Annual Medicare Part D Open Enrollment Begins Every year, those who have enrolled in a Medicare Part D prescription drug plan may select a new plan between October 15th and December 7th for an effective date for January 1st. Should I Consider Changing Plans? Every individual who has experienced service problems with a plan; goes into the donut hole or gap (the part of the year you pay more of the cost of your prescription medications); or has concerns about a plan because

Shopping for Coverage for 2014 As everyone has heard, the Healthcare.gov website experienced many problems when it launched in October. The administration has stated operations should be smoother by late November. In most states, residents are relying on Healthcare.gov, the federal website, to shop for insurance coverage for 2014. The following states and DC are not relying on Healthcare.gov. These states are operating state exchanges for their residents: California Kentucky New Mexico Colorado Maryland New York Connecticut Massachusetts Oregon DC Minnesota Rhode

Why is My Coverage Being Terminated? By now everyone is familiar with President Obama’s statement that “If you like your health plan, you can keep it.” The statement was likely intended to reassure those who have stable coverage through employment or Medicare, but it was an unwise statement, more political than anything else. The fact is that the Affordable Care Act requires most individual and small group plans (two to fifty employees) to change, adding benefits like maternity to individual plans, expanding mental health

Choosing to Self-Insure for Medical Services (Madness) I have been to several presentations over the last few months where financial advisors have approached me to discuss a “self-insured” client. A self-insured individual is actually an uninsured individual in our view and that is not advisable. If you don’t have the protection of rates that your insurer has negotiated with hospitals or through Medicare or Medicaid, you are vulnerable to substantially over-paying for services. There is no out-of-pocket maximum because you don’t have

Affordable Care Act Frustrations For many who purchased individual insurance for 2014, either on or off an exchange, this has been a trying time.  The Act reformed the individual insurance marketplace on January 1st and there have been numerous problems and glitches at the state and federal levels and with insurance companies themselves.  Some insurers have even run multiple full page newspaper ads apologizing for the current state of affairs. What You Need to Know If You Purchased Coverage Enrollment A completed application is just

New COBRA Perils as of April 1, 2014 COBRA is an important protection.  COBRA is the temporary extension of group coverage at one’s own expense when someone loses or leaves their job (and their dependents) or to a dependent losing group coverage due to aging off a parent’s plan, divorce or death of a spouse. Until March 31, 2014, anyone electing COBRA could voluntarily terminate COBRA and apply for individual coverage.  THIS IS NO LONGER TRUE.  One can decide to buy individual coverage during the

Decision Time for Coverage Options is Almost Upon Us Options and Deadlines for Individual Coverage Q: I bought a new individual insurance policy for 2014. Should I be looking at my options for 2015? A: We believe that everyone should do some minimum due diligence to verify the network status of doctors and the prescription drugs on the insurer’s formulary. If money is no object AND you are totally healthy and don’t expect to use medical services, you might consider letting your 2014 plan

Shrinking Out-of-Network Benefits Many people don’t have reason to think about the out-of-network benefit in their health plan. They understand that they will pay more if they use a physician or facility that is not part of their plan’s network but expect to be reimbursed for a large part of the expense. A woman came to us after she had surgery in New York last summer. The out-of-network orthopedic surgeon’s charges were $68,046. Her plan paid $3,221. She never expected such a

Mind the (Coverage) Gap, Please! Healthcare coverage transitions can be perilous. At Healthcare Navigation we are hearing from too many people who suddenly realize that they do not have individual insurance (past policy not renewed; they thought payment was being debited, etc.) and are surprised to learn that they can’t simply buy coverage at any time of the year. The Affordable Care Act (“Obamacare”) has changed the health-insurance world.  Enrollment rules are strict.  As an individual you must apply for Obamacare coverage during an annual enrollment period – or

Shakespeare and COBRA The quality of mercy IS strained– Pay COBRA Premiums Timely The quality of mercy is not strain’d, It droppeth as the gentle rain from heaven Upon the place beneath. It is twice blest: It blesseth him that gives and him that takes. When Shakespeare’s Portia urged Shylock to be merciful he couldn’t have been thinking about COBRA. COBRA, the Consolidated Omnibus Reconciliation Act of 1985,  is the federal law which provides a temporary safety net for employees and dependents to maintain group coverage through employers