Special Enrollment Periods

There tends to be confusion as to when you can do what in regard to health insurance and Medicare in particular. Health insurance in reality does not follow the rules of insurance. You can’t purchase coverage for your car after the accident.

Fire insurance for a home must be in place before the fire. Wouldn’t it be
great if you could purchase a policy and get reimbursed for your losses after the robbery?

The bottom line is, that insurance companies take and “bank” the cumulative premiums of all participants and then have funds to pay on legitimate claims. Since Obamacare; the Affordable Care Act, health plans have changed, and are not truly “insurance”.

In bygone days, individual plans were available only to healthy people. Today, plans are available during certain times of the year to even the unhealthy. Because the risk pool can be drained by claims submitted
by people with medical problems new to the plan, the monthly premiums paid have gone up annually while benefits have been reduced.

The government is subsidizing the health plans in addition to the rising costs to offset the cost for certain groups. In this Covid-19 pandemic, a Special Enrollment Period (SEP) has been authorized in California helping people who have lost employer coverage.

Keep in mind, that coverage doesn’t start until the first of the following month, and applications must be received before the 20th of the month.
Medicare works differently. Joining Medicare is normally for people first turning 65.

Enrollment is for three months before your birth month, your birth month, and for three months after your birth month. If a person is working past 65, they can enroll for a period of two months following termination of the
group plan either because you retired, or the group coverage ceases.

At the time a person first enrolls in Medicare, they have limited time to purchase a Medicare supplement or enroll in a Medicare Advantage plan.
Medicare supplement plans are designed to pay the Medicare deductibles and co-pays.

They work much like traditional insurance. With a few exceptions, you must be in good health to enroll. Medicare Advantage (HMO) plans also have restrictions as to when you can enroll, but during the Annual Enrollment Period (AEP) October 15 to December 7, most can enroll without medical questions.

These plans have some specialized plans called Special Needs Plans (SNP).
They are designed for people with certain medical conditions. Locally, plans are available year-round for persons with diabetes or chronic heart conditions.

Even if the diabetes is controlled by diet, or the heart condition is just high blood pressure, you may be eligible year round. These plans also have
a $0 monthly premium in most Southern California zip codes with $0 copays for office visits.

Persons who are also receiving Medi- Cal benefits can also find special
plans providing no cost offering additional benefits beyond that offered by
Medi-Cal. These plans are available January through August with coverage beginning the first of the following month.

If you have questions or think you may qualify for a plan, give us a call. We can discuss your situation and offer a no-obligation free consultation. Due to Covid-19, we remain open as an essential service, but all business is conducted over the phone.

Harry P. Thal, MA, is a licensed insurance broker in California (0621106) and 24 other states. His offices are in Kernville. He is a member of the Society of Certified Senior Advisors and Past-President of the Kern Association of Health Underwriters.

He may be reached at 760-376-2100, e-mail harrythal@aol. com or visit him on the web at www.harrythal.com.

Click here to add a comment

Leave a comment: