Medicare

Are you paying more than you need to for Part B?: Medicare charges more through the Income Related Monthly Adjustment Amount (IRMAA) if in 2023, you earned more than $106k as a single person or $212k, if filing jointly. You can appeal this if your income is less now. Ask us how.

Open Enrollment Dates: Medicare Advantage and Prescription drug plan part D October 15, 2024 – December 7, 2024.
Changes to coverage may only be made during this period unless there is a special circumstance.

Open Enrollment Considerations:
Does the plan cover my preferred doctors and specialists?
Are my prescription medications still covered, and are the copays affordable?
Have my health care needs changed over the past year?
Have my out of pocket maxes changed on my Medicare Advantage Plan?
Do I want to switch to a Medicare Advantage Plan?

Medicare Advantage Plans (Part C) – these are all in one plans that bundle Part A (hospital insurance), Part B (medical insurance for providers) and Part D (prescription drugs), along with additional benefits such as dental, vision, hearing, transportation, and wellness programs. Be sure to check the network for your doctors and the formulary (list of covered drugs) for your medications to make sure your drugs are in the formulary and for changes in premiums and co-pays as these variables can change every year.

Original Medicare Plans
Part A Hospitals – The cost is covered by the Medicare tax.
Part B Doctors – These premiums can change year to year and effect monthly expenses.
Part D Prescription Drug Plans – The formulary (list of covered drugs) may change every year, so it’s important to make sure your drugs are in the formulary and check for changes in premiums and co-pays.

Medigap aka Medicare Supplement Policies – These plans are not available to those enrolled in a Medicare Advantage plan. The benefits do not change much each year. The plans were standardized in 1992, so all insurance companies offer the same benefits. Any carrier change requires medical underwriting to move to a different supplement policy.

Changes in 2025
• Medicare Part D enrollees will have a hard cap of $2,000 on out of pocket covered prescription drug expenses. Previous cap was $8000.
• More seniors may qualify for assistance in covering prescription cost due to relaxed eligibility criteria.

Beware of Medicare scams. Be cautious of unsolicited calls or emails from people claiming to represent Medicare. Medicare will never call asking for personal information or payments over the phone.

Individual Marketplace

Open Enrollment Dates:
November 1, 2024 – January 15, 2025
For an effective date of January 1st, you must enroll by December 15, 2024.
Enrollments after December 15th will have an effective date of February 1st.
Changes to coverage may only be made during this period unless there is a special circumstance.

Open Enrollment Considerations:
Does the plan’s network cover my preferred doctors and specialists?
Are the plan’s copays, deductible and out of pocket max affordable or changing from the previous year?
Are my prescription medications still covered, and are the copays affordable?
Have my health care needs changed over the past year?
Are you eligible for a premium tax credit subsidy and cost-sharing reductions?
Has your income changed since you enrolled in a marketplace plan if so you may qualify for better benefits such as a lower deductible and out of pocket max?
Is a Health Savings Account (HSA) the right choice in lieu of a plan that has copays?

What’s New in 2025?
Georgia will have its own exchange, which is called Georgia Access. This exchange will be used by Georgia residents and brokers in lieu of healthcare.gov for enrollment. Georgia Access will guide users to private insurance sites and approved brokers where they can compare plans, prices and options. Individuals will still be eligible for subsidies and the marketplace will still offer a variety of options just like the federal marketplace. Georgia Access does not change your plan or your relationship with your advisor.

DACA recipients now qualify for marketplace insurance and subsidies. Ask us how.

How to Enroll and Get Help with your questions

The best way to get the help and advice you need is to work with a broker/advisor that you trust. They are a free service and will take the time to understand your specific needs, help determine if you are eligible for a subsidy, make plan recommendations, enroll you in the plan of your choice and provide you with any needed customer service over the course of the policy period.
Anyone has the ability to go directly to Healthcare.gov and enroll on their own unless their state has its own exchange, but you are unlikely to receive personal advice or ongoing service that will not result in long wait times. Georgia residents will use the new Georgia Access marketplace.

A word of caution: There are many organizations that will try to sell you a plan that is not ACA compliant and not eligible for subsidies. If it sounds too good to be true, it likely is.

For Employers Sponsoring Benefit Plans

There are many things to consider during your open enrollment such as plan designs, tax advantaged strategies, cost-sharing adjustments, new healthcare trends, funding options, compliance and regulations, employee education, technology and service.
Plan Designs – are the plans you are offering meeting the needs of your employees?
Tax Advantaged Strategies – There are many options available to effectively lower healthcare costs by setting up plans that allow for tax free contributions or benefits. Your advisor should be able to explain and review these strategies and make recommendations.
Cost Sharing Adjustments – Do you need/want to change your contribution strategy? Are you paying too much for dependents? There are many ways to structure this based on years of service, position in company, etc
New Healthcare Trends – Does it make sense to implement specialty coverage for wellness, mental health, or other programs to lower the cost of claims?
Funding Options – There are many funding options available to employers, such as fully insured, level funded, self-funded, captives, ICHRA’s and PEO’s. Your advisor should be able to advise you on all your options.
Compliance and Regulations – The Affordable Care Act (ACA), Internal Revenue Service (IRS), Centers or Medicare and Medicaid Services (CMS) and the Employee Retirement Income Security Act (ERISA) all require employers to comply with their regulations. These regulations include benefit summaries, employer required notices, tax forms for employees and employers, Cobra, Medicare credible coverage, Wrap documents, etc to name a few. Your advisor should understand all these regulations and be able to assist you with complying with them.
Employee Education – How are benefit options and rates communicated to your employees? Do you have company meetings with your advisor, use enrollment teams, virtual meetings, benefit platforms?
Technology – Do you utilize a Benefit Administrative Platform or are you filling out paper forms? Are ADOBE documents used or are paper signatures required?
Service – How quickly does your advisor answer phone calls and email? Do they assist you with customer service issues until they are resolved? Do you feel like a valued customer? Are your renewals handled in a timely manner?