Open Enrollment

2020 Medicare Open Enrollment Runs October 15 through December 7

Medicare is a program for people who are 65 or older and people with disabilities. You can read more about Medicare here. If you have Medicare now, then...

It's time to review your Medicare Plan!  

October 15, 2019 to December 7, 2019 is the annual Medicare Open Enrollment Period. Your new selections go into effect on January 1, 2020.  During Open Enrollment you may:

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  • Change from original Medicare to a Medicare Advantage Plan

  • Change from a Medicare Advantage Plan back to original Medicare

  • Switch Medicare Advantage plans

  • Join a Medicare Part D Prescription Drug Plan

  • Switch Medicare Part D Prescription Drug Plans

IMPORTANT: Review your coverage--especially Part D and Medicare Advantage Plans--every year!

Premiums, co-pays and the drugs covered can change from year-to-year, even within the same plan.  Your current plan should send you an "Annual Notice of Change" before Open Enrollment that outlines any changes for the next year.  Medicare Part D plans are sold and managed by private companies and vary greatly in terms of monthly premiums, annual deductibles, drugs covered and prescription prices.  

Insurers tweak Medicare Advantage Plans every year, and those changes could mean that you can't see your favorite doctor or that you might need to pay more. 

So--REVIEW, REVIEW, REVIEW!!!

Note: Low-income individuals on Medicare may be able to change their plans more frequently. A MMAP counselor can explain your options.

MMAP Counselors Are There For You--For Free!

Got questions? MMAP Counselors can help!

Got questions? MMAP Counselors can help!

Every state has people who will help you figure out your Medicare options. In Michigan, these people--paid staff, and volunteers--work with the Medicare/Medicaid Assistance Program. In Michigan, you can find your local MMAP program here. Nationally, the SHIP (State Health Insurance Assistance Program) can help you find assistance locally. 

MMAP Counselors can help explain how Medigap and Medicare Advantage programs work and can help you sift through your options for Part D plans. They can help you figure out if you can defer taking Medicare because you are still working. They can help you figure out if you qualify for extra help!

Some People Qualify For Extra Help

If your income is low, you may qualify for extra help.

One kind of support is the Extra Help with Medicare Prescription Drug Plan Costs. In most cases, to qualify for Extra Help, your annual income must be limited to $18,735 for an individual or $25,365 for a married couple living together. (There are some cases where your income can be higher.) Your resources (assets) must be limited to $14,390 for an individual or $28,720 for a married couple living together—but this does not count your home, car, or life insurance policies.

Another kind of extra help is the Medicare Savings Program. The Medicare Savings Program may help you pay your Medicare premium, or you may qualify for Medicaid and Medicare which together will cover all your health care costs. To qualify for the Medicare Savings Program you must be low-income and not have many assets.  For married couples, your combined income must be less than $1923/month and you must have less than $11,600 in assets (excluding a house and car).  For single people, your income must be less than $1426 and you must have less than $7730 in assets.  

If you think you may qualify for Extra Help, talk to a MMAP (Medicare/Medicaid Assistance Program) counselor. 

Just MMAP It!

Washtenaw County is in a MMAP region that includes Livingston, Monroe, Macomb, St. Clair and Oakland counties. There are multiple ways to meet with MMAP counselors and MMAP and the Area Agency on Aging 1B have multiple events scheduled for Open Enrollment.  Call 1-800-803-7174 to schedule an appointment.  Call now because availability is limited!


 

2020 Open Enrollment Washtenaw County Events

Medicare beneficiaries can make an appointment to meet one-on-one with a MMAP Counselor and review their 2019 Medicare coverage options.  Call 800-803-7174 to schedule an appointment.  Appointments are required.

Washtenaw ISD 1819 S. Wagner Rd. Ann Arbor, MI 48103

  • Tuesday, October 15 9am - 2pm,

  • Tuesday, November 12 9am - 2pm

  • Thursday, December 5 9am - 5pm

Milan Seniors for Healthy Living 45 Neckel Ct. Milan, MI 48160

Call 734-508-6229 for appts

  • Thursday, October 17 9am-2:30pm

  • Thursday, November 14 9am - 2:30pm

Pittsfield Twp. Senior Center 710 W. Ellsworth Rd Ann Arbor 48108

Call 734-822-2117 for appts

  • Wednesday, October 25 9am - 1pm

  • Wednesday, November 13 9am - 1pm

Printable schedule of events for Southeastern Michigan including Washtenaw, Livingston, Monroe, Macomb, St. Clair and Oakland.

Useful resources

Medicare.gov

Medicare Medicaid Assistance Program (MMAP) or call 1-800-803-7174

Medicare Savings Program Information Sheet

Part D/Prescription Extra Help Information Sheet

Medicare Fraud - Learn about potential fraud and how to report it.

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A Word Of Advice: Don't Auto-Renew

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The new plans are out, and Open Enrollment is upon us! People who have been enrolled in Marketplace plans in the past may be getting notices offering for them to auto-renew their plans. That sounds easy, but it may not be in your best (financial, or health coverage) interests!

Provider Changes

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First, a plan may sound the same, but providers may decide to affiliate or disaffiliate from year to year. So you always to want to make sure that your doctors take your health insurance.

Financial Changes

The plans that are offered may change also. For instance, in Washtenaw County in 2019, there will be a new health insurance provider—Oscar—that has not previously been in the Michigan health insurance market. And even without that new insurer, some insurers may decide to charge less or more for their plans.

The pricing of these plans matters, because tax credits are based on the actual cost of the second lowest silver plan. That is the benchmark from which all tax credits get calculated.

Let’s say that your income is exactly the same between 2018 and 2019, and you qualify for tax credits. If you auto-renew, you could find yourself paying a whole lot more. Even if the plan has not changed, and the full cost of the plan doesn’t have a big difference, there could still be a big difference in tax credits.

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In this case, in 2018 the Pacesetter A plan was the lowest-cost plan, and in 2019 it is the third-lowest-cost plan. Even though the full cost of the plan only went up by $20, the subsidized cost went up a lot more. In this example, for the same exact plan, and with the same exact income, you could end up paying $70 more per month ($840 more per year), more than double what you paid the year before!

The Moral Of The Story?

Do not Auto-Renew.

Instead, give us a call at 734-544-3030; walk in to our Ypsilanti office M-F 9-4; or find local help at this link.

Remember, Open Enrollment on the Marketplace runs from November 1-December 15, 2018.

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Preparing For Open Enrollment - Employer, Marketplace and Medicaid

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Don’t be frightened! Health care isn’t scary!

Medicaid Enrollment is Always Open.

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You can always apply for Medicaid. Anytime during the year you become eligible, you can apply for Medicaid. No qualifying events, no special documents. Check your income here and apply here. As always if you have questions, call us at 734-544-3030.

Employer Open Enrollment

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If you are offered health insurance through your job, chances are your open enrollment period is in the fall with a January 1, 2019 start date. Some employers (schools, universities, businesses with fiscal years based on other calendars) may have open enrollment during other times of the year.

Evaluate your options every year.

Each year your employer negotiates new benefit packages with health, dental and vision insurance companies. Your open enrollment may also include retirement options, disability and life insurance. When it comes time to evaluate your options make sure to look at each plan. If you don’t understand the details of a benefit, contact your HR department to explain it to you. Here are some tips for thinking about your particular family and your how you use your health insurance.

  1. How much health care do you expect to use?

  2. What is my deductible? What is my maximum out of pocket?

  3. Is my employer insurance affordable? Do I have another option?

You may be wondering if you can sign up on the Marketplace, read more about that option, Do I Have To Take My Employer Healthcare Coverage? (Usually, Yes).

Marketplace Open Enrollment Nov. 1 - Dec. 15

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The Open Enrollment Period for the Marketplace (aka Obamacare, healthcare.gov, ACA) is November 1 to December 15. During open enrollment anyone who is eligible can sign up for health care coverage that will start on January 1, 2019. In order to sign up on the Marketplace ask yourself these 3 questions:

  1. Am I eligible for Medicaid? If yes, you are not eligible to enroll with tax subsidies on the Marketplace. If you are a family, children may be eligible for Medicaid/MIChild and parents may be eligible for the Marketplace.

  2. Does my employer offer affordable insurance? If your employer insurance is less than 9.69% of your income for the lowest priced, ACA-compliant employee only plan, you are not eligible to enroll with tax credits on the Marketplace. Read more here Do I Have To Take My Employer Healthcare Coverage? (Usually, Yes).

  3. Do you have income and are you filing taxes? You must have income and file taxes to receive tax credits and enroll in health care on the Marketplace.

Information needed for a Marketplace application

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Did you answer yes to all 3 questions? The next step is to gather the documents and information you will need to complete a Marketplace application and select your health care plan. You will need the following:

  • Names and social security numbers for everyone in your tax household. Your tax household includes anyone you will claim on your tax return.

  • Earned income information -recent paystubs for everyone who is working or self-employment records (Schedule C from the previous year’s return).

  • Unearned income information - pension, retirement, real estate income, social security (RSDI or SSI) income or capital gains.

  • 2017 Tax return including Schedule C, if applicable.

  • List of doctors

  • List of prescriptions

  • Marketplace Account information - user id and password.

    • If you don’t have an account and need to create one you will need an active email account that you can access immediately. You must be able to access the email to access a verification email.

The next step is to estimate your income for 2019. For some people this is easy, but for anyone whose income varies during the year, it can be tricky. (We have written many posts about income, click here to browse all the income blogs.)

Now go to the Marketplace website, healthcare.gov, complete an application and select your 2019 health care coverage. You can preview 2019 plans here.

If you have questions, if you need assistance with the application or if you need help with the whole thing, please call the Washtenaw Health Plan and make an appointment. Michigan residents, we can also answer questions over the phone. Call us at 734-544-3030. The sooner you call the better! If you are not in southeast Michigan, use this resource to find local help for healthcare.

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Washtenaw Health Plan

734-544-3030

We Help People - Like You!




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Open Enrollment Question: Do I Have To Take My Employer Healthcare Coverage? (Usually, Yes)

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For many employees, Open Enrollment period for employer insurance comes in the fall, and is a short two or four week period where you have to make important decisions about health care for the coming year. This can be a lot of pressure, and so it turns out that a little preparation can go a long way. If you are a new employee at a job, you may be offered insurance right away, or after a period of 90 or 180 days.

Know your options, because if this were a relationship on Facebook, you might say, "It's Complicated!" What follows is a series of questions that will hopefully help you figure it out.

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If you are going to turn down your employer insurance, you want to make sure you are clear about the alternatives. Although it doesn't matter to Medicaid if you have an offer of employer insurance, it does matter if you were hoping to get subsidies on the Marketplace. Don't turn down your offer of coverage without studying your options!

1. Does your employer coverage meet Minimum Essential Coverage guidelines?

This would mean the the employer coverage covers:

  • Ambulatory patient services(Appointments and procedures in a doctor's office);

  • Emergency services;

  • Hospitalization;

  • Maternity and newborn care;

  • Mental health and substance use disorder services, including behavioral health treatment;

  • Prescription drugs;

  • Rehabilitative and habilitative services and devices;

  • Laboratory services;

  • Preventive and wellness services and chronic disease management and Pediatric services, including oral and vision care.

If the answer is yes, continue. If the answer is no, consider Marketplace and Medicaid eligibility and enrollment.

BEWARE: Some employers offer very inexpensive medical plans that do not cover hospitalization or emergency services. These do not meet Minimum Essential Coverage guidelines.

 

2. Does your employer coverage meet Minimum Value standards? 

Minimum value standard is a standard of minimum coverage that applies to job-based health plans. If your employer’s plan meets this standard and is considered “affordable,” you won’t be eligible for a premium tax credit if you buy a Marketplace insurance plan instead.

A health plan meets the minimum value standard if both of these apply:

  • It’s designed to pay at least 60% of the total cost of medical services for a standard population

  • Its benefits include substantial coverage of physician and inpatient hospital services

If you are unsure, ask your employer to fill out the Employer Coverage Tool.  

If the answer is yes, continue. If the answer is no, consider Marketplace and Medicaid eligibility and enrollment. 

NOTE: If the answer is no to EITHER the minimum essential coverage or minimum value standard, and you are income-eligible, you should be eligible for advance premium tax credits.

 

3. Is your family income low enough for some or all of your family to qualify for Medicaid?

Look here for the income eligibility tables for Medicaid. If you (or some members of your family) are income-eligible for Medicaid, you can apply for Medicaid instead of or in addition to your employer coverage. Because the income cutoffs for children are higher than for adults, often children can be enrolled in Medicaid or MIChild while the parents enroll in employer coverage. You can also have both Medicaid and your employer insurance--Medicaid will pay co-pays and deductibles not covered by your employer coverage, and this can be useful if you have a high-deductible plan. 

 

4. What is the cost of your insurance, relative to your income? 

To figure this out, look at the lowest-cost plan your employer is offering that meets the minimum standards (see #1 and #2 above), and the cost for the health coverage for the employee alone. 

Example 1: The cost is $100/month for the employee alone, and the employee makes $1000/month. $100/$1000=10% of income.

Example 2: The cost is $100/month for the employee alone, and the employee makes $2000/month. $100/$2000=5% of income.

Generally, if the cost is more than 8% of family income but less than 9.69% of family income, you are exempt from having to take the insurance, but you are not eligible to get advance premium tax credits on the Marketplace. [You may, however, be eligible for Medicaid!]

If the cost is more than 9.69% of family income, you don't have to take your employer insurance, but you can buy on the Marketplace and qualify for advance premium tax credits.

 

5. What about the rest of the family?  The Family Glitch

The Affordable Care Act looks primarily at affordability for the employee only. Different people in a family can get covered in different ways. 

If the cost of insurance for the employee is affordable, and the cost for the rest of the family is not affordable, you fall into what is called the "family glitch." The rest of the family is probably not going to be eligible for subsidized plans on the Marketplace. At this point, help from someone familiar with insurance options can be a big help. You may very well be exempted from the mandate to have health insurance, but that doesn’t help with getting health care. On the other hand, other family members may get covered differently. Possibilities may include: 

Thanks to healthinsurance.org for the image.

Thanks to healthinsurance.org for the image.

Don't forget: in many cases, different people in a family are covered in different ways. For example, each parent may be covered by his/her own employer, and the children may be covered by MIChild.

 

6. What if employer coverage gets offered or dropped in the middle of the year?

Changes in employer coverage in the middle of the year create Special Enrollment Period opportunities. If employer coverage is offered, you should evaluate it. If you have Medicaid and will continue to qualify for Medicaid, you may not want to take it. If you have a Marketplace plan and the employer coverage meets minimum standards, you may need to take the employer coverage because you will no longer be eligible for APTCs. If you take it and have a Marketplace plan, make sure to let the Marketplace know!

If you lose employer coverage during the middle of the year, you may be eligible for Marketplace or Medicaid plans. The Special Enrollment Period on the Marketplace after you lose employer insurance is good for 60 days. Medicaid is open year-round.

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If you have questions, call or walk in to the WHP office.

Washtenaw Health Plan, where We Help People like you!

Monday through Friday from 9am to 4pm

555 Towner, Ypsilanti, MI 48198

 

Resources

Employer Coverage Tool:  Use this tool to gather answers about any employer health coverage that you’re eligible for (even if it’s from another person’s job, like a parent or spouse). You’ll need this information to complete your Marketplace application. Complete one tool for each employer that offers health coverage that you’re eligible for.

Healthcare.gov: Apply here for Marketplace insurance. 

MiBridges: Apply here for Medicaid insurance. 

HealthSherpa:  Use this tool to compare health plans. 

Healthcare.gov Estimator: Compare or preview plans and rates with this estimator. Plans for 2019 should be available during the last week of October.

 

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2019 Medicare Open Enrollment Runs October 15 through December 7

Medicare is a program for people who are 65 or older and people with disabilities. You can read more about Medicare here. If you have Medicare now, then...

It's time to review your Medicare Plan!  

October 15, 2018 to December 7, 2018 is the annual Medicare Open Enrollment Period. During Open Enrollment you may:

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  • Change from original Medicare to a Medicare Advantage Plan

  • Change from a Medicare Advantage Plan back to original Medicare

  • Switch Medicare Advantage plans

  • Join a Medicare Part D Prescription Drug Plan

  • Switch Medicare Part D Prescription Drug Plans

IMPORTANT: Review your coverage--especially Part D and Medicare Advantage Plans--every year!

Premiums, co-pays and the drugs covered can change from year-to-year, even within the same plan.  Your current plan should send you an "Annual Notice of Change" before Open Enrollment that outlines any changes for the next year.  Medicare Part D plans are sold and managed by private companies and vary greatly in terms of monthly premiums, annual deductibles, drugs covered and prescription prices.  

Insurers tweak Medicare Advantage Plans every year, and those changes could mean that you can't see your favorite doctor or that you might need to pay more. 

So--review, review, review!

Note: Low-income individuals on Medicare may be able to change their plans more frequently. A MMAP counselor can explain your options.

MMAP Counselors Are There For You--For Free!

Every state has people who will help you figure out your Medicare options. In Michigan, these people--paid staff, and volunteers--work with the Medicare/Medicaid Assistance Program. In Michigan, you can find your local MMAP program here. Nationally, the SHIP (State Health Insurance Assistance Program) can help you find assistance locally. 

MMAP Counselors can help explain how Medigap and Medicare Advantage programs work, and can help you sift through your options for Part D plans. They can help you figure out if you can defer taking Medicare because you are still working. They can help you figure out if you qualify for extra help!

Some People Qualify For Extra Help

If your income is low, you may qualify for extra help. For instance, the Medicare Savings Program may help you pay your Medicare premium, or you may qualify for Medicaid and Medicare which together will cover all your health care costs. To qualify for the Medicare Savings Program you must be low-income and not have many assets.  For married couples, your combined income must be less than $1871.75/month and you must have less than $11,340 in assets (excluding a house and car).  For single people, your income must be less than $1391.67 and you must have less than $7560 in assets.  

If you think you may qualify for Extra Help, talk to a MMAP (Medicare/Medicaid Assistance Program) counselor. 

Just MMAP It!

Washtenaw County is in a MMAP region that includes Livingston, Monroe, Macomb, St. Clair and Oakland counties. There are multiple ways to meet with MMAP counselors and MMAP and the Area Agency on Aging 1B have multiple events scheduled for Open Enrollment.  Call 1-800-803-7174 to schedule an appointment.  Call now because availability is limited!


 

 2019 Open Enrollment Washtenaw County Events - Medicare beneficiaries can make an appointment to meet one-on-one with a MMAP Counselor and review their 2019 Medicare coverage options.  Call 800-803-7174 to schedule an appointment.  Appointments are required.

Washtenaw ISD 1819 S. Wagner Rd. Ann Arbor, MI 48103

  • Tuesday, October 16 9am - 4pm,

  • Monday, November 12 9am - 4pm

  • Thursday, December 6 9am - 4pm

Milan Seniors for Healthy Living 45 Neckel Ct. Milan 48160

Call 734-508-6229 for appts

  • Thursday, October 18 9am-3pm

  • Thursday, November 15 9am - 3pm

Pittsfield Twp. Senior Center 710 W. Ellsworth Rd Ann Arbor 48108

Call 734-508-6229 for appts

  • Wednesday, October 24 9am - 2pm

  • Wednesday, November 14 9am - 2pm

Printable schedule of events for Southeastern Michigan  including Washtenaw, Livingston, Monroe, Macomb, St. Clair and Oakland.

New Medicare Cards

A quick note about Medicare cards. Medicare is no longer using your Social Security number as your Medicare number. Everyone (all 55 million people on Medicare!) will receive a new card before May 2019. You do not need to call to receive your card and no one will call you asking for your Medicare information to receive a new card. Read 10 Things to Know About Your New Medicare card.

Medicare cards will no longer include your Social Security number. Everyone should have a new cared before May 2019.   Read more.

Medicare cards will no longer include your Social Security number. Everyone should have a new cared before May 2019. Read more.

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Last Two Weeks: Walk-In and Evening Hours! Spread the Word! Tell Your Friends!

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Open Enrollment ends December 15th. Don't miss this window of opportunity!

We have walk-in hours, Mon.-Fri. from 9 a.m. - 4 p.m., at 555 Towner in Ypsilanti, MI. You can also call for information or an appointment at 734-544-3030. 

EXTRA!!! SPECIAL EVENING HOURS!!! 12/13 until 8pm!

The WHP office will be open on Wednesday, December 13th until 8 p.m.!!!!

Map to WHP office or call (734)544-3030

HELP US!

Help your friends, clients and community! 

Download and distribute the flyer below.

Friends let friends know:

Dec. 15th is the deadline to sign up for 2018 healthcare on the Marketplace (healthcare.gov).

Here is the link to the poster.

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Open Enrollment Tips, Part 3: Should I Choose A Dental Plan?

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After you choose a health insurance plan on the Marketplace (healthcare.gov), you generally will get a screen that says that dental insurance is not included. Would you like dental insurance?

If you answer yes, you will be directed to look at some of the dental insurance plans on the Marketplace.

How does individual dental insurance work?

In general, individual dental insurance is similar to individual health insurance in two ways:

  1. You pay a monthly premium.
  2. Preventive care (cleanings and x-rays) are covered 100% and are encouraged. Other procedures will be covered at different percentages (50%, 80%, 100%) depending on the procedure, the dental network, and the company. Just like with most health insurance, dental insurance works with a "network" of providers, and out of network providers may be covered at a much lower cost, or not at all.

Individual dental insurance is different from individual health insurance in two ways.

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  1. More significant procedures (fillings, crowns, extractions, root canals, bridges, dentures) often have a waiting period of 6 or 12 months before you can use the benefit. 
  2. Most individual dental insurance has a maximum dollar amount that can be spent on you in any year. This is the opposite of medical insurance, where once you hit a maximum out of pocket costs, everything is covered.  With dental insurance, if you need a couple of expensive procedures, you will likely hit the point where the dental insurance has maxed out.

 

Can you use tax credits for dental insurance on the Marketplace?

In general, no. Dental coverage is an essential benefit for children under the age of 18. If it is not included in their health plan then you can use tax credits (if you have any left over) toward their dental plan.  Adults cannot use tax credits to buy dental insurance.  Marketplace dental information.

Are there other options?

Yes, there are (at least) three other options.

1. Take employer-offered dental insurance. If you are buying health insurance on the Marketplace because your employer health insurance is unaffordable, their dental insurance may still be affordable--and may not have the waiting periods that individual dental insurance has. You can only choose this during employer open enrollment or a special enrollment period.

2. Buy off the Marketplace. Since you are not using tax credits, you should look around. You can work through an insurance broker or directly with companies that offer dental plans like Blue Cross, Delta, Golden, etcetera. You can only do this during Marketplace open enrollment or when you qualify for a special enrollment period.

3. Set money aside each month for dental expenses as if you were paying a dental premium. Call around to find a dentist you like and who is affordable. Dentists' rates vary. Pay out of pocket for cleanings, fillings, etcetera. [You can also use money from a health savings account or flexible spending account to cover dental expenses.] You can choose this any time of year.

Read more about dental care, insurance and coverage here.

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Open Enrollment Tips, Part 2: How Much Will I Pay? Best and Worst Case Scenarios

You know what you might pay for your health insurance premium--a fixed, monthly cost.  But what about the rest?  What will you actually pay for health care next year?  Will you pay just your Monthly Premium or will you pay your full Maximum Out Of Pocket Cost?  $1200, $5200, or something in between? 

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Best Case Scenario

One way to think about health insurance is to imagine the Best Case Scenario. Imagine that you have a year where you are healthy, and nothing goes wrong. 

In this scenario, you pay:

Your Premium: $100/month for a subsidized silver plan

Annual doctor's visit (preventive care, covered 100%): $0

Flu shot (preventive care, covered 100%): $0

Birth control pills (covered 100% under the ACA): $0

TOTAL COSTS FOR THE YEAR: $100/month premium x 12 months=$1200

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Worst Case Scenario

Now imagine that you have a year where everything goes wrong. You start out the year with appendicitis, then you fall and break your arm, you have a cancer scare, Lyme disease, and you are hospitalized for pneumonia. You might be wondering--if you have a year like that--what is it going to cost? What is the Worst Case Scenario--not for your health, but for your budget?

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Actually, it's not that hard to figure this out either--there is a mathematical formula for it. 

Start with the cost of your premium.

We'll use the same premium: $100/month for a subsidized silver plan. 

Your deductible is $2000, but that turns out to be more important (in a worst case scenario) for the pace at which you pay bills, and less important for the actual Worst Case Scenario.

What is important is the line marked Maximum Out Of Pocket Costs. We'll say, in this case the Maximum Out of Pocket number is $4,000. Once you spend that maximum number, you pay nothing more. 

TOTAL COSTS FOR THE YEAR= Total premium cost + Maximum out of pocket amount

In this scenario, you would pay: ($100/month)*12 + $4000 = $1200 + $4000 =$5200

So with this plan, under the best case scenario you would pay $1200 and under the worst case scenario you would play $5200. Try out these formulas on any plan. 

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Just one caveat: In some cases, the maximum out of pocket number applies only to in-network spending; or out-of-network spending may be subject to a higher maximum out of pocket number. Except for emergencies, try to stay in network. 

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Open Enrollment Tips, Part 1: An Educated Consumer Is Our Best Customer

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Some of you--of a certain age--may remember the Sy Syms commercial, with the tagline, "An Educated Consumer is Our Best Customer." Well, what's true for buying clothes is even more true (100 times more important, probably!) for choosing health insurance. 

So here are a few things to know, if you are shopping for health insurance. 

1. If you are very low income, you may be eligible for Medicaid. If you think you are eligible for Medicaid, do the MIBridges Medicaid application. Don't assume the Marketplace will send you there correctly--it is supposed to, but the two systems are not well-calibrated. (We help with those applications, too.)

2. If you had a plan last year, don't let it auto-renew. Spend the hour it requires to assess everything again. Provide revised income estimates, check your dependents, update your address. Most importantly, the plans have changed. In some cases, they have changed A LOT. 

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Make sure you are aware of which doctors or health systems are in-network or out of network for any plan that you choose. These networks can also change between plan years. 

Because costs are calibrated for tax credits based on the second-lowest cost silver plan, when the costs for that plan change (and this year they changed a lot!), the tax credits change a lot too. But if you were eligible for subsidies before, and your income is similar, you will pay the same or less--but you may need or want to change plans.

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3. If your income is a bit higher than Medicaid, but still under 200% of the poverty level ($24,120 for a single person, $49,200 for a family of 4) you will probably find the best deals with the Silver plans. (Probably. You may still want to compare the gold and bronze plans as well.)

4. If your income is between 200% and 400% of the poverty level ($24,120-$48,240 for a single person, $49,200-$98,400 for a family of 4), it is highly likely that you will find the gold and bronze plans more appealing. Gold plans, on average, will cover 80% of your medical costs and Bronze plans, on average, will cover 60% of your medical costs. 

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Explainer: The Trump administration made some last-minute changes removing cost-sharing subsidies, which are only applied to silver plans. Because of this, the cost of silver plans went up more than the cost of gold or bronze plans. But because tax credits are calculated based on silver plans, your tax credit will likely go further on the bronze or gold plans. If you want the details, read this

5. If your income is over 400% of the poverty level ($48,240 for a single person, $98,400 for a family of 4), you will not qualify for tax credits. But you might find better deals off of the Marketplace. Work with an in-person or online insurance broker, and make sure you are choosing from ACA-compliant plans. These should be marked as Bronze, Silver, Gold or Platinum. If they are ACA-compliant, they will have the same essential benefits, but the cost may be less expensive.

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Washtenaw Health Plan staff will answer your questions and help you figure it out.  It's complicated.  Different people in a family may get different coverage. Parents may qualify for the Marketplace, kids may qualify for Medicaid or MIChild.  An older couple might have Medicare, Medicaid and/or Marketplace.  No situation is too complex, no question should go unanswered.  We'll help sort it out.  

Call 734-544-3030 or walk-in to 555 Towner St. Ypsilanti from 9 am to 4 pm Monday through Friday.  

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Don't Be Scared, Healthcare Isn't Spooky! Instead, Get Ready!

If it's Halloween, then Open Enrollment on the Marketplace (healthcare.gov) is just around the corner!  It may also be time for your employer's open enrollment period! 

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Here's What You Need To Get Ready

1. Income information for everyone in your household

For Medicaid and MIChild, you need income information for  the current month/year. If you are applying on the Marketplace, you are trying to project your income and household information for next year (2018).  Income limits for Medicaid and MIChild can help you understand what you are applying for.

2016 Taxes: Your 1040 form (first page), as well as W-2s and  Schedule C or E if you are self-employed. 

Paystubs:  Bring 30 days of the most recent paystubs for anyone who is working.  If you don't have paper copies, make sure you can access your pay information online. 

Self-employment Information: Recent income and expense statement, Schedule C or E. 

Do you have a working teenager in your family?  Read more about whether or not their income counts at  Teens Who Work: Does Their Income Count?

2. Household composition

For the Marketplace, what matters is your tax household. For Medicaid and MIChild, both who is in your tax household and who is living in your house are important. For everyone in your house, you need certain documents. 

Who was in your household this year and who will be in it next year?  (Hint: Is your college senior graduating? Did you just have a baby?)

Social Security Numbers for everyone in the family who has them.

Immigration documents, such as permanent resident green cards, work permits, visas. (People who have DACA status cannot apply on the Marketplace and should contact the WHP for help.)

Home and/or mailing addresses for everyone in the household.

Dates of birth for everyone.

3. Employer coverage

Does your employer offer coverage?  What does it cost?

Your employer can fill out this form to help decide if your employer coverage is affordable and meets minimum coverage standards according to the Affordable Care Act:  Employer Coverage Tool.

In some cases, employer insurance may be affordable for the employee, but not for the rest of the family. Contact the WHP for help in that situation.

Open Enrollment Question: Do I Have To Take My Employer Healthcare Coverage? (Usually, Yes)

4. Log-ins and password

If you had Marketplace insurance, you already have an account.  Find your Marketplace account information sheet or make sure you have the password for your email account. (If you have multiple email accounts, you can usually identify the one with the active healthcare.gov account by searching for emails from healthcare.gov.)

Want Help? We are making appointments now, so call 734-544-3030.

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