Fall is here, and like clockwork, we have amazing foliage, corn mazes, and all our food is turning pumpkin spice. This time of year also brings health coverage open enrollment and, like most years, there are many changes. Below is a brief overview of the different types of coverage, but you may still have questions. Lamprey Health Care has Certified Application Counselors available to anyone in the community. They can answer questions, check plan eligibility, and even help you with enrollment. Best of all these services are FREE, and you do not have to be a patient at the health center to talk to a counselor. Let us jump in.
Benefits of Coverage
Anyone who has ever had an unexpected illness or hospitalization knows the value of health insurance. Too often though, healthy people forgo coverage.
“It’s a waste of money. I am young and healthy. I don’t need it.”
It might seem like this statement is true when looking at the cost of premiums, but no one can predict when they will be sick and need expensive care. One of the most heartbreaking things we see at Lamprey Health Care is when people delay care only for it to lead to a more advanced health situation. Delaying care because of concern for out of pocket costs often leads to expensive care with less desirable health outcomes.
I think we can all agree, preventing a disease or illness is preferable to treatment. Beyond protecting you from emergency medical bills, insurance covers essential health benefits such as screenings, immunizations, mental health, and substance use disorder services.
What is open enrollment?
Open enrollment is the time of year when you can enroll or change insurance plans. Open enrollment typically takes place in the fall, with coverage going into effect at the start of the New Year. It is important to watch for dates and deadlines as they do change from year to year.
Under special circumstances, you can enroll or change health plans outside of open enrollment. These are called qualifying events. Qualifying events include things such as loss of health coverage through an employer, a change in marital status, or a new child in the family. What counts as a qualifying event can vary between the healthcare marketplace, employer plans, Medicaid, or Medicare.
What Do The Plans Cover?
All plans are different. Most plans cover the essential health benefits that we mentioned. Once a plan meets the essential health benefits, they have the flexibility to offer different levels of coverage for different pricing. Carefully consider your personal circumstances when selecting a plan keeping in mind:
- Premium costs – the amount you pay each month.
- Services – what the insurance company will cover and what will they exclude.
- Co-pays – how much you pay at each visit.
- Deductibles – how much you pay out of pocket before insurance coverage begins.
“I’m just going to pick the cheapest plan.”
You might want to take a few minutes and consider if that is the best choice for you and your family. What might seem like a good deal could end up costing you more out of pocket if the plan doesn’t cover medications or services you are likely to use.
Healthcare Marketplace through the Affordable Care Act (ACA)
The healthcare marketplace is simply a service that allows you to shop for health coverage. In NH, we use the federal marketplace at www.healthcare.gov. If you live in another state, check with your State Insurance Bureau for guidance. Small businesses can also use the marketplace through the Small Business Health Options Program (SHOP) to provide coverage for employees.
Open enrollment for the Healthcare Marketplace is from November 1 to December 15 this year. This is the only time you can enroll in a plan, without a qualifying event.
I already have coverage through the Marketplace. Do I need to do anything?”
You should have received an email or letter from your insurance carrier. Please read it! It has important information specific to your plan. If you aren’t happy with your plan and want to make a switch, now is the only time you can do that.
The Healthcare Marketplace open enrollment period is from November 1 to December 15, 2018.
Medicare is the federal health insurance program for people over the age of 65. It is also available for some people under 65 with disabilities. Most people are eligible to enroll in Medicare Part A (hospital expenses) and Part B (outpatient health expenses) during the initial enrollment period. This starts three months before turning 65 and ends three months after turning 65. You can also opt to enroll in Part C (Medicare Advantage), Part D (prescription drug plan) and supplemental plans (Medigap) during the initial enrollment period.
“So if I enroll when I turn 65, why is there an open enrollment period?”
Except during your initial enrollment period, open enrollment is the only time of year that you can enroll, change, or un-enroll your Part C or Part D plan.
Open enrollment for Medicare is from October 15 to December 7. Information on Medicare Open Enrollment is available by contacting the Social Security Office at (800) 772-1213 (TTY users 1-800-0778) Monday through Friday from 7 AM to 7 PM. New Hampshire residents can also contact Service Link for assistance on Medicare Open Enrollment.
The Medicare open enrollment period is from October 15 to December 7, 2018.
Medicaid provides health coverage to qualifying low-income adults, children, pregnant women, elderly adults, and people with disabilities. To enroll in Medicaid, you will have to meet enrollment guidelines. You can enroll any time you qualify, and coverage can begin immediately.
“If I can enroll anytime, why is there an open enrollment period?”
There are different plan options under Medicaid. Open enrollment is the time of year you can switch plans. Additionally, this year the state is transitioning to a Managed Care plan. People who have a Medicaid Blue Card will need to select a plan during open enrollment. You will be automatically enrolled in a plan if you don’t make a selection. You will not lose coverage, but you will lose the chance to choose your plan.
“Wait, I have a blue card AND a Managed Care Card. What about me?”
In addition to your Blue Card, you may have a card from either Well Sense or NH Healthy Families. If so, you are already in a Medicaid Managed Care Plan. You don’t need to do anything. Your coverage will automatically renew. Of course, if you want to switch to a different plan, now is your chance. You need to change plans during open enrollment.
“I don’t have those. I think I am in a Medicaid expansion plan?”
If you are in a Medicaid expansion plan, your insurance card says Premium Assistance Program or PAP in the top right corner and your coverage is with Ambetter, Anthem Blue Cross Blue Shield, or Harvard Pilgrim Health Care. Your plan will also be switching to a Managed Care plan as of January 1. Just like the people with a Blue Card, you will need to choose the plan that you feel is best for you. You will be automatically enrolled in a plan if you don’t make a selection.
Starting in 2019, enrollment in certain Medicaid programs will require 100 hours a month of work or other community engagement activity. Details on what counts towards the 100-hour requirement are available through the NH Easy website.
Open enrollment for Medicaid is from November 1 to December 28.
Are you feeling overwhelmed?
That’s normal. It’s also, why we offer Certified Application Counselors to help you understand your options. They can also assist in the enrollment process. Meeting with a counselor is FREE, and you do not need to be our patient to use this service.
To speak with a counselor or schedule a one on one appointment call (603) 292-7278.
NH Medicaid (800) 852-3345 ext. 9700 or (603) 271-9700
NH Department of Health and Human Services (800) 852-3345
Healthcare Marketplace (800) 318-2596, TTY (855) 889-4325
Social Security Administration Manchester office (866) 814-5408, Nashua office (877) 444-0134,
Portsmouth office (888) 397-9796
ServiceLink Atkinson office (603) 892-9769, Manchester office (603) 644-2240,
Nashua office (603) 598-4709, Rochester office (603) 332-7398, Stratham office (603) 334-6594