Weekly newspaper of Three Rivers, California, and Sequoia-Kings Canyon National Parks

Health insurance open enrollment is now ongoing

By: 
Sarah Elliott

 

Although everyone in the US now has access to health insurance, the process is complicated. Here are some important dates that folks need to be aware of: 
 
 
Covered California 
There are two times within each year to enroll, or make changes, in an Affordable Care Act health insurance plan using Covered California: open enrollment and special enrollment periods.
 
Open enrollment is when almost anyone can sign up for individual or family health insurance. The current deadlines are December 15 for a January 1 effective date and January 15 for a February 1 effective date.
 
In most states open enrollment begins November 1 and ends December 15, with all plans effective January 1 of the coming year. In California, however, legislation has been enacted that permanently establishes different enrollment dates within the state. 
 
Open enrollment in California begins October 15 and continues through January 15.
 
Outside of open enrollment, plan changes and new enrollments are only possible for people who experience a qualifying event. This is “special enrollment.” A qualifying event includes permanently moved to or within California, got married, and or had an involuntary loss of health insurance.
 
To shop and compare plans or renew a health insurance plan, create an account (or log into your account) at CoveredCA.com.
 
 
Medicare 101
The Medicare Annual Election Period, during which people with Medicare can enroll in a Medicare Advantage or Prescription Drug Plan, ends Friday, Dec. 7, for Medicare coverage that starts Jan. 1, 2019. Even if you’re enrolled in a plan, your insurance company’s drug formularies, provider networks, and copays may change in 2019. Plus your health care needs could be different than they were last year.
 
Here are four simple steps to help you decide which kind of Medicare coverage is best for you:
 
—Review your current Medicare health plan. Look at what you’ve spent on health care in the past year, including hospital expenses and prescriptions to decide whether your current health plan meets your needs, both financially and medically.
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—Know your options:
 
1. Original Medicare (Medicare Parts A and B) provides basic coverage for medical services and supplies in hospitals, doctors’ offices and other health care settings. Original Medicare does not include coverage for most prescriptions and includes cost-sharing in the form of deductibles and coinsurance.
 
2. Medicare Advantage (Medicare Part C) includes all the coverage offered under Original Medicare and typically also includes prescription drug coverage. Medicare Advantage plans are offered through private insurers.
 
3. Medicare Prescription Drug Plans (Medicare Part D) offer coverage for prescription medications. Such a plan can be added to Original Medicare, a Medicare Supplement (Medigap) plan, some Medicare Advantage plans, some Medicare Cost Plans, and some Medicare Medical Savings Account plans.
 
4. Medicare Supplement (Medigap) Plans pay most costs not included under Original Medicare, such as deductibles and coinsurance. These plans do not have a set provider network (and enrollment is not limited to the Medicare Annual Election Period). These plans are also sold by private insurance companies.  
 
—Comparison shop. Research a plan’s benefits, out-of-pocket costs, and its network of doctors and hospitals. Check to see if your prescriptions are on your plan’s list of covered drugs (this can change each year). 
 
—Ask an expert. There are resources if you have questions:
 
Call 1-800-MEDICARE (1-800-633-4227) (TTY: 1-877-486-2048) 24 hours a day, seven days a week, for 2019 Medicare plan information.
 
Medicare information provided by Rick Beavin, California market president for Humana.
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