Question from Nora:
I have an ACA (Affordable Care Act) plan that I purchased on Pennie last year. Is there anything I need to do during the Open Enrollment Period (OEP)?
Answer
Changing Plans on Supplements
Answer: The ACA Open Enrollment started November 1st and runs through December 15th. This is the only time someone who currently doesn’t have insurance can enroll in a plan. The good news is that ACA plans from the two companies that offer them in Western PA, Highmark and UPMC, have not made any significant changes for 2023. In fact, benefits on a couple popular plans have gotten better and rates remain relatively unchanged.
In the recommendation letter we sent out to our ACA clients this past week, we requested they contact us if any of the following applies: 1) Household adjusted gross income will be increasing or decreasing $5,000 or more in 2023. This can have a significant impact on premiums and even out of pocket costs. People or families who have an adjusted gross income under 250% of the poverty level get what is known as Cost Sharing Reduction (CSR), which can significantly lower deductibles, co-pays, and the MOOP, but only on certain plans. 2) Have a Bronze plan. With higher subsidies having been extended, moving to a Silver or Gold plan with much lower deductibles and co-pays may provide excellent value at a very reasonable cost. Bronze plans have very high deductibles and every single medical service that isn’t considered preventative, including primary care doctor visits and medications, are subject to the deductible. 3) Have a Silver plan and DO NOT get any subsidy. As crazy as it sounds, Silver plans with much higher deductibles are more expensive than Gold plans. I’m not even going to attempt to explain why but it’s indeed the case. The only people we recommend enroll in a Silver plan are those with adjusted gross incomes under 250% of the poverty level. 4) Moved to another county during 2022. Costs and plans differ by county and can have more or less restrictive networks. For example, the lowest cost Highmark and UPMC plans in some counties limit access to just Allegheny Health Network or UPMC providers and no others. 5) Those who have any questions or would like their plans reviewed. If none applies to you Nora, or anyone else who has an ACA plan, you will automatically be renewed in your current plan and don’t need to do anything.
There is one very significant and positive new ACA regulation that goes into effect for 2023. Up until now, if an employer offered health coverage to the spouse or children of that employee, regardless of the cost, those dependents were not eligible for a premium subsidy. We have continuously run into people who were offered plans through their husband’s or wife’s employer with extremely high deductibles and expensive monthly premiums of $600 or more. Now, these people qualify for ACA subsidies if the cost of the employer plan is more than 9% of the household income.
Another important item to remember is that only Highmark and UPMC offer true Major Medical individual health insurance in Western Pennsylvania that puts a cap on how much one can be billed for medical and prescription services in a calendar year. If you speak with someone who is offering any plan that isn’t provided by those two companies, it is not Major Medical and would put you in a terrible financial situation if you were to be diagnosed with Cancer, needed brand name medications, had a lengthy hospitalization or Skilled Nursing stay, complications from surgery, among other expensive care and treatment.
I want to mention that anyone who purchased an ACA plan through the marketplace or from another agent or agency can become a client of The Health Insurance Store with all the benefits that come with it. Our team is available to help clients to ensure they never pay an erroneous medical bill, advocate and file appeals and complaints if they are ever denied a claim or made to jump through hoops to get an MRI, CT scan, surgery, etc. We also have a dedicated Prescription Drug Caseworker, Tony Diroma, who is an expert at finding foundations, assistance programs, and other ways to help with the financial burden of costly prescription drugs. If you would like to have your ACA policy assigned to The Health Insurance Store, have questions about this column, or want to make an appointment for a no cost consultation, please give us a call or reach out to me personally at aaron@getyourbestplan.com.
My live radio show on WMBS Uniontown 590am and 101.1fm is this Monday, November 7th from 1:15 to 3. I will be discussing the ACA as well as Medicare and taking calls on air. For those out of radio range, go to station’s website at wmbs590.com.
Lastly, with some employees of the Post-Gazette now on strike, it’s come to my attention that some people aren’t getting the paper on Sundays. I would like to remind my readers if for some reason the print edition is not delivered, is no longer offered, or if the digital edition goes down due to further implications of the strike, the columns can always be found on our website.
Get Your Part D Reviewed
Another mistake those on Supplements make is remaining on their Part D prescription plan without having it reviewed professionally, which should be done every year. Two of the most popular plans are almost doubling their premiums while not offering better coverage. It’s also common for drug tiers on plans to be moved from 1 to 2, 2 to 3, and so on. Failure to change Part D plans can be extremely costly. Even if you didn’t buy your Supplement from The Health Insurance Store, we can review and recommend a plan for 2023, just like we do for all our active clients. If you’re interested, please contact us as soon as possible so we can get you the necessary form.
There aren’t many significant changes to Advantage Plans, but indeed some items worth mentioning. Probably the biggest news is the reduction of the MOOP by one of our three major companies. In 2021 they raised it significantly across the board on all their plans to the maximum allowable by Medicare. It stayed the same in 2022 and many members chose other carriers due to the increase. However, on a select number of plans, including what we feel is their best for 2023, it has been reduced by $3,000 and is now the lowest in the market for those that supply prescription coverage.
If you weren’t aware, there are no preexisting condition clauses with Advantage Plans. Anyone who has Medicare Parts A and B can change plans or companies regardless of their current or prior health, even those who have End Stage Renal Disease. All Advantage Plan companies must accept you and begin to pay claims the 1st day the policy goes into effect. In addition, all Advantage Plans must cover the same categories of benefits. As I’ve written on so many occasions, paying more in premium doesn’t get you any additional coverage for medical services! In fact, we will not be advising our current or potential clients to choose any Advantage Plan that will have a premium above $40 per month in 2023. If you are paying over $40 for your HMO or PPO, you should call or email us to set up an appointment and see side by side why paying more doesn’t equal more.
How will Inflation Affect AEP?
Lastly, due to inflation, we’re expecting this AEP, which begins on October 15th, to be the busiest we’ve ever had in terms of moving people from Supplements to Advantage Plans out of financial necessity. If there was ever a good time to do that, now is it because the most competitive plans have never been better in the 15 years I’ve been in the Medicare industry. For those who don’t like the thought of leaving a Supplement, there is some good news. You may not have to as it appears one of the biggest increases in the Social Security Cost of Living Adjustment (COLA) is going to be announced soon. It’s estimated to be from 8.5% to almost 10%. And for once, the raise will not be eaten up by a large Part B premium increase. In fact, many people believe it’s going to remain $170.10.
AEP is right around the corner!
I’d like to remind readers that the Annual Election Period (AEP) is right around the corner. Pre AEP, when plan details are made public, starts October 1st and AEP, when changes to your plan lineup can be made and applications submitted, begins October 15th and runs through December 7th.
If you enjoy the columns, please consider using our no cost services when going on Medicare for the first time or looking at possibly making a change in plans as well as referring friends or family who are. Enrolling new clients in plans, which cost the same whether you use our free services or go directly through a company, helps us cover the expense of the articles so we can continue to run them every week. As brokers, we are appointed to provide plans from every competitive Advantage Plan and Supplement company in Western PA and West Virginia.
Thank you!
If you have any questions or concerns regarding this column topic, or would like to make an appointment for a no-cost consultation, please feel free to give us a call – we would be happy to help. I’d like to remind everyone that I do a live call-in talk show called Medicare A to Z every 1st and 3rd Monday of the month on WMBS Uniontown, 590AM and 101.1FM, from 1 to 3 PM. You can listen in on their website, wmbs590.com.
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