Tag Archives: premiums

SEP Changes like Moving

When Change Happens, We Can Help

Things change. We understand that the unexpected is a part of life. But there are ways we can help you get covered when the unexpected happens.

If you weren’t able to get coverage during this Annual Enrollment Period, or if something important has changed and you need a new plan, you may be able to get a Special Enrollment Period (SEP).

During an SEP, you can buy a new plan or make changes to your current plan.

To get an SEP, you need a qualifying life event (something that has changed your insurance needs). Qualifying life events include:

  • Getting Married
  • Having, adopting, or the placement of a child
  • Permanently moving to a new area offering different health plan options
  • A change in income or household status, which can change how much government help you can get
  • Losing other health coverage because of:
    • Job loss
    • Divorce
    • Loss of eligibility for Medicaid or the Children’s Health Insurance Program (CHIP)
    • Expiration of COBRA coverage
    • Your health plan no longer meets the requirements of the Affordable Care Act (ACA)
    • Reduction or termination of employer contributions
    • Significant increase in the cost of your plan

If any of these items describes your situation, you have 60 days after that event to enroll in a new plan. You can shop with us online or call us at 1-877-686-1168 for help finding a plan.

Your new coverage date will depend on the kind of life event you had and what day of the month you enroll. Learn more about when your new plan will start.

Losing your coverage doesn’t always mean you get an SEP. You can’t get one if you lose your insurance because:

    • You didn’t pay your premiums
    • You chose on your own to quit your other health coverage
    • You lost a short-term plan or (in some cases) a Catastrophic plan

If you can’t get an SEP, you can always get covered with a short-term plan at any time. While they do help with your health costs, they aren’t qualified health plans under the ACA, which means you could still have to pay a tax penalty in the next year.

Still not sure what to do in your situation? Call us at 1-877-686-1168 for help figuring out your options.

AEP Autumn

Vantage Point: It’s That Time of Year

Days are warm and evenings crisp. Orchards bustle during the pear and apple harvest. It is my favorite time of year, but for seniors it can be stressful because of Medicare’s Annual Enrollment Period (AEP), which runs from October 15 through December 7. This is the time of year when most Medicare beneficiaries can choose or change their Medicare coverage.

Better-than-ever health care coupled with healthier lifestyles means people are living longer. With that, living on a fixed income means many seniors worry about having affordable health care for years to come.

One of the most common questions we hear in our Wenatchee office is, “What is the difference between a Medicare Supplement and Medicare Advantage plan (also known as Part C)?” Learning about each product can help people understand what best fits their lifestyles, pocket books, and health care needs.

Whether choosing a Supplement or Advantage plan, you must continue to pay your part B premium.

Medicare Supplements work much like a secondary insurance. They pick up their share of the covered health care cost after Medicare pays, depending on what plan you purchase. For example, it may pick up 10 percent of the 20 percent coinsurance (meaning you would still pay 10 percent). Supplements will not cover any cost Medicare denies, and some Supplements require medical underwriting to gauge the health of the individual. Premiums, or the cost you pay for the coverage each month, are generally more expensive. Like with Original Medicare, you can see any doctor who accepts Medicare.

Medicare Advantage plans replace Original Medicare, which means hospital and doctor visits are paid directly by the plan. Many Advantage plans also include prescription coverage making for one tidy package. To be clear, you still keep all your Medicare benefits. There is no medical underwriting, and premiums are generally lower. Advantage plans also cover extras that Medicare does not, like dental and fitness programs. They also work closely with provider offices to help coordinate care. This helps many members stay healthier. Advantage plans have contracts with provider offices so a member normally must chose a doctor within the plan’s network.

Health Alliance takes Medicare seriously, and our Wenatchee office and helpful customer service representatives are a resource you can count on to help make a great decision for you during AEP and beyond.

Visit us at 316 S. Fifth St. in Wenatchee from 8 a.m. to 5 p.m., weekdays. Or call 1-877-561-1463, TTY 711, from 8 a.m. to 8 p.m. daily. That looks like a toll-free number, but our local representatives are on the other end waiting to help.

Summer Relaxing with a SEP

What’s So Special About Summer?

Didn’t buy health insurance by the deadline? Had some unexpected changes since then and need a plan, fast? A Special Enrollment Period (SEP) might be right for you. We have just what you need this summer to take a little of that heat off.

Dog Days

  1. Ice Cream
  2. Humidity More Ice Cream
  3. Getting a Special Chance to Buy Health Insurance

Every year, as summer turns to fall, and fall to winter, millions of Americans buy health insurance. During that season, the government gives everyone a chance to buy the plan they need, but by early spring, time’s up!

But here’s some good news, everyone knows the world doesn’t stop turning during the summer months. That’s why some special rules help you out when life gets interesting.

Special Enrollment Periods (SEPs) are special chances to buy or make changes to your health insurance plan the rest of the year. Here’s a quick Q&A on how they work.

Interested in signing up or need to learn more? Give us a call at 1-888-382-9771! We’re here to help.

Q:  What’s an SEP?

A: After March 31, only people with a qualifying life event can change their individual or family plan or enroll in a new plan. That’s called having an SEP.

Q: What’s a qualifying life event?

A: Events include:

  • Getting married
  • Having, adopting, or the placement of a child
  • Permanently moving to a new area with different health plan options
  • Losing other health coverage because
    • You lost your job
    • You don’t work enough hours to stay on your employer’s plan
    • Your employer stops paying for your plan or stops paying as much
    • Your plan doesn’t cover the essential health benefits as required by the Affordable Care Act (ACA)
    • A big increase in how much you pay for your plan

Q: Is a change in my income a qualifying life event?

A: For people who already have a qualified health plan, a change in income or household status can be a qualifying life event. Both of these events might change how much government help you can get to pay for your plan.

Don’t forget, you can apply for Medicaid or the Children’s Health Insurance Program (CHIP) any time.

Q: Why don’t I always qualify for an SEP if I lose my coverage?

A: Some events don’t count as a qualifying event:

  • Losing your plan because you didn’t pay your premiums
  • Choosing on your own to quit other health coverage
  • Losing coverage that’s not minimum essential coverage, like a short-term plan or (in some cases) a catastrophic plan

Q: What if I don’t have a qualifying life event?

A: You have to wait until the next Open Enrollment Period (OEP), which will begin during the fall. The government sets the start and end dates of OEP, not Health Alliance.

You can enroll in a Short-Term plan at any time. But remember, they don’t meet the requirements of the ACA for being a qualified health plan, which means you’ll have to pay a tax penalty in 2015.

Q: How long do I have to enroll in a plan after a qualifying event?

A: 60 days.

Q: How do I enroll?

A: You get to choose how you’d like to enroll. Find what works best for you, and if you need help along the way, call us at 1-888-382-9771. Or if you’re in the Champaign area, stop by our office at 206 W. Anthony Drive (near Alexander’s Steakhouse) for help!

Q: When will my coverage start?

A: Your start date depends on your qualifying event.

If you have questions about an SEP or about your situation, give us a call at 1-888-382-9771 or stop by our office—we’re more than happy to help you find the answers.

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Young Invincibles Growing Up

Young Invincibles Feel the Love for Health Insurance

Young Invincibles

Young invincibles are young, healthy, independent, and don’t have a lot of cash to throw around, but, like everyone else, they need help when it comes to:

  • Understanding their options under the new health care law
  • Choosing the plan that’s best for them
  • Listening to their mother

ecard1

Conventional Wisdom

All kidding aside, the conventional wisdom surrounding young invincibles in need of insurance isn’t so conventional, after all. Sure, they aren’t flocking to the exchanges in droves, but they aren’t avoiding them, either.

In fact, according to this article by Aaron Smith, co-founder and executive director of Young Invincibles, as well as this press release from his organization’s website, it seems these youngsters are signing up in numbers proportional to the overall population, and possibly even at a higher rate than their older and wiser counterparts.

So good job, Mom—it turns out you raised them right!

What’s the Deal?

This may be their first time around the health insurance block, but the appeal to reason, and their very limited budgets, is bringing youthful buyers to the table. One small car or bike accident, sports injury, or even a bad case of mono could add up to HUGE medical bills that a struggling student or first-rung employee could never afford.

While many feared the typical response to the pay premiums vs. pay a tax penalty debate would be to just pay the penalty, stats show many young invincibles can do the math:

Paying a penalty and all of their potential medical costs for a year is not a good deal.

Not so Invincible, After All

It’s important to note that young invincible isn’t a title these people gave themselves. Obviously, they’re well aware it’s a big, dangerous world out there, and the smart play is getting yourself covered.

In fact, not only are your super-smart kids signing up to protect their wallets, they’re actually signing up to protect their (gasp!) health. They’re taking advantage of subsidies to buy up from the high-deductible catastrophic plans many assumed they would purchase, and investing in more benefit-rich Silver, and even Gold and Platinum, plans.

And why wouldn’t they? With many plan premiums starting under $100 a month, it’s a small price to pay for peace of mind and financial security.

Take Good Care of My Baby

So Mom, while we know you always want to take care of your kids, maybe it’s OK to let them leave the nest. And here’s something else that might ease your mind:

We’re here to help.

Keeping your family healthy and safe is a priority for us, too. Maybe you already have our group or individual plans, or know someone else who does. After all, we’ve been helping people find plans that meet their needs and situations for over 30 years, since before most of the young invincibles were even a gleam in anyone’s eye!

We have great plans, a great network of doctors and hospitals, and great people ready to explain the options, answer questions, and find the right match for your babies, as if they were our own.

Get signed up. To learn more or shop for plans, call 1-888-382-9771, visit us online at HealthAlliance.org, or stop by our Anthony Drive location in Champaign today!

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