Health Care Buzz: Updates on Medicare and the Exchange/Marketplace in 2023 – Times-News

Note: As many yearly updates and decisions have due dates, we will return to the Long COVID patient stories in Dec.

Open Enrollment happens every year. Between Oct. 15 and Dec. 7 you can join, switch or drop a Medicare Advantage Plan during the Open Enrollment Period. Your coverage starts on Jan. 1 as long as it is requested by Dec. 7. If you join a Medicare Advantage/MA plan during this period but change your mind, you can switch back to Original Medicare or change to a different MA plan (depending on which coverage works better for you) during the MA Open Enrollment Period – Jan. 1 and March 31. (Think of this as a do-over period with limitations). You can only switch once during this 2nd ‘do over’ enrollment period. However, there are parameters:

• You cannot switch from Original Medicare to a Medicare Advantage Plan.
• You cannot join a join a separate Part D Drug Plan if you have Original Medicare
• You cannot switch from one Part D Drug Plan to another one if you have Original Medicare

Points to remember: Even if you move to a Medicare Advantage plan, there will still be your Part B premium due each month. Additionally, with all the TV ads about ‘free services with Medicare Advantage’ – just remember that MA plans are sold per county with very individual coverage packages. Medicare/CMS oversees all MA packages being sold including beginning new oversight in 2023 regarding the ads that the MA plans are putting on TV. Plenty of mis-information. (There are approximately 4800 different MA plans being sold nation-wide). WOW!

NOTE: If your income for 2022 is below $18,600 ($25,000 for married couples), you may be able to save on your monthly Medicare premiums and other out-of-pocket Medicare costs including prescription drug costs. See if you qualify- go to Medicare Savings Program.

Fabulous tool: MyMedicare.Gov – a resource that includes “Medicare & You 2023” booklet of all Medicare benefits and great descriptions of same (online or you can request one) and a full list of MA plans and Part D/prescription drug plans sold in your county/use your zip code.

When making decisions about plans -including remaining with Original Medicare – develop a checklist of important steps to do each year:

• Do a thorough review of all your medications. Look at each Drug Plan within a chosen MA plan. Look at each free standing/individual Part D Plan. This will be the most important step that must be done yearly. There are changes in coverages for drugs – always! (Remember – Insulin!)
• Do a check-in with your providers – hospitals, oxygen, pharmacy, all providers, dentists, eye doctors – to ensure they are STILL in your MA plan. This must be done to avoid being ‘surprised’ and find yourself out-of-network. This is not known unless you ask.

Marketplace/Exchanges

In the past year, the Biden Administration and Congress have taken steps -mainly related to premiums and subsidies – that will affect 2023 coverage. This includes funding Navigators again that were previously eliminated. Open enrollment for people who buy health insurance thru the Marketplace begins Nov. 1 and, in most states, lasts through Jan. 15. However, to get coverage that begins on Jan 1st, enrollment must occur by Dec. 15.

Key elements within the Marketplace:

• Four in five customers will be able to purchase a plan for lower monthly premiums due to increased Affordable Care Act coverage and additional subsidies added as part of the Inflation Reduction Act.
• The average enrollee has between six and seven insurance plans to choose from in 2023.
• Monthly premium reductions are based on income and family size, usually. There are federal and state plans so there is variation.
• If you qualify for a reduced monthly premium, the insurance plans being offered may have high deductibles and copayments. (EX: Silver plan $5100 yearly deductible). Look into all options.

This insurance option for small employers, self-employed, recently unemployed, recently moved with no insurance, early retirees/prior to age 65/Medicare are excellent. This could be an option if you don’t qualify for Medicaid-especially in states with Medicaid Expanded coverage (which Idaho has). There is help -utilize the options versus going without insurance. Go to yourhealthidaho.org for plans, navigators to assist and find your insurance coverage.

All historic articles and training material are available on the Patient Financial Navigator Foundation’s webpage: PFNFinc.com. The Foundation is an Idaho-based, Family Foundation formed in 2017. Call 208-423-9036 for more information.

Do you have a topic for Healthcare Buzz? Would you like to tell your LONG COVID story? Send contact to daylee1@mindspring.com.