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According to the Institute on Aging, by 2010, 5.5 million Americans lived to the age of 85+. By 2050, this 85+ age group will climb to 19 million Americans -- or 5% of the total population. And with the medical insurance open enrollment period getting underway, it's more important than ever to explore your options thoroughly. This also means understanding the benefits and limitations to be aware of during this enrollment period. Here's what enrollees should know about the benefits and limitations they may face during open enrollment for medical insurance.

Insurance and Medical Suppliers

Medicare:

First, you should know that the open enrollment period ended on Dec. 7 (Oct. 15- Dec. 7) for people utilizing Medicare. This was also the time to make changes to your plan, sign up for Medicare Advantage plans or Medicare Drug Plans, drop or add coverage, or switch plans. However, there is a Medicare Advantage open enrollment period from Jan. 1-March 31st, but restrictions apply and you must be enrolled in a Medicare Advantage Plan for 2019.

Luckily, if you missed the open enrollment period for Medicare, don't worry! You can sign up for Part A and/or Part B during the General Enrollment Period between January 1-March 31 of the new year if both of these apply:

  • You didn’t sign up when you were first eligible
  • You aren’t eligible for a Special Enrollment Period. (details)

Keep in mind you may have higher premiums for late enrollment, and coverage won’t start until July 1st.

There are special circumstances that allow for special enrollment periods and more information about these can be found, here.

Private Individual and Family Health Insurance:

The 2018 Open Enrollment Period is coming to a close on December 15, 2018. Outside the Open Enrollment Period, you generally can enroll in a health insurance plan only if you qualify for a Special Enrollment Period.  You’re eligible if you have certain life events, like getting married, having a baby, or losing other health coverage. You job may have different Open Enrollment Periods, so make sure you check with your employer for details.  Also, you can apply and enroll in Medicaid or the Children's’ Health Insurance Program (CHIP) any time of the year. However, if you live in these states your deadline is extended accordingly:

  • California – Oct. 15, 2018 to Jan. 15, 2019
  • Colorado – Nov. 1, 2018 to Jan. 15, 2019
  • C. – Nov. 1 ,2018 to Jan. 31, 2019
  • Massachusetts – Nov. 1, 2018 to Jan. 23, 2019
  • Minnesota – Nov. 1, 2018 to Jan. 13, 2019
  • New York – Nov. 1, 2018 to Jan. 31, 2019
  • Rhode Island – Nov. 1, 2018 to Jan. 31, 2019

Between the different Medicare plans and Private insurances for individuals/families there are a wide variety of coverage types, each with a different set of benefits and limitations, so it is important to do your research and know when action is needed.

Benefits and Limitations

States and medical suppliers vary when it comes to determining when your coverage will actually begin. This is important to note considering that CMS found that retail spending for durable medical equipment (which includes contact lenses, eyeglasses, hearing aids, wheelchairs, mobility aids, and more) reached $48.5 billion in 2015 and continues to rise. With that in mind, it's essential to choose a plan and provider that's transparent about start dates -- the last thing you want is to experience even a small lapse in coverage. Also, you want to make sure the things you need are covered under your plan. For example, you can get Original Medicare or Advantage plans that don’t cover prescriptions or ones that do.

There are a ton of different plans out there that vary in their coverage and cost. Depending on the plan you choose, you may be limited on what and who is covered and how much is covered. You will also have to decide on which plan’s benefits and limitations work best for you because you usually will not find a perfect insurance. On one hand, you may have to add coverage to your plan to include additional benefits, but this will come at an additional cost. On the other, you will have to choose between high premiums with low out of pocket for services (co-pays, deductibles, etc.) or a low premium with high out of pocket costs. Depending on your health history and health conditions each have their own benefits and drawbacks. Also, keep in mind that plans change every year and you must ensure that your current plan is still the best for you.

 

While selecting the right medical plan comes with plenty of benefits, it's critical to navigate the process carefully, as the open enrollment period only comes around once per year. There are some exceptions, but they're under special circumstances and shouldn’t be relied upon. Also, making sure everything is taken care of during open enrollment is the best way to avoid additional fees. If you have questions about the process, talk to your doctor and/or your insurance company.

Ultimately, navigating the complexities of the healthcare industry isn't always easy, but informing yourself of the most important and relevant information is the best way to choose a provider for medical insurance that you'll stay happy and healthy with. Even though, enrollment has ended or is coming to an end, all these aspects are important to keep in mind and to understand. Enrollment will come around again. Preparing early and knowing what you need can make this process smooth and ensure you have the best plan for you! For more information about medical supplies and your coverage, contact Get Complete Care.

For more information, to compare plans, and for additional help check out:

  • The Centers for Medicare & Medicaid Services (CMS) website: https://www.cms.gov 
  • The Official US Government Site for Medicare: https://www.medicare.gov
  • Call: 1-800-MEDICARE