Healthcare Marketplace

Six Facts Folks with a Medicare Supplement need to know

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1.Make sure you have a current copy of Medicare & You. This handbook has details about what Medicare covers and provides websites and phone numbers where you can get additional information.

2.Remember that if Medicare does not pay for a medical procedure your Medicare Supplement will not pay for their share. If you are uncertain if a procedure is covered, you can probably find the answer in Medicare & You. You can also call Medicare at 1 800 633 4227 and they are opened 24 hours per day, seven days per week.

3.During Open Enrollment, which is from October 15th through December 7th, you can change Medicare drug plans. Also during this period you can change from a Medicare Supplement to a Medicare Advantage plan. Unless you have creditable drug coverage from a previous employers or the VA, do not drop your Medicare Drug Policy without enrolling in a new one. Medicare Beneficiaries who have gaps in coverage normally pay a penalty when they enroll in a Medicare Drug plan in the future.

4. Medicare Prescription Drug plans often make changes to their formularies, deductibles, preferred pharmacies and other features from year to year. Also, often Medicare beneficiaries have changes in their medications. It is in your best interest to register on and store your prescription drugs as well as preferred pharmacies on their site. This will allow you to quickly check during Open Enrollment to see if you need to change to a different Medicare Prescription Drug plan.

5. If your doctor recommends  you take a new drug that is not in the formulary of your current Medicare drug plan, you can contact their customer service and request an exception.

6.You can apply for a different Medicare Supplement at another insurance company any time of the year. Medicare beneficiaries sometimes do this when they find a company with a much lower premium. However, unless you have a guarantee issue because your current plan is being cancelled, you will have to go through medical underwriting. This means the insurance company will ask you medical questions, review your medical records and can decline you.

Six Facts you need to Know to Prevent Problems with your Marketplace Health Insurance Policy

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Once you have made your first payment and received your insurance ID please be aware of these requirements and procedures to avoid losing your government subsidy or being penalized:

  1. Normally the method to make your first insurance payment for a Marketplace policy is different from the subsequent payments. To pay for the first month of your Marketplace policy you are given an 800 number or a website. This means you will receive an invoice every month unless you go to the insurance web site or call their customer service number to arrange for automatic bank draft. I’ve had several customers ignore invoices thinking they were on automatic bank draft. Unfortunately, some did not realize the problem until they lost their insurance policy and could not re-apply again until open enrollment.
  2. If you have a computer make sure you register on the website of your health insurance company. Although you will have a customer service number, this will give you a chance to view your claims and payment history without making a phone call. Also, sometimes these sites offer discount coupons.
  3. Make sure you read your Marketplace Letter carefully. Sometimes the Marketplace requires you to provide additional information several weeks after your policy begins. The type of information can be proof of your income, citizenship, identity or proof that you are in the U.S. legally. Even if you are paying your insurance premiums on time the Marketplace will stop your government subsidy if you do not provide the information they have requested by their deadline. This information can be uploaded to their website or can be mailed. If you mail it make sure you follow their guidelines and include the barcode in Marketplace letter. Often your insurance agent can upload your information if you encounter problems.
  4. To receive assistance from the government to pay for your health insurance you must agree to file your tax returns. This also means the Marketplace will mail you a 1095 A form, which provides information on how much the government subsidized your health insurance plan. This information is needed to complete the 8962 form of your taxes. The 8962 form is used to reconcile your estimated income that you provided to the Marketplace with your actual income. If you don’t receive the 1095 A form you can go to to retrieve it or call the Marketplace at 1 800 318 2596. Even if you are only on a Marketplace policy for a short period you are required to compete this form when you file your tax returns. Failure to do this can prevent you from obtaining a subsidy in the future.
  5. If you have a change in circumstances such as new job where you make a higher income or obtaining a job with health insurance make sure you contact the Marketplace. A new job with a higher income needs to be reported because your new income could cause you to lose all or part of your subsidy. Failure to comply with this policy could cause you to pay an IRS penalty. Sometimes my clients have a policy where the government is totally subsidizing their policy. In this case it is extremely important to call the Marketplace to cancel your policy if you no longer need the coverage. Otherwise they are making unnecessary payments to your insurance company.
  6. If you need to cancel your Marketplace policy do not call your health insurance company. Instead call the Marketplace at 1 800 318 2596. Once the Marketplace receives your request, they will contact your insurance company and cancel your policy.