Review of your healthcare plan depends on which plan you are on. You may have an employer plan, marketplace exchange for Pennsylvania, also known as a Pennie plan, or Medicare coverage, but regardless of which, it should be done annually. Just like your annual checkup, your health plan needs an annual checkup.
Reasons why you need to review:
- Your health changes, so the high deductible option you chose may be costing you more than paying a higher monthly premium if you have health issues pop up.
- Your prescriptions are likely to change – you may need more meds or be able to drop some meds, which will reduce your costs. Good Rx is becoming a good alternative as a discount plan for maintenance-type drugs and generics.
- The plan itself changed. Typically, there are annual updates on your employer plan choices; if you are on the marketplace exchange for PA, the plans will change; additionally, Medicare plans do change if you are on a stand-alone prescription plan or Medicare Advantage plan.
- Your family dynamic changes – maybe your child is now 26 and needs to come off your group plan; congrats – you had a baby! That will have you adding a participant, obviously. Employer plans don’t have to, but many cover a domestic partner who lives in the household. Ask your HR company or employer benefits consultant if this is possible and weigh costs and coverage to determine the best option for your family.
In addition, employer group plans should also be reviewing coverage annually. Just being okay with the increase and not seeing if there is a better option isn’t always the best coverage for you as the plan owner or the employees.
There are certain times of the year when it makes more sense to review the plan. Employer plans all have a starting date sometime throughout the year, not always January 1. They receive their renewal rate 60 days in advance and can review the changes with their agent to see what’s changed besides the cost. This gives time to shop the plan and see if there are new carriers offering coverage in the area, make sure the employees that continue to be employed are renewed, and any family updates are accounted for. This review will take a few minutes or hours, depending on how many employees are in the plan. Larger companies will have a human resource department or an employer benefits consultant to help analyze the changes.
The federal marketplace, formally known as Obamacare, then the marketplace exchange for Pennsylvania, has shifted to Pennie. Each state was given the opportunity to start its own exchange if it so chose to, and PA did and named it Pennie. These plans change each year, and it is best to do this review on November 1st – December 15th, their annual enrollment period. This will have your new plan starting on January 1st. There is a second enrollment option from December 16th through January 15th. Those plans will start on February 1st. Part of the healthcare plan via Pennie may include a tax subsidy. This is a good time to adjust your income for the following year, so you don’t have to pay additional at tax time. Subsidies will change annually, you will be a year older, and the plans will also have different options to choose from. Selecting a broker on your portal will help you make sure you understand the plan choices and give you a place to go with questions. There is no cost for you to connect with a broker.
Lastly, if you are on a Medicare plan – this should be reviewed annually on October 15th – December 7th each year. This is their annual enrollment period. Plans changed during this timeframe will begin on January 1st.
During this period, beneficiaries can make various changes to their Medicare coverage, such as:
- Shopping for their Medicare Advantage plan within the carrier or outside the carrier
- Enrolling or shopping to change their Part D prescription plan
The Annual Enrollment Period in any factor is crucial because it allows you to review your healthcare needs, consider plan changes, and make adjustments to ensure your coverage aligns with your evolving health requirements. It’s an opportunity to optimize your coverage for the coming year.
Make sure you are working with a dedicated agent like those at Bridgeman Strategic Concepts. Agents can take the mystery out of finalizing your plan. Book your appointment now or attend one of our many seminars that can be found on our website. www.bridgemanhealth.com
