insurance companies. They all change a little bit every year. Medicare Part A is free, while Medicare Part B is subsidized, with recipients currently responsible for $135.50 per month, which is generally deducted from a social security check or paid through a personal account. Next year, that cost will be $144.60 for most individuals.
When you are not on Medicare and you purchase insurance through the ACA Marketplace (also known as Obamacare), the open enrollment period runs from November 1 through December 15. There are a few states where the dates are different, but this is the enrollment period for Florida.
There are three companies that provide healthcare plans to Polk County through the ACA Marketplace: Ambetter, Molina, and Florida Blue, an affiliate of Blue Cross and Blue Shield of Florida, Inc. These companies offer a total of 68 plans in Polk County. The ACA is designed specifically for individuals and families who are not offered insurance through their employers. The government pays a portion of the premium, based on the individual’s income. For example, a couple earning less than $67,500 per year will qualify for substantial assistance from the ACA for their premiums. Over that amount, and they won’t qualify for the subsidy at all.
Health insurance plans are subject to change every year. There may be changes to the premium, the co-pays, prescription drug coverage, even which doctors are included in that network. This is true whether you have Medicare, an ACA plan, or a group plan through your employer.
“Now is the time to evaluate those changes, and if you are comfortable with the changes you can stay on the plan you have, if it’s still available for 2020,” Sumner explains. “If you’re not comfortable, now is the time to shop and find another plan that you are comfortable with because you’re going to be stuck on that plan from January 1 until January 1 of the following year, unless you have a qualifying life change.”
Sumner advises speaking with an insurance agent each year to go over the changes in insurance plans.
“As an insurance agent, the last thing we want is a surprise for our client,” Sumner says. As a broker, Sumner is licensed to represent all of the ACA carriers and nearly all of the Medicare carriers that are available in Polk County. He evaluates his clients’ needs and compares them to available plans to ensure that they are getting the coverage they need.
The main reason Sumner sees individuals changing plans is cost. Like in so many other areas of life, insurance costs tend to go up every year. Florida Blue, for example, is the most popular plan among HealthMarkets’ clients, and it has seen rate increases across the board this year. This is causing many people to shift their coverage to more affordable plans. Whether it is the premium, the deductible, or the co-pays, patients are looking to maximize their coverage in a way that fits their budget.
The ACA Marketplace was created to allow individuals to go onto healthcare.gov to choose their own insurance plan. However, with so many options to choose from, it can easily become overwhelming, and many people simply opt for the cheapest plan. Unfortunately, this doesn’t always translate to coverage they can really use. This is what makes it so important to consult a licensed agent.
Now, if you have health insurance coverage through your employer, Sumner advises staying on it. Typically, the employer will subsidize all or part of the premiums for the employees, and offer one to three options for plans, generally a lower-deductible option and a higher-deductible option. If your employer offers group coverage, you also will not qualify for subsidies through the ACA Marketplace. You may still opt to purchase insurance through the Marketplace, but it will most likely cost you more than what your employer offers.