Medicare and Marketplace: 9 Questions to Ask During Open Enrollment

Use open enrollment to evaluate and improve your health care choices

Enrolling for health insurance
Each fall, set aside time during open enrollment to review your options. Jane_Kelly/iStock

The end of the year is drawing closer, which means the season for making healthcare benefits choices has arrived. Two key time periods for millions of Americans overlap briefly, particularly during November.

About 55 million Americans are participating in Medicare annual open enrollment from Oct. 15 through Dec. 7.

In addition, about 28 million Americans are eligible to participate in the Health Insurance Marketplace open enrollment November 1, 2016, through January 31, 2017.

It’s one of the busiest healthcare shopping times of the year, especially when you factor in the millions of people who are choosing healthcare benefits through their employers. In most cases, healthcare plans chosen during this season will take effect Jan. 1, 2017.

Following are 9 questions to ask during open enrollment, especially when you have multiple options available to you.

1. What plans are available to me?

Depending on your situation, whether using Medicare or the Marketplace—you may have several plans to choose from. For example, individuals using Medicare can choose from an average of 19 Medicare Advantage plans. Choosing healthcare can seem complicated and overwhelming. But it’s important to realize that you could be missing out on key cost savings by not closely evaluating all of your options.

2. Are my needs covered under the plan?

Your healthcare situation is personal, including your medications, your physicians, your specialists, and your treatment plan.

Some individuals manage chronic healthcare conditions. For instance, the Centers for Medicare & Medicaid (CMS) reports that more than two-thirds of Medicare beneficiaries have two or more chronic conditions. Choice of a healthcare plan will be important to addressing your special needs, which provides another reason to closely evaluate your options.

3. Is my doctor covered under this plan?

Doctor choice is one of the most important issues for individuals who renew their health insurance coverage from year to year. Many people don’t realize, however, that physicians can leave a health plan at any time throughout the year. If your physician choice is important, then stay in close communication with your doctor. It’s possible to confirm that your physician is covered with the health plan you choose for next year, but be aware that your doctor has the freedom to make changes in the coming year.

4. What is the plan premium?

The monthly premium for your healthcare coverage is important. This dollar figure can help you when evaluating different plans and what they offer. It’s also important to examine the full costs for coverage, which leads us to the next point.

5. What other costs do I need to check into?

Your out-of-pocket healthcare costs aren’t just about the monthly premium. The healthcare plan you choose will include provisions for the deductible, co-insurance and/or co-payment amounts. The deductible is the dollar amount that an individual is responsible for paying before the healthcare plan starts to pay. For example, with Original Medicare Part A (hospital services), the deductible must be paid each benefit period.

In other cases, like Original Medicare Part B (medical services), the deductible must be paid each year.

Co-insurance is the portion of payment for services that the individual must pay. For example, the plan may have an 80-20 rate, which means the plan pays 80 percent of the costs while you pay the remaining 20 percent. Along with these costs, there are co-payments, which are set amounts that are paid at the time you receive services.

6. Do I think my healthcare needs might change next year?

It can be easy or more convenient to simply renew your current plan for next year. This could be a misstep, however, if there are signs you might need more coverage in the coming year.

Issues with health aren’t necessarily predictable, but it’s important to review the past year and look forward to the types of needs you’ll have in the coming year, especially if you or a family member has a chronic health issue.

7. What if I don’t make any choice?

If you are already enrolled in a plan, you may be automatically re-enrolled if you don’t make any type of choice. This is true for Medicare beneficiaries. You should receive information from your health insurer about next year’s plan and whether there will be changes to the coverage and provisions. Review these documents closely to ensure your needs will be met.

8. What options do I have for additional coverage, such as dental, vision, hearing, or supplemental?

Depending on your situation, you may want to purchase additional coverage or look for plans that incorporate some health services that are seen as supplemental. Examples include dental, vision and hearing coverage. If these items are important to you, they can be a good reason to consult with a benefits coordinator to understand your alternatives.

9. What are my options for my spouse and dependents?

Matching your family’s needs with the health plans available can be complicated. In today’s environment, it may be possible that you, your spouse, and your dependents all use or need different healthcare plans.

Because there are so many alternatives, it’s becoming more important to closely explore your benefit options. It also can be vital to work with a health benefits coordination specialist who is experienced in Medicare, the Health Insurance Marketplace, and with other types of coverage.

The long-term benefit of getting assistance and making careful choices during this open enrollment season include cost-savings over the next year, as well as coverage that truly meets your family’s healthcare needs.

Tricia Blazier is a Personal Health and Financial Planning Director for Allsup, a company that offers a comprehensive suite of services, including the coordination of employee benefits and workers' compensation programs with Social Security Disability Insurance (SSDI) and Medicare.