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Tis the (thinking about health insurance) Season

In addition to football and colder weather, millions of Americans should be thinking about health insurance in the fall. We’ve outlined helpful hints below by major category of coverage.


Annual Open Enrollment is October 15th through December 7th. This is a time anyone on a Part D drug plan can consider changing to another plan. This is also a time one can change from original Medicare to an Advantage Plan or from an Advantage Plan back to original Medicare.

The attractiveness of an Advantage Plan depends entirely on where you live, whether your doctors are in-network and how much you value choice. Unfortunately, in our experience, many individuals and web sites promote Advantage Plans because they are lucrative to sell rather than the best plan for the individual concerned. There is a Medicare Advantage Annual Disenrollment Period from January 1st to February 14th which allows someone on an Advantage Plan to return to original Medicare. This “Buyer’s Remorse” enrollment period exists for a reason so best to make an informed decision without needing it.

October 15th through December 7th is also a time when those on Medicare Part A but who missed getting on Part B during an Initial or a Special Enrollment, can sign up for a drug plan that will take effect January 1, 2019.


If you are on inexpensive generic drugs covered by your Plan, you may not want to bother considering a change. If you’re taking more expensive drugs, we believe it’s a good exercise to compare plans. After all, most people in an urban area have a choice of over twenty plans to choose from and they are not the same in terms of the drugs they cover, how much they charge you or their rules. You use the tool on medicare.gov to compare plans. We also use information from the Q1medicare.com web site when we do this work for clients. Anyone can sign up for their informative newsletter.

Read your mail. If a plan is terminating coverage in a given area you’ll be notified and will have to sign up for a new plan.


Retiree benefits have been on the decline for years so substantial changes are to be expected. These benefits are through a former employer or union. If they continue beyond age 65, one always has to be on both Medicare Part A and Part B so that Medicare pays as primary. Although retiree annual renewal can be at any time, like group coverage, most renewals occur during October and November for January 1st.

Many employers have outsourced handling of retiree benefits to private consulting firms and/or exchanges managed by benefit consulting firms. Always be aware of when a packet or email should arrive and follow-up if you don’t receive a renewal notice.

The challenge with retiree medical is understanding the value of the benefits. If the former employer is putting a specific amount in a health reimbursement account for you, which is common, then the subsidy is clear. If the former employer is simply directing you to an exchange which provides a subset of choices available in the private market with no subsidy, then you might want to explore all your options.

It is common for employers to move retirees to Advantage Plans or make Advantage Plans very attractive. Often these types of Advantage Plans are superior to what one can buy on their own. It is important to understand whether your doctors are in-network with an Advantage Plan and if they’re not, will they submit claims to the Advantage Plan. There are medical offices that won’t cooperate if they are not in-network and will ask patients for payment which is a situation to be avoided unless you’ve consciously chosen the doctor and are willing to pay cash up front. In sum, do your homework to make the best decision you can.


Annual open enrollment begins November 1st and ends December 15th in most states. You can change plans, get coverage if you are uninsured or consider terminating your COBRA earlier and buying a plan for January 1, 2019.

The individual market remains the most difficult to navigate due to the changing environment. In spite of the changes and litigation, the Affordable Care Act protections with respect to pre-existing conditions remain in effect. Anyone can obtain coverage during the open enrollment window no matter what their health status.

Short-term policies, long term care policies and travel policies can consider pre-existing conditions but not products offered on the federal or a state-based exchange or an ACA-compliant policy purchased off exchange (directly from the insurer).

Many individual products have narrower networks meaning fewer hospitals are in-network. You need to know which hospitals are in your plan’s network.

Also, read your mail. We know of a number of people who were uninsured this year because they failed to read the notice they received by mail that their plan was being discontinued and/or required them to reapply for coverage beginning January 1st.


Although group coverage can renew at any time of year, millions of employed individuals have open enrollment during the fall. Coverage through a group is usually subsidized by the employer and offers broader networks of providers. However, deductibles are increasing, drugs are more expensive and providers can drop out of networks. Do your homework and meet the deadlines for enrollment. Some employers are not tolerant of those who miss enrollment deadlines.


You don’t want to regret healthcare coverage decisions because you’re almost always locked in to them for a period of time. Even if you feel your choices are suboptimal, you still want to make the best decision possible. And even if you and your family are totally healthy we all know that can change too. Please take the time to evaluate options and act timely to enroll.

If you’d like our support and are not an ongoing client please reach out soon. Tis a season that passes quickly!