Health Insurance Blog and Resources

Guest Post by AJ Cohen Despite a myriad of efforts to make health care more affordable, costs continue to rise. Medical costs have outpaced income by 14 percent over the last 10 years, and 2020 is predicted to see the largest jump in costs yet — up 5 percent from 2019, which was already up 3.6 percent from 2018. Finding affordable care is an issue that hits at the heart of most Americans. Few families can absorb even a modest health care crisis when the average cost of a three-day hospital stay is $30,000 and the average cost of an ER visit is anywhere from $3,000 (with insurance) to upwards of $20,000 (without insurance). And if you need to get to the hospital via ambulance? Plan on at least another $1,000. Cost has become such a prohibitive factor in U.S. health care; many patients prolong needed medical care or forego it altogether to try and spare themselves the expense. As the saying goes, "When you have your health, you have everything," which is why everyone should have the benefit of being able to afford quality medical care when they need it and as long as they need it. Government officials and health care experts have long tried to devise a plan that makes sense for everyone, but until they do, I’ve compiled a few tips to help you stay on top of your health in 2020 without finding yourself in the poorhouse. First, take stock of what you’re paying now for health care and whether you can afford it.Insurance premiums and copays add up quickly. You may not find out if you’re carrying enough insurance, or the right kind of insurance, until it’s too late. No one wants to find themselves in the middle of a medical emergency only to discover they don’t have the necessary insurance to cover at least part of the costs. This is the time of year for open enrollment on most health care plans, and a good time to assess your needs in 2020. Will the size of your family be changing? Do you anticipate new medical needs for the coming year? Will there be out-of-pocket expenses, or expenses deemed not medically necessary, that you’ll need to account for over the next 12 months? Are you taking advantage of a Health Savings Account? Does your deductible seem reasonable? These are questions you should consider when determining what type of medical insurance you have and whether it will fit your needs in the coming year. Now is the time to make changes without penalty. Be realistic with how much you can afford each month and make sure it will deliver value when you’ll need it most. Next, shop around and take advantage of freebies.Surprisingly, most Americans don’t look for a bargain when they seek out medical care. A survey of nearly 3,000 individuals revealed only 13 percent of respondents who had to pay out-of-pocket for recent medical treatment had sought information about expected spending before receiving that care, and only 3 percent had compared costs across providers before receiving care. Reasons vary, but there is a long held belief that health care that costs less isn’t as valuable or effective as health care that costs more. This couldn’t be further from the truth. For some procedures, medical clinics are a far better bargain that in-hospital treatment, for example. Not to mention one doctor or hospital may charge significantly more for a service than another. It’s worth the time to ask around and compare your best deals. The government has even made it easier for all of us, requiring hospitals to publish the costs for common procedures. Don’t forget to take advantage of free and low cost services as well. Preventive care is free with many medical plans and for a healthy individual, this can cover the bulk of your medical needs in a given year. Ask for generic versions of prescriptions and shop your services around to various pharmacies. Many stores offer incentives on groceries and other items to have your prescriptions filled with them. Finally, don’t overlook free or low cost services for things like flu shots, wellness exams and sports physicals. There is no reason you need to see a primary care physician for some of these routine treatments. Finally, make a plan to pay your medical debts off now.Sounds easy on paper right? Medical debt can be scary, because the numbers can be large. There’s also the psychological issue at play — you feel better, so why do you need to go back and spend money on something that is fixed and done? Medical debt can quickly get out of hand however, and hospitals, clinics and doctors offices are feeling the pain of not being paid. For this reason we are seeing larger numbers of medical providers suing their patients for payment. Once a judgment has been rendered against you, you have little choice but to pay the bill in full — often with zero negotiating power. There is no need to let it get to that point. As tempting as it is to ignore medical bills, take the time to open those letters and understand what you owe and why. If something seems wrong to you or overly inflated, call your provider and discuss it. Most are willing to negotiate if you offer to pay in cash or pay the bill in full. If the costs are more than you can pay right now, consider a medical loan. Unlike credit cards, medical loans can have a far lower interest rate and more flexible repayment terms. At BetterMed, for example, we offer loans as high as $350,000 with a fixed 3.9 percent APR, and we approve 97 percent of our borrowers without a credit check. health care costs can feel insurmountable as they continue to rise, unabated. While no one can predict with any certainty what kind of medical needs you or your family may have in the coming year, there are ways to prepare now so those events don’t come with the added burden of how to pay for it. AJ Cohen founded BetterMed in 2011 and has served as Managing Partner since its inception. BetterMed is a global health financing company that provides holistic medical loans for patients facing critical, chronic or cosmetic health care costs. AJ started BetterMed with a mission to meet the needs of today’s borrowers, and has defined the company’s vision and strategy while leading the company through rapid growth. Today, BetterMed offers the lowest interest rate and most compassionate borrowing terms of any medical loan provider on the market, enabling borrowers to pay anywhere from four to six times less than they would with any other medical loan. AJ received a Doctor of Law at New York University, as well as a Masters in Finance from London Business School.

Open Enrollment is the annual period when anyone can enroll in health insurance for the following year. It ends every year on December 15th. If you missed it, don’t think that you’re out-of-luck when it comes to health insurance coverage next year. You may still have time to enroll in a health plan for the coming year, even if it’s not a qualified health plan. Here are five things you should do to see if you can still get coverage: Check the Open Enrollment dates in your state See if you qualify for a Special Enrollment period Review eligibility for government-sponsored health plans Find a job with health insurance benefits Consider other options Check the Open Enrollment dates in your state While most states end Open Enrollment on December 15th, some have extended it. For example, California, Colorado, and Washington, D.C. have permanently extended their open enrollment periods. California and Washington, D.C.’s open enrollment periods end on January 31st. Colorado’s open enrollment period ends January 15th. If you enroll after December 15th, your Affordable Care Act (ACA) coverage may start February 1st instead of January 1st. Other states may choose to extend the enrollment period on an annual basis. However, states that have lengthened the period in the past may not lengthen it in the current year. A quick Google search can help you find out what your state is doing. You may still have time to enroll in a health plan for 2022. See if you qualify for a Special Enrollment period Whether or not your state has extended open enrollment, you may qualify for a special enrollment period if you experience a qualifying life event, like getting married or divorced, having or adopting a child, or moving to a new state. Missing open enrollment alone doesn’t usually qualify you for a special enrollment period. Review eligibility for government-sponsored health plans Government-sponsored health plans like Medicaid and CHIP typically allow enrollment throughout the year. Medicaid and CHIP are available in all 50 states, U.S. territories, and Washington, D.C. Medicaid and CHIP eligibility is based on your income level. Eligible income levels vary by state. The Medicaid website for your state can give you more information on eligibility requirements and enrollment. Find a job with health insurance benefits If your current employer does not offer health insurance in its benefits package or if you can’t afford what your current employer offers, you can start applying for other jobs with employers that do offer an affordable benefits package. Keep in mind that it’s best not to ask for details about the benefits package until you have an offer. If you ask for details about the benefits package before, it can show the company that you’re more interested in what they can do for you than what you can bring to their company. The company may not be convinced of the value you bring and decide not to make an offer. Once you have an offer, asking questions about the benefits package is totally appropriate. Some jobs have a waiting period for benefits to start. Keep this in mind as you consider job offers. Look into other health insurance options, like government-sponsored plans and short-term health insurance, to give you some coverage while you wait for full benefits. Consider other options If you are unable to enroll in an Affordable Care Act (ACA) plan, you can consider other ways to manage your health expenses, like short-term health insurance and prescription discount finder tools. Short-term health insurance “The ACA is the only health insurance coverage that limits consumers to buying within the open enrollment period, and there are several options available throughout the year,” says Jan Dubauskas, Vice President at Health Insurance Innovations, Inc. (HIIQ). Short-term health plans don’t cover everything a qualified health plan does, like pre-existing conditions, but they can help cover preventive care and emergency care. Some plans include coverage for prescriptions. Carefully review what each short-term health plan covers because there is variability. Be aware that you and anyone else on the health plan will need to go through the underwriting process to be accepted on the plan at specific rates. When the Affordable Care Act first became law, it included a tax penalty for not having qualified health coverage. “Starting in 2019, there is no longer a penalty for choosing to forego an ACA plan, which means that if someone doesn’t need the robust coverage available under the ACA, they can buy another, more affordable type of health insurance like short-term medical without risking a tax penalty,” says Dubauskas. While there is no longer a federal penalty, you may be subject to tax penalties at the state level depending on your state’s laws. States also have different guidelines regarding short-term health insurance. “Short term medical is now available in many states for up to 36 months,” says Dubauskas. While short term health insurance may be available for long periods of time in many parts of the United States, some states may have different rules. Double-check the guidelines in your state and keep them in mind as you navigate purchasing health insurance. Prescription pricing tools Prescription pricing tools are becoming increasingly common. While these pricing tools aren’t considered insurance, they can help you manage your medication costs. One example is RxSaver by RetailMeNot. “RxSaver is a website and an app that shows you the lowest retail prices at pharmacies in your neighborhood. You just put in your drug name and choose from a list of prices at nearby pharmacies,” says Dr. Holly Phillips, Board Certified General Internist in Manhattan and a Medical Expert for RxSaver by RetailMeNot. Knowing your options can help you ensure that you have the health coverage you need to maintain your physical, mental, and financial health.

Updated September 10, 2021. Guest Post by Elissa Suh Open Enrollment for health insurance is soon to be underway — the federal open enrollment is from November 1 to December 15, 2021. However, more than 88 percent of Americans could not correctly identify these dates, according to the third annual Policygenius Health Insurance Literacy Survey. The survey also found that many people — more than one in four — avoided getting treatment because they didn’t understand their health insurance coverage. Health insurance can be daunting and challenging to navigate, but starting with the basics is a good place to help you prepare to make the best choices for your health and finances. Survey respondents also had trouble with basic health insurance terms like copay, deductible, and premium. Fewer than a third of people correctly defined all three terms. To help you get ready to choose your health insurance plan for 2021, here are seven terms to know: Premium Copay Deductible Coinsurance Out-of-pocket maximum Essential health benefits Short term plans 1. Premium A premium is the amount you pay for health insurance every month, whether you pay it directly or it’s automatically deducted from your paycheck if you have insurance through your employer. It’s the first cost you encounter when you have health insurance, and yet only a little over half (55.9 percent) of survey respondents could correctly identify the term. There are five plan categories — Bronze, Silver, Gold, Platinum, and Catastrophic — and each has a different way you and your insurer share costs for your care. You will have to pay a higher premium for Platinum plans, but will pay less out of pocket before insurance starts to cover the bills, or you can opt for a Bronze plan, which means you’ll have lower premiums but pay more out of pocket before insurance starts to cover medical bills. 2. Copay Copay, short for copayment, is a fixed amount you pay for a covered medical expense. Your copay amount will vary, based on your health plan and the type of service you receive (like a specialist physician, primary care physician, urgent care visit). Generally, copays are around $30 and do not count toward your deductible. Out of the health care terms asked about in the survey, “copay” caused the greatest confusion — only 40 percent of people could define it. 3. Deductible A deductible — the amount of money you pay out of pocket before insurance coverage kicks in — was a term that approximately half (49.6 percent) of survey respondents could correctly identify. For example, if your plan has a $1,000 deductible and you need to undergo a $3,000 surgery, you would have to pay $1,000 on your own, before the insurance company could start helping with the costs. And, because you’ve met the deductible, the next time you have a covered medical expense in the calendar year, insurance will pick up the bill in its entirety. Knowing how the health insurance deductible works can help you understand other types of insurance, too, like homeowners or auto insurance, as the concept remains the same. 4. Coinsurance Coinsurance is the percentage of health care costs you have to pay after you’ve met your deductible (until you meet your out-of-pocket maximum). Coinsurance is represented as a percentage or split, like 20 percent or 80/20. This means you pay for 20 percent of the costs for a covered medical expense, and the insurance company pays for the remaining 80 percent. 5. Out-of-pocket maximum The out-of-pocket maximum is the most you’ll have to pay for covered health care services in a given year. After you spend enough money on medical expenses to reach the out-of-pocket maximum, your insurance provider will cover 100 percent of your care. The out-of-pocket maximum limit depends on your health plan and resets annually. The government also sets an overall limit: For 2021 plans, the limits are $8,550 for individuals and $17,100 for families. 6. Essential health benefits Did you know that under the Affordable Care Act, all health insurance plans are required to cover the same 10 essential health benefits? The 2019 Policygenius survey asked about these benefits and found that nearly 87 percent of people didn't know what services were required. The 10 essential health benefits are ambulatory services (outpatient care), emergency services, hospitalization (inpatient care), laboratory services, mental health coverage, pregnancy/maternity/newborn care, rehabilitative services, pediatric care, prescription drugs, and preventative care. 7. Short-term health plan Short-term health plans were established as a way to help fill temporary gaps in insurance coverage, not to act as a comprehensive health plan. They’re not substitutes for traditional health insurance plans and do not have to adhere to standards in place by the Affordable Care Act, so they aren’t required to offer any of the essential health benefits mentioned above. This type of health insurance may cost less than a marketplace plan, but it also includes less coverage. Short-term plans are increasing in popularity, but not many people know how they work. According to the Policygenius survey, only 9.9 percent of people knew how long a short term plan could last — they’re typically limited to under a year, but can be renewed for up to a total of 36 months. Elissa Suh is a personal finance and insurance expert at Policygenius in New York City. She has previously worked in television research and written about film for IndieWire, MUBI, and Paste Magazine.

"It's complicated," said your ex about breaking up with you. Or were they talking about health insurance? Health insurance has lots of terminology and specific processes that can be daunting and difficult to understand at first. Luckily, there is plenty of information available regarding health insurance terms and how health insurance works. “Although the United States is considered a leader as it relates to delivering healthcare services to our populous, we typically lack in providing the basic education on how the health care ecosystem as a whole operates. From a customer perspective, this becomes increasingly confusing and overwhelming during the Open Enrollment Period,” says Austin Ridgeway, HGS Director of Sales Support and Business Development. Open Enrollment is one of those terms. So, here’s a quick definition: the time period you have to enroll in a health plan for the following calendar year. Open Enrollment typically runs November 1 through December 15. Buying health insurance also presents its own challenges. To make an educated choice and find the best fit for your situation, you need to be able to analyze and understand your options properly. So, here are five things that can cause confusion during Open Enrollment: Open Enrollment vs. Medicare Annual Enrollment Enrollment deadlines Where to shop Plan classifications Plan costs Open Enrollment vs. Medicare Annual Enrollment Medicare has an Annual Enrollment period that allows Medicare beneficiaries to review their current coverage to make sure it will meet their needs and make changes as needed. It wouldn’t cause so much confusion, except that sometimes it’s also called Medicare Open Enrollment. It also usually runs October 15 through December 7. The overlapping time frames and unclear references don’t help prevent the confusion, but now you know. Enrollment deadlines Another point of confusion: the deadlines. “Many people assume you should just be able to enroll, but there are very good reasons to not have ongoing open enrollment,” says Jason B. Ball, CFP® ChFC® CLU®. However, this confusion is understandable because health insurance didn’t always require enrollment during a specific annual period. “Before the Affordable Care Act, plans could deny people based on pre-existing conditions and therefore if someone wanted to apply say in April, they could, but the company could deny them due to a pre-existing condition or pending surgery. The enrollment period is put in place to discourage people from trying to game the system by applying for coverage only when needed since companies would have to accept them,” says Lorena Tomasini, owner of the MALM Life and Health Insurance Agency. While having deadlines can be one more thing to keep track of, it also benefits health insurance shoppers and helps keep enrollment stable for health insurance companies. Repeat to yourself: Open Enrollment is November 1 through December 15. Say it three times. Set a reminder on your phone so that you don’t end up without coverage next year. But, if you miss Open Enrollment or lose your current health insurance coverage, you may be able to buy health insurance outside of Open Enrollment if you have a Qualifying Life Event. These events trigger Special Enrollment Periods. “People can apply outside of open enrollment if they have a special enrollment period. This can be triggered due to recently (past 60 days) getting married, having or adopting a child, a death, losing health coverage (such as changing jobs but not because they missed payments), obtaining a legal immigration status (parole, work permit, residency), change in address (not within the same county) or going to happen in the future (60 days) will lose health coverage in the next 60 days,” says Tomasini. Where to shop With the all the resources available on the internet and licensed insurance agents willing to help, it can be difficult to know the best way to find a good health insurance plan. Health insurance carriers also can change plan offerings and features year-to-year. Even if you liked your plan this year, it may not still be a good health plan for you next year. So, you should know your options. If your employer offers health insurance as part of its benefit package, you can enroll in that. You can also look for options in the Health Insurance Marketplace. These plans also also called on-exchange plans. “Some individuals are also confused about whether they can still purchase health insurance through the ACA. With the repeal of the individual mandate and the subsequent ruling that it is unconstitutional, some are not sure an ACA plan is still an option,” says Dr. Nicole T. Rochester, Your GPS Doc, LLC CEO and Founder. Even with all of the political changes and challenges to the Affordable Care Act, the Health Insurance Marketplace still exists. You can find plans that cover the Essential Health Benefits and offer affordable premiums on HealthCare.gov. Most states use HealthCare.gov to list on-exchange health plans in their state, but some states have a separate site. In addition to on-exchange plans, you can consider off-exchange plans. These plans are not required to meet the same coverage requirements that on-exchange plans must, though some do. Be sure to understand the covered services included with these plans before enrolling. Off-exchange plans that do not offer the same coverage as on-exchange plans include short term health plans and health sharing plans. “Most are unaware that you can find decent, affordable health insurance choices off the exchange. Off-exchange websites, like Kind, offer more choice for families and individuals shopping for health insurance and choice allows you to pick a plan that is more customized to your needs,” says Nick Soman, CEO of Decent. Whether you’re looking for an on-exchange or off-exchange health plan, you can use health insurance comparison websites, work with an insurance agent, or reach out to insurance carriers directly yourself. However, as you research and evaluate plans, you should know the limits of each source. “You can use a broker to find the right plan, but they are typically a sales person who may have an ulterior motive, like higher sales commissions, for you to select a particular plan,” says Ridgeway. Check with the insurance agency to see how they pay their insurance agents. Are they commission-based or salaried? Even if you’re just looking at commercial health insurance comparison websites, like HealthCare.com, it’s important to pay attention to the order in which the site displays available health plans in your area. In some cases, these sites prioritize plans based on contracts with insurance carriers. “You can ask your friends and family what options they use. This typically will give you an unbiased review of their plan, but, as described above, they are not typically experts within the health care industry and are typically given based on a singular point of view, which is harder to get a complete picture from," says Ridgeway. Online reviews have similar issues. However, online reviewers likely represent a more diverse range of health needs than your friends and family. It’s not easy to pin representation down, but if you look at ratings and reviews in aggregate, they can help you identify a good insurance company from a bad one. “There are aggregator sites and applications that bring together a number of nonbiased user reviews of health plans and the services they provide. Although a great option, to get a number of individual opinions through this channel, users have been jaded by 'fake' reviews often provided by the company themselves to ensure that they appear more favorable to the general public,” warns Ridgeway. If you’re looking at online reviews, check a few review sites and read how each one vets reviews before publication. While Best Company doesn’t list specific health plans from various carriers, it does offer customer reviews of health insurance companies. Each review is vetted to prevent fake reviews from being published. Ridgeway recommends doing your health plan research by diversifying your sources. “My advice would be to find a hybrid approach that will combine all of the above: speak with family and friends, do your research, and possibly speak with a broker about what options are available that fit your particular situation. No matter what route you choose, always remember to be informed as to what your family needs and how much impact the selected plan will have on your life because you will not be able to choose another plan until next year’s Open Enrollment Period,” he says. Plan classifications Understanding plan classifications and costs will help you determine whether a plan meets your needs. “While there have been concerted and successful efforts to improve the HealthCare.gov website, many continue to be confused about open enrollment. This is largely due to the sheer volume of information you have to sift through and interpret while searching the site. In some cities, there are more than 40 available plans from which to choose. Understanding the differences between the various metal levels (Bronze, Silver, Gold) and the meaning of all of the terminology (deductibles, coinsurance, etc.) is daunting, even for those of us in the health care field,” says Rochester. Understanding health plan classifications is the first step to being able to evaluate and choose a health plan. Health plans are classified several different ways to indicate the kind of plan they are, the kind of network offered, and how plan costs are broken down. Here are two common abbreviations for classifying plan-type: CDHP — Consumer-Directed Health Plans. These plans tend to have lower premiums and come with accounts to set aside money for medical expenses. These accounts include Health Savings Accounts (HSAs), Flexible Spending Accounts (FSAs), and Health Reimbursement Accounts (HRAs). HDHP — High-Deductible Health Plan. These plans have high deductibles that put a greater responsibility for out-of-pocket costs on the policyholder. These plans often have low monthly premiums and can include HSAs, FSAs, or HRAs. Here are a few common abbreviations for classifying network type: HMO — Health Maintenance Organization. These plans typically offer coverage for care received in-network. If your doctor is not included in the plan’s network, you’ll fully pay those costs yourself. PPO — Preferred Provider Organization. These plans offer coverage in- and out-of-network. However, there are separate deductibles and cost-sharing rules for in-network and out-of-network coverage. Out-of-network care typically places greater cost-sharing responsibility on the policyholder. In addition to plan-type and network categorization, the Affordable Care Act created metal tiers to show how total plan costs were determined. “The most confusing part of buying health insurance for most people is understanding the tiers of coverage: bronze, silver and gold,” says Lev Barinskiy, SmartFinancial CEO. While there is a variety of plans and costs within each tier, the costs fit the following trends: Bronze — These plans have the lowest monthly premiums and highest out-of-pocket costs. Policyholders are typically responsible for 40 percent of care costs out-of-pocket. Silver — These plans have higher monthly premiums and lower out-of-pocket costs than Bronze plans. Policyholders are usually responsible for 30 percent of medical expenses. Gold — These plans have higher monthly premiums and lower out-of-pocket costs than Silver plans. Policyholders are generally responsible for 20 percent of their medical expenses after the plan pays 80 percent. Platinum — These plans have the lowest out-of-pocket costs and highest monthly premiums. Policyholders are responsible for about 10 percent of their medical costs. Keep in mind that these tiers typically only apply to health plans offered on the Health Insurance Marketplace. As you’re shopping for cost-effective plans, these tiers can help you evaluate the overall cost of a plan. Understanding these costs and your health needs, will help you find a good fit. “You can't compare a bronze plan with a gold plan, but this tends to leave many people wondering which to choose. Your premium may be lower with a bronze plan, but you'll likely pay more in doctor visits and for care from specialists. If you see several doctors and anticipate continuous care, it may cost less to buy the more comprehensive gold plan," says Barinskiy. Plan costs While the tiers can help you understand how costs are spread out in a health plan, it can still be tricky to understand how much a health plan actually costs. “People are typically most confused by what plans will end up saving or costing them when trying to project out-of-pocket expenses along with premiums, deductibles, and prescriptions,” says Vinay Amin, health and wellness expert and Eu Natural CEO. It’s important to analyze each plan you consider, including the deductible, out-of-pocket limit, copays and coinsurance, and monthly premiums. Because there are different kinds of costs to consider, how much a health plan costs is tricky to pin down. It also can vary based on your health needs. Talking to your health care providers can help you understand your health needs. “The best approach is to plan ahead and have a talk with the right people, notably your doctor and your pharmacist. Your pharmacist is familiar with your medications and is an ideal source of consultation regarding a plan for prescriptions. Your doctor knows your medical history. Review your options with the appropriate medical professionals and don't wait until the last minute,” suggests Amin. Once you can anticipate your health needs, you can ask the insurer to project out-of-pocket costs for services you may need. Soman recommends asking the following questions when considering health plans: Do you have access to free primary care? If not, how much is your copay to see a doctor when you’re sick? What about telemedicine options? What is your prescription medicine benefit? If you focus too much on lower premium costs instead of the overall cost and coverage of a plan, you may end up with higher out-of-pocket costs and more limited coverage. “Choosing skimpy short term or health sharing plans may be cheap in the short-term but carry a big risk if you get ill or are injured,” warns Soman. If the premiums or out-of-pocket max for a better plan are difficult to fit into your budget, you should investigate the Advanced Premium Tax Credit (APTC) and the Cost Sharing Reduction (CSR). The APTC subsidizes monthly premiums based on your projected income for the following year. When you file taxes for that year, the difference between the subsidy you took and the actual subsidy you qualify will be reconciled. “The Cost Sharing Reduction (CSR) also known as ‘extra savings’ means that a family not only qualifies for the tax credit, but if they choose a silver plan will also benefit in lower deductibles, copays, and out-of-pocket maximums,” says Tomasini. To see if you qualify for the APTC or CSR, you can complete this form on HealthCare.gov. Open Enrollment success and clarity It’s complicated. So what? It doesn’t mean you can’t understand health insurance and navigate Open Enrollment successfully. Understanding the processes, terminology, costs, and coverage will help you analyze health plans. The clearer your health needs are to you, the better you’ll be able to identify a health plan that will fit your coverage and financial needs. Doing your research using the help of licensed insurance agents, online reviews and tools, and talking with friends and family will allow you to gather more information from a variety of perspectives. This variety will help counterbalance the shortcomings of relying on one source for information. Ready to find a good health insurance company? See the top carriers in your state. Still need more information on health insurance and Open Enrollment? Check out these articles: 4 Things to Look For in a Health Plan Pitfalls to Avoid During Open Enrollment

Taking care of your physical and mental health can help make life more enjoyable. Now is the time to get prepared and make necessary changes as the season changes to get the most out of fall. Physical health Fitness is an important part of maintaining physical health. But there's more you can do to stay in good physical health, like preventing disease and making necessary adjustments for seasonal changes. Disease prevention Germs spread easily. It's a good idea to take precautions, like washing your hands and getting a flu shot. “Prepare for flu season. According to the CDC, flu season can start as early as October and end as late as May. This means that for more than half of the year, you are at risk. It is recommended that you receive a flu shot sometime in September or October before flu season gets underway. Other measures you can take to protect yourself include washing your hands frequently, eating a healthy diet to boost your immune system, covering coughs and sneezes, and staying away from others who are sick,” says Jack Burke, Community Outreach Coordinator forhims.com. It’s also important to get enough rest and listen to your body. “One main thing to be cautious about during the fall months is to take care of yourself. If you feel an illness coming on, listen to your body and rest as you need to,” cautions Melissa Morris, ACSM certified exercise physiologist and ISSN certified sports nutritionist and writer for Exercise.com. Giving your body what it needs will help keep it in good health and make it easier to recover from illnesses. Seasonal changes and adjustments The transition from fall to summer makes adjustments for cooler and drier weather necessary. “Autumn may not bring the frigid temperatures and harsh weather of winter, but temperatures still dip enough to have an effect on your health. Cold, dry air can cause dry, cracked skin, as well as cold sores,” says Burke. Many people associate the heat of summer with sunscreen, sunburns, and aloe vera. However, it’s not the heat that causes sunburns, it’s the sun. “Even though there is less sun in the fall, you are still at risk from UV rays, so any products should contain SPF,” adds Burke. Seasonal changes can also affect your hair. Alisha Lawson, Product Development Expert for Shiny Leaf, has some tips for keeping your hair and skin healthy. “Protect your hair and skin by using nourishing hair and skin care products. The best products are infused with natural oils like argan oil and castor oil. These oils come from seeds that are rich in essential fatty acids, necessary for maintaining moisture and glow,” she suggests. You should also be prepared to make minor adjustments for your sleeping schedule. “As the seasons change and daylight gets shorter, you may find yourself feeling sleepier than before. This is because your circadian rhythm changes based on your exposure to light, affecting your internal clock. Try giving yourself a little extra sleep, and solidify the habit by going to bed and waking up at the same time each day,” advises Nina LaRosa, Moxie Media Marketing Director. Consistent, regular sleep will help you function better during the day. Just be careful if you’re starting to sleep excessively. “If you find yourself oversleeping, consider talking to a doctor and investing in artificial light sources. You may be one of the many individuals whose moods and energy levels are impacted by the changing seasons,” says LaRosa. Being mindful of how cooler weather can affect you will help your body transition smoothly between the seasons. Mental health  Reema Beri, PhD, licensed clinical psychologist at Great Lakes Psychology Group, identifies three challenges that the transition from summer to fall presents for mental health. The end of summer means shorter days and less sunlight. Fall is prime-time for people to begin to feel "down" or "low" due to our decreased exposure to sunlight. Summer allows us all, no matter where we live, to access the outdoors. Fresh air and sunlight are a great stress relief, and the incoming colder weather begins to limit our outdoor access. Fall represents "back-to-school" time, and back to the routines of school, sports and extracurriculars. It can be a jarring change from the lazy, relaxed, sun-soaked days of summer. For all of these reasons, you may find yourself susceptible to the "fall letdown" which is experienced by many and also completely normal. Being aware of these specific challenges can help you plan ways to meet them and have a smoother transition between summer and fall. Below are three things you can do to boost your mental health during the fall. Spend time outside Reduce stress Practice self-care Spend time outside  Luckily, fall weather is still great for being outdoors in many places. As a bonus, it’s not nearly as hot as the summer months. “Whether it’s going for a walk at lunch or a hike on the weekends, it’s important to go outside and get a daily dose of natural light. Furthermore, you can still exercise outside if you dress to protect against the elements,” advises Burke. Once fall weather begins moving towards winter weather, it can be harder to spend time outside. “If you're missing the sun, try using a sun lamp. These lamps have a light that is comparable to sun rays and even has multiple settings to vary light intensity and color. Sun lamps also emit vitamin D so you can feel like you're sitting outside soaking up some vitamin D from the actual sun.” suggests Renata Trebing, Founder and Recipe developer for Nourish With Renata. Purposefully taking time to connect with nature or just to be outdoors is an important way to take care of your mental health. If you start having bad fall weather or if it’s too cold, a sun lamp can help give you some of the benefits of being outside. Reduce stress  Your stress levels affect your mental health. Whatever is causing the stress, you can take action to reduce your stress by slowing down and making a plan. Even if you’re in a fast-paced environment, you can plan time to take a break and slow down. “De-stress yourself to keep your hormones flowing naturally, supporting your natural rhythms. Try meditating, writing in a gratitude journal, or deep breathing. If you’re traveling, spend some time reconnecting with nature and turn off your electronics,” suggests Anna Cabeca, MD, author of The Hormone Fix. Practicing gratitude and meditation can help you develop a positive outlook on life, which will also support your mental health. “By incorporating meditation into your daily routine and simply sitting in a quiet place, without interruption, and becoming aware, you open yourself to the feeling of love and reflection. Reflect on your day with gratitude and look optimistically toward tomorrow,” says Cabeca. When you have a lot on your plate, it can be overwhelming. Identifying urgent tasks and determining a plan to get them done can help you reduce stress. “At work and at home, if you’re feeling stressed, make sure your space and tasks are organized. Many businesses experience an uptick in work following the summer slowdown, and fewer hours of sunlight at home may make it harder to finish certain chores or projects. Once you have a list of everything you need to do, prioritize what needs to come first to help reduce stress and boost productivity,” LaRosa confirms. Practice self-care  Slowing down and taking time for yourself is an important part of self-care, but it’s not the only thing you can do. You should also be mindful about how you treat yourself. “Be good and kind to yourself, and do not beat yourself up when you suffer, fail, or feel inadequate. Treat yourself the way you would your best friend — speak loving truths to yourself and do some positive coaching,” says Cabeca. Treating yourself kindly will help you feel better. It’s also important to make sure that you’re treating your body well. “Self-care includes developing or maintaining good sleep habits, exercising regularly, and eating wholesome and nutritious foods,” says Beri. And don't underestimate the power of connecting with people and having fun. “Doing things you enjoy, such as seeing and spending time with friends, and taking time out for yourself on a weekly basis, is also essential. Doing all of these things may have felt effortless during the summer months, but moving into fall means actively taking steps to engage in regular self-care. It will take intentional work, but it is doable!” Beri suggests. Being intentional about self-care and taking time to enjoy life will help you have good mental health. Physical and mental health hacks Taking steps to reduce your exposure to germs and getting enough sleep will help keep you well physically. Being intentional about self-care, spending time with people, reducing stress, and going outside will help you maintain good mental health. Looking for more fall health hacks? Check out Fall Health Hacks for Your Nutrition and Fitness.  

Maintaining good health is important year-round. As each season changes, it's a nice opportunity to evaluate your habits and make changes. Because of harvest season, fall is a great time to add more vegetables and fresh fruits to your diet. It's also a good time to prepare for winter fitness and try new fitness routines. The following fall health hacks will help you make this season your fittest yet: Nutrition Our diet fuels our body, so it’s important to make sure that we eat the nutrients our body needs. “Nourish your body. Most of us do not receive nearly enough vitamins and nourishment daily. Choose a diet and lifestyle that promotes a healthy balance and keeps you feeling happy and energetic,” says Anna Cabeca, MD, The Hormone Fix author. Healthy food choices year-round is important, but fall poses some challenges because of the holidays and warm comfort foods many of us enjoy. The following four suggestions can keep your nutition on track as you anticipate the cooler months: 1. Add fresh, seasonal produce One of the biggest advantages of the end of summer and beginning of fall is that it’s harvest season. There are lots of fresh fruits and vegetables to choose from. “Try to incorporate some delicious fall seasonal vegetables into your eating plan like broccoli, beets, bell peppers, cauliflower, sweet potatoes, kale, or green beans. They are full of nutrients, priced well, and tasty when they are in season,” advises Melissa Morris, ACSM certified exercise physiologist and ISSN certified sports nutritionist and writer for Exercise.com. Some of this produce may not be a normal part of your diet. Adjusting recipes and finding new ones is a great way to mix-up your typical diet and get good nutritional value from your meals. “Just like wardrobe selection, your diet changes with season too! Take advantage of the seasonal food choices available during fall. Enjoy delicious recipes with root vegetables like carrots, squash, pumpkin, and sweet potato. A warm soup with vegetables and legumes or grains will comfort you through the cold temperatures. They are healthy and nutritious too!” says Alisha Lawson, Product Development Expert for Shiny Leaf. Grocery shopping has other health advantages, especially if you take advantage of farmers markets.“A great way to maintain health during the fall months is to get out of your house and go to a farmers market. Being outside will give you some much-needed vitamin D and the wide array of seasonal produce will be a great addition to your diet,” says Jamie Bacharach, licensed alternative medicine expert. Taking advantage of farmers markets doesn’t just give you the opportunity to be outside. It also offers safer food choices with health benefits beyond the nutrients in fresh produce. “It's no secret that eating seasonal fruits and vegetables is a great way to stay healthy and have a well-balanced diet. Eating locally grown produce is also a great way to minimize unhealthy pesticides and preservatives that are on many mass-produced produce. It is also a great way of supporting your local farming community. Furthermore, research has found that eating local, naturally farmed foods can help prevent neurodegenerative diseases. This is particularly true regarding berries, which are high in polyphenols — a phytochemical which has been shown to help prevent dementia and Alzheimer's,” adds Bacharach. 2. Find good substitutes to make recipes healthier It’s hard to beat a warm bowl of macaroni and cheese during fall months. No one wants to skip out on mashed potatoes or pie on Thanksgiving either. But, some of these comfort foods are high in fat and sugar. Finding some good substitutes can make your comfort foods healthier while preserving the flavor and taste. “Most fall and winter dishes have a higher caloric intake because of the increased use of cream, butter and sugar. Try to find healthier alternatives for these ingredients, such as greek yogurt, coconut oil, or monkfruit sweetener,” suggests Renata Trebing, a recipe developer. You can also adjust recipes to make them healthier. “There are simple changes that can be made to these comfort fall foods that will help boost their nutrients and reduce their calories. Switching those dense soups for a lighter version that is broth based rather than cream based is a great first step. Choose vegetable loaded soup options over meats. Curb your Halloween sweet tooth with sweet fruits or low sugar baked goods,” recommends Lisa Richards, Nutritionist, The Candida Diet. 3. Make good snack choices Making sure that you eat nutritional meals is a great place to start. It’s also important to make sure that you’re eating good snacks. “If you snack in between meals, start incorporating healthier, more satisfying options, such as fresh fruits, vegetables and low-fat dip, unsalted or lightly salted nuts, or unbuttered popcorn,” suggests Nina LaRosa, Moxie Media Marketing Director. 4. Evaluate your diet Consider the foods you’re eating and decide what things you want to add and what things you want to reduce. Be creative by adding seasonal vegetables and making substitutions for some ingredients. “Channel your inner Marie Kondo and think about your own eating habits and food choices. Do they spark joy? Or do they spark anxiety, misery, or frustration? Choose what you’ll eat, and how much, based on tuning in and listening to what your body needs — what would feel good and spark joy for you? This means you might have to lower the caffeine, sugar, and alcohol intake,” suggests Cabeca. Fitness “Just because the days are getting shorter, it doesn’t mean that we need to change anything about our exercise, nutrition, or mental wellness habits. If you are feeling bored with your exercise routine, mix it up! Try a new fitness class, practice meditation, workout with a friend or partner, sign up for a 5K race, or find a new workout plan,” says Morris. Keep these three tips in mind as you think about exercising and maintaining fitness during the fall season:1. Exercise regularly If you have a gym membership at a fitness center, colder weather is a great time to take advantage of it. If you haven’t found one that you like, it’s a good idea to explore what’s available in your area. You can do this by asking friends for recommendations, researching online, and taking advantage of trials.Fitness classes are also a great option to explore. “Use the colder weather as an opportunity to try some indoor workout classes that you haven't tried before! Indoor rock climbing, boxing, or zumba are great options to add variety into your workout routine,” says Trebing. If you want to attend classes as several different gyms, a ClassPass membership can be helpful. “ClassPass will help people to find dynamic fitness classes that fit their schedule. We now offer classes from over 22,000 studios and gyms in over 20 countries,” suggests Mandy Menaker, Senior PR Manager. If it’s difficult to make it to a gym or class regularly, you can also workout at home. You can buy workout videos yourself or try online classes to get some variety. “YouTube is such a great platform with thousands of workout videos you can easily follow and do at home. Rather than just spending your time watching television the whole day, start with a jumping jack warm up. Once you feel your body is ready, hormones called dopamine are released and pushes you to train more. This is a sneaky way to stay in shape while at home,” says Lawson. 2. Incorporate movement into your day While setting aside time for serious work-outs is an important part of taking care of your body, it’s important to mix-in movement throughout your day as well. “When it’s cold out and you’re spending more time indoors, you may find yourself getting less exercise. It can be easy to fall into a sedentary lifestyle, so make a conscious effort to get up and move around. Consider using a standing desk at work and doing periodic stretches or exercises to get your blood flowing,” suggests LaRosa. Beyond making sure that you have breaks while sitting behind a desk, you can even be creative when setting meetings with clients or colleagues. “Instead of meeting up with your local colleagues at a coffee shop, over a meal or chatting with them on the phone, meet them for a walk so you can catch up while you are getting some exercise, too. You'll feel great after, the time will fly, and it will be a fun activity to share,” says Paige Arnof-Fenn, founder and CEO of Mavens & Moguls. Movement throughout the day can keep you engaged and help break-up your work. For more helpful information about how moving can improve your well-being, check out Fall Health Hacks for Your Physical and Mental Health. 3. Spend time outdoors While fall brings cooler temperatures, it’s not winter yet. It’s still possible to exercise comfortably outdoors. As you start preparing for cold weather, it’s a good idea to make sure that the air in your home is good. “Americans spend the vast majority of their time indoors, never having been educated of the potentially harmful effects that are associated with poor indoor air quality. In fact, what we often come across in our line of work, is a resounding misconception that indoor air quality is vastly superior to outdoor. From worsening of allergies to dry skin and respiratory issues, the hidden affects of a home's indoor air quality are prevalent, says Steve Truett, President of Aire Serv, a Neighborly company. Truett recommends the following to keep the air in your home clean: Change your HVAC filter monthly Regularly dust and vacuum Avoid chemicals use indoors Utilize existing spot ventilation (e.g. bathroom and kitchen vents and fans) Replace or clean your furnace’s air filter every three months Check that your home has good ventilation Run an air cleaner Making sure that the air in your home is high quality will make it a good space to work-out, meditate, and be during cold weather. Trying new workouts, finding time to be outside, and finding ways to fit movement into your normal day activities will help you maintain and even improve your fitness levels. As you prepare for even colder weather and spending more time indoors, be sure that your home has proper ventilation to ensure that you’re breathing clean air. The bottom line Fall brings a lot of great seasonal foods and produce. It’s a great time to improve your diet and nutrition with fresh fruits and vegetables and make recipe adjustments as necessary. If you've worked hard to establish good fitness routines during the spring and summer, don't let all your effort go to waste. It’s still warm enough to spend time outdoors and keep any outdoor exercise habits going. It’s also a good time to start exploring other indoor activities that will help you keep your fitness up.

Updated September 10, 2021. Medicare Open Enrollment for 2022 coverage runs October 15, 2021 to December 7, 2021. It's a good opportunity for people with Original Medicare to evaluate if a Medicare Advantage plan might be better and vice versa. It's also important to double-check your Part D prescription drug coverage for 2022. To make the most of Medicare Annual Enrollment, it’s a good idea to research and prepare. You should also be aware of pitfalls to avoid during the once-per-year enrollment period. Here are five pitfalls that Medicare experts identified: Not looking for changes Not considering other plans Not enrolling in Part D Following ill-advised recommendations Procrastinating Not looking for changes The saying “The more things change, the more things stay the same” does not apply to Medicare plans. When a Medicare plan is changed, the coverage is not the same. Insurance companies make changes to the coverage and costs each of their plans have. Double-checking to make sure your prescriptions are covered is important to do each year. John Hill, Gateway Retirement President“The biggest pitfall is assuming things are the same. Medicare seems to be always changing. The next pitfall is timing, you have from October 15 until December 7 to make your selections for your drug plan or Medicare Advantage plan. If you assume your Medicare Advantage plan or drug coverage is the same, you may be disappointed.” Adam Hyers, Hyers and Associates, Inc“Oftentimes, Part D plans will change their premiums and copays while also moving certain drugs into different (more expensive) tiers or out of formulary altogether. By the time someone might realize this in January, it can be too late to do anything about it. Part D plans are required to send out an ANOC (Annual Notice of Changes) form for all Part D and Medicare Advantage plans, but sometimes they are lost or ignored. Consumers should never assume their drug plan will stay the same year over year. They should contact their agent to make sure or double check their prescriptions using the Plan Finder tool at Medicare.gov. Enrolling the most suitable plan can save people hundreds of dollars or more for the next year.” Danielle R. Plummer, PharmD Consultant Pharmacist“Insurance companies are constantly changing their formularies, so just because a medication was on the lowest tier formulary this year, it may not be the next. If you are not comfortable using the internet, ask for help through local library, insurance brokers, and pharmacies. If a chain pharmacy does not have time to work with you, check with your local independent pharmacies. Insurance contracts also change which pharmacy is their preferred provider year to year, so don't assume that the pharmacy you've been using will still have the lowest copays for your plan. Call your plan to ask which pharmacy is preferred. Also ask about copays at independent pharmacies and mail order options.” Not considering other plans As Medicare health plans change and your health situation changes, it’s important not to assume that your current plan will always be best for you. By considering all your plan options for Medicare Advantage and Part D, you’ll make sure that you’ve got a plan that meets your health and budgetary needs. Kathryn Casna, Eligibility.com“Many plans change each year, so look for your plan's Annual Notice of Change (ANOC) in the mail in October, and make sure the plan still meets your needs. On the flip side, it never hurts to call an agent or run your info through the plan finder at Medicare.gov each year to see if you can get a better plan or a lower price elsewhere.” Not enrolling in Part D Medications and prescriptions are important, especially if you rely on a daily medication. If you don’t currently take medications, it may not make sense to enroll in prescription drug coverage. But, if you eventually do need medication and have not had prescription drug coverage, your costs may be higher down the road. Alex Enabnit, Eligibility.com“If you don’t have drug coverage but anticipate needing it at some point in the future, find a Part D plan during AEP. If you know you’ll never want drug coverage, that’s fine. But if at some point you will, you need to know that Medicare enforces a penalty charge for every month you went without drug coverage. This penalty remains in force, monthly, for the rest of your life. Yes, you read that right. Avoid this pitfall!” Following ill-advised recommendations Lots of people get advice from family members and friends for some major life decisions. While it’s nice to have a good support network, it’s important to realize that everyone’s health and financial situation is different. A plan that worked well for your friend may not be great for you. Kathryn Casna, Eligibility.com“Medicare beneficiaries will get tons of recommendations this season, but unless those recommendations are closely matched to your individual situation, you could be enrolling in the wrong plan. Both of these pitfalls can be side-stepped with a bit of research into the plans that fit your individual needs.” Procrastinating Don’t underestimate how long the underwriting and approval process can take when enrolling in a new Medicare plan. You’ll want to know if your application has been declined with plenty of time to apply for another. Danielle K. Roberts, Boomer Benefits“It’s important to start early. Don’t procrastinate until the end of the enrollment period because both insurance companies and Medicare get swamped with applications. There are longer hold times if you call in with a question. You also need adequate time to research your options so that you are not rushing to choose a plan. Another pitfall can occur if you are wanting to disenroll from a Medicare Advantage plan and return to Original Medicare and add a Medigap plan. In most cases you must answer health questions on the application for Medigap and the insurance company needs to time to decide whether they will accept for decline you. So it’s important that you apply for the Medigap plan first and well in advance of the December 7th deadline. Don’t cancel your Medicare Advantage plan until you have received approval from the Medigap carrier that they are granting you a policy.” Avoiding pitfalls Avoiding these Medicare Annual Enrollment pitfalls will help you find an affordable plan that meets your coverage needs. Reviewing any changes, double-checking prescription coverage and costs, and applying early in the enrollment period will help you decide if it's best to stick to your current plan or make a change.

Updated Septeber 10, 2021. Medicare Open Enrollment is a valuable opportunity to re-evaluate your Medicare plan, review Medicare options, and even find a better plan. The Annual Enrollment Period for coverage during 2022 runs October 15th through December 7th. Preparing for Annual Enrollment can help you take full advantage of this opportunity to make sure that your Medicare plans meet your needs. Here are three things you can do to be ready for this year’s Annual Enrollment Period: Analyze this year’s health costs Do your research Set an appointment with an agent Analyze this year’s health costs “People should prepare for Medicare Annual Enrollment by reviewing their health care utilization this past year and thinking about anticipated utilization and needs for the coming year,” advises Gayle Byck, PhD, Board Certified Patient Advocate, Certified Senior Advisor®, and founder of InTune Health Advocates, LLC. Understanding what you spent on health care this year can help you project costs for next year. As you think about how much your health plan costs, be sure to include the monthly premiums and all out-of-pocket expenses. Out-of-pocket expenses are the costs you paid for prescriptions, doctor visits, and treatment. While you’re evaluating this year’s costs, it’s important to consider how well your current plan met your coverage needs. While it can be less work to stay on the same plan, it’s not worth staying if there are cheaper options that offer better coverage. Byck recommends considering this question as you evaluate your current plan: Does your current plan (A, B, Supplement, and D, or Medicare Advantage) continue to meet your needs and make the most financial sense? As you evaluate the total cost of your plan and other health plans you are considering, include the monthly premiums and all out-of-pocket expenses. It’s important to do this in-depth analysis, especially if you’re considering switching between Original Medicare and a Medicare Advantage plan. While this kind of evaluation can be tedious and time-consuming, it’s worth it. If you’re living on retirement savings, you only have a certain amount that you can spend. It’s important to find the most cost-effective plan with the coverage you need to make your retirement savings last as long as possible. Do your research Medicare Advantage and Medicare Part D (Prescription Drug Plans) change every year. Additionally, companies offer new plans. There are a couple of important things to research about your current plan and for any new plan you consider: Changes New plans Coverage Cost saving resources Changes Make sure you know how your plans are changing by doing your own research. There are several great resources to help you understand how your current plans are changing, like Medicare.gov and Annual Notice of Change (ANOC) letters. Medicare.gov Troy Baccus, Medicare Life Group owner, suggests using Medicare.gov reports to check for changes in your Prescrption Drug Plan (PDP): “The best thing you can do to prepare for AEP is run a new prescription drug plan report on Medicare.gov. You'll want to wait until at least October 1 to run the report and make sure you are running the report for the year 2022 (it may default to the current 2021). Running a prescription drug plan report will help you confirm your current plan is still your best option for 2022. If not, you can usually enroll in the another plan directly from the Medicare.gov website.” Annual Notice Of Change Danielle K. Roberts, Boomer Benefits founder, suggests reading the Annual Notice of Change letter:“Review your Annual Notice of Change letter from your current Part D or Medicare Advantage carrier. You will receive this by mail in September. Look for what is changing that might affect you. Is the premium going up? Have your copays substantially increased? Are they dropping any of your important medications? If you find something you don’t like, then you have an opportunity to make a change during the upcoming OEP that begins on October 15th. Make a list of all your current medications, including dosage and frequency. You can enter these into the Plan Finder Tool on Medicare.gov website beginning in October. This will help you to search for plans that you know will cover your necessary medications.” New plans Because Medicare Advantage plans are privately operated by companies, companies can release new plans every year that can be a better option than your current plan. “New Medicare Advantage plans may be available in 2022 that provide superior coverage to your current plan. The easiest approach to review your Medicare Advantage plan is speaking with an independent agent. Just make sure they've got your best interest in mind and aren't looking to make a quick sale (we recommend checking out their Google reviews, if possible),” suggests Baccus. Coverage Coverage and access to your doctors are some of the most important things you need to double-check for your Medicare plans. To be clear, you can always see any doctor you like, but the cost-sharing available from your plan based on what plans your doctor accepts will affect how high your health care expenses are. “Reviewing your plan every AEP is important. Not only will you want to make sure your current plan will remain your best option for prescription coverage in 2022, but you'll also want to confirm your doctor will remain in network,” says Baccus. When checking your coverage, it’s a good idea to do your own research instead of relying on third-party information. “Please do not take a salesperson’s word for your network coverage, call your providers and ask – “will you be taking this specific plan next year?” Why specific? Because some companies have multiple plans, and your provider may not take them all. Going to medicare.gov is a safe recourse to get the facts,” recommends John Hill, President of Gateway Retirement. Cost saving resources Each state has federally funded programs to help people pay their Medicare premiums, typically for Original Medicare. If you qualify and apply, you may be eligible to participate in some of these Medicare Savings Programs. “During enrollment, be sure to look into the various savings programs available that can help pay for premiums, out-of-pocket costs, prescription costs and more. There are a number of services available and utilizing them can help you save money,” suggests Michael Stahl, HealthMarkets Executive Vice President and Chief Marketing Officer. Set an appointment with an agent If you’re new to Medicare or want help evaluating plans, meeting with an independent agent can be a smart move. “I always stress the importance of sitting down with a licensed, non-biased insurance agent who can provide information on Medicare, what is or is not covered, and pricing so you can be informed when it comes time to make decisions during enrollment and choosing your Medicare provider(s),” says Stahl. While experienced and knowledgeable agents can offer valuable insight and assistance with Medicare plans, it’s important to find a trustworthy one. “Seniors should find a solid broker with a consistent track record of providing value in the senior community and giving unbiased advice,” says Christopher Westfall, Sr, Senior Savings Network founder. Looking at client reviews and taking recommendations from friends can help you find a reliable agent. Beyond considering reviews, Medicare has rules regarding what insurance agents selling Medicare can and can't do when working with clients. Understanding these can help you identify good agents. Knowing that you’re getting good advice can be difficult to determine, especially if you’re not familiar with Medicare. If you want to be an informed decision-maker, it’s worthwhile to do your own research. “Do your own research rather than only relying on information from insurance agents. There are quality rating systems online and free resources from your state’s Senior Health Insurance Program,” advises Byck. Preparing for Medicare Annual Enrollment Understanding your health care expenses and coverage levels from this year will help you forecast costs for next year. It will also help you determine if it’s best to stick to your current plan or if another Medicare plan would be better. It’s also essential to be aware of any changes to current plans for next year. Knowing these changes will also help ensure that you enroll in the coverage you need in 2022. Working with a good agent can also help you understand your options and make an informed choice. Even working with an agent, do your own research so that you can ask these important questions and get the information you need to make the best choice for your health plan.

Guest Post by Danielle K. Roberts When your Medicare benefits begin, your Part B effective date kicks off a 6-month open enrollment window during which new Medicare beneficiaries can enroll in any Medigap plan with no health questions asked. However, once that window has passed, changing plans will require underwriting in most states. We often get asked about what this underwriting entails. Here’s what you need to know: It starts with your application Medigap applications come with a page of health questions which you must answer if you are not in your open enrollment period or a guaranteed issue period after rolling off employer insurance. In most instances, the insurance carrier wants you to be able to answer “no” to all the health questions. Some insurance companies won’t allow any “yes” answers at all and instruct the agent to automatically decline the application if the applicant answers yes to any questions. While chronic conditions like COPD or congestive heart failure will often cause an automatic decline, other things won’t necessarily be a problem. For instance, if you take a few routine medications, such as a blood pressure medication or a thyroid medication, these are often not a problem if they aren’t part of treating a larger health condition. On the flip side of that, just because you answer “no” to all of the health questions doesn’t mean you will be approved. This is just the first step that qualifies your entry into the underwriting process. Ultimately, the underwriter at the insurance company will decide whether to approve you after reviewing your application and medical records they can find. Medical questions vary by company, so if you can’t pass one carrier’s health questions, your agent may know of another carrier that has different questions. He or she may suggest that you apply there instead to give you the best chance of being approved. You can find some examples of underwriting questions here. Apply after any pending medical appointments When applying for a Medigap plan, you should do so after you have completed any pending medical procedures, surgeries, or follow-ups. Something as small as one last pending physical therapy session after a surgery that occurred months ago can cause a decline. If you have any kind of medical follow-up appointment on your calendar, get that done first and then apply for your Medigap plan afterward. Your prescriptions matter Underwriters have access to systems that will pull up records of any prescriptions that you have been prescribed over the last several years. For this reason, it is very important to be honest on your application and list all of the medications that you are taking or have taken recently (if the application asks for that). Medigap insurance companies also publish Underwriting Guidelines for agents that list all of the medications that will cause an automatic decline. Certain medications indicate that you have an underlying health condition, so if you take one of these medications, you are not eligible for coverage. Important tip: The underwriter can usually find records of any medication that has been prescribed to you even if you no longer take the medication. Often, we see problems occur when a client goes into their doctor about an issue, and the doctor prescribes a medication. The client thinks “I don’t need that,” and they never take the medication. Just because you choose not to fill the prescription doesn’t mean it’s not in your records. For example, if you mention feeling a bit foggy to your doctor and he prescribes Namenda for memory loss, you will run into a problem. This drug is associated with Alzheimer’s disease and dementia and will cause an automatic decline in most instances. If your doctor talks to you about a medication that you think you don’t need, tell the doctor NOT to prescribe it. This will help to prevent it from getting on your prescription history. Don’t overshare When the underwriter calls you to ask health questions, don’t share anything more than what they ask. Give yes or no answers whenever possible. When you volunteer information, that can sometimes lead you down a rabbit hole that you don’t want to go into. Sometimes applicants want to share that they have recently lost a bunch of weight or they were able to drop all their diabetes medications. While you may view this as positive, underwriters are sometimes wary of recent changes like this as they want you to have had enough time to stabilize on those medications. Going into any application knowing these things about the underwriting process should help both you and your agent to decide whether it makes sense to try applying with a new Medigap company. Danielle K. Roberts is a Medicare insurance expert and co-founder at Boomer Benefits where she and her team help thousands of beneficiaries navigate their Medicare decisions every year.

Health insurance is an important way to get the health care you need while protecting your finances from large medical costs. It's also important to find a health plan that fits into your budget from a trustworthy insurer. However, not all health plans are equally beneficial. So, how do you know if you have a good plan? There are four essential things to look at when evaluating your health insurance options: Coverage Health services costs Prescription costs Premiums Analyzing these four aspects will help you understand how good your health plan is and its overall affordability. Coverage The most essential part of your health plan is what it covers. If there are medical services or prescriptions that you know you will need, check to make sure that the health plans you’re looking at covers those. Health insurance plans on the Health Insurance Marketplace (on-exchange plans) cover the Essential Benefits outlined in the Affordable Care Act. Off-exchange plans offered by private insurers also meet these guidelines. Essential benefits include preventive care services like your annual physical, certain prescriptions and vaccinations, and care for pregnant women, children, and infants. Plans that are not compliant with the Affordable Care Act may not cover all of the essential health benefits. These include short term health plans and indemnity plans. It’s especially important to carefully review the coverage on these plans before choosing one. Some plans may also cover medical devices like crutches and blood sugar monitors. Coverage rules can vary by plan, so check your plan to learn more about what's covered.  Coverage also goes beyond covered services and medical devices. It includes the network of doctors and specialists included with your health plan. If you already have doctors that you like or prescriptions you require, it’s worth checking to make sure they would be covered under any new plan you’d choose. When it comes to networks, some plans only offer in-network coverage. Other plans offer in- and out-of-network coverage, though the cost-sharing rules may put a higher burden on policyholders for out-of-network services. Emergency services are always covered, regardless of where they were received. Keep in mind that health insurance companies have negotiated discounted rates with in-network providers, which makes visiting those providers cheaper for them. Since they do not have discounted rates from out-of-network providers, it's more expensive for the company when you receive out-of-network care. The company passes some of this expense on to you by charging higher rates in these cases. Questions to ask yourself What health services do my family and I need? Are there procedures or surgeries that my family and I will need in the next year? What medications, medical devices, and prescriptions do my family and I need? Know the answers to these questions before shopping for health insurance. This will help you quickly eliminate plans that won’t meet your health needs. Health services costs Many people assume that the monthly premiums reflect the full cost of the insurance plan. While premiums are the most frequently occurring cost for a health plan, the full cost also includes the cost-sharing burden on the policyholder. Each health insurance plan has its own cost-sharing rules, so be sure to look at how much the health insurance plan covers for different medical services. This will be listed in your plan’s Schedule of Benefits. Depending on your plan’s cost-sharing rules, you may be responsible for a portion of the cost of the medical services you receive. This is in addition to the monthly premiums. Fortunately, there are annual caps on how much you’ll have to pay for cost-sharing expenses. These are called the deductible and out-of-pocket limits. The deductible is the amount you must pay for your health expenses yourself before the insurance company will start paying some of the costs. Don’t worry — many health plans cover preventive services fully, at no cost to you. Health insurance also gives you access to discounted, negotiated rates from health care providers in your plan’s network. These discounted rates are advantageous, even when additional coverage and cost-sharing is delayed. The out-of-pocket maximum is the total amount you’d have to pay for health care costs for the year. Once it’s met, your insurance company will pay fully for covered services, other than your monthly premium. The deductible is often lower than the out-of-pocket max for this reason. Copays and coinsurance count towards your deductible and out-of-pocket maximum. Look at how high the deductible and out-of-pocket limits are for each health plan you consider. Compare the deductible and out-of-pocket limits across plans. It can also be useful to look at differences in copays and coinsurance. Copays are a set amount that you pay when you receive medical services. Coinsurance is a set percentage of the cost of services that the policyholder is responsible for. Coinsurance can be trickier to estimate because it depends on the negotiated price the insurance company has with the doctor. Questions to ask yourself What would the health services my family and I need cost under each health plan? (General information about these costs is available in each plan’s Schedule of Benefits. For specific pricing and cost information for your current providers, you can contact the insurance company directly.) Which plan has the best cost-sharing for specialist visits and urgent care clinics? Which plan has the best overall cost-sharing for the health services my family and I need? Prescription costs The cost sharing methods for prescriptions varies based on what tier the prescription falls under. Depending on the plan, you’ll either pay copays or coinsurance on prescriptions. Some health insurance plans may have different deductibles and out-of-pocket limits for medications than for other health services. Once these are met, the insurance kicks in at a higher level. Questions to ask yourself What tiers are my family’s and my prescriptions in? What would the regular prescriptions that my family and I need cost? (General information about these costs is also available in each plan’s Schedule of Benefits. For specific pricing and cost information for your current providers, you can contact the insurance company directly.) Premiums While the monthly premiums do not reflect the full cost of a health plan, they still contribute to the total cost of the plan and you need to make sure that they fit into your monthly budget. Look at a few health plans to get a better sense of what current premium rates are in your area. You can also check to see if you qualify for a government subsidy that can make premiums for an on-exchange plan more affordable for you. Questions to ask yourself What is the most I want to spend on health care next year? (Take the overall cost into account.) What is the most I can comfortably spend on premiums? What would I ideally spend on premiums? Answering these questions will help you narrow down your options further and choose the most affordable plan for your situation. Affordable health care Fully evaluating your health insurance plan before enrolling will help you make an informed decision. Understanding the details of each health plan will help you find one that covers the medical services you need. Looking at the deductible, out-of-pocket max, and cost-sharing amounts will give you a sense of what you’ll spend on medical care and medications in addition to the monthly premium. Working with the insurance company to get pricing on what different medical services and prescriptions would cost with a certain policy will help you understand the total cost of the plan in more detail. Analyzing your budget, premium rates, cost-sharing expenses, and coverage are key to finding affordable health care. Oscar Health Insurance and "GAUZE: Unraveling Global Healthcare" executive producer and director Suzanne Garber consulted on this article. Need more health insurance enrollment tips? 4 Ways to Prepare for Open Enrollment Pitfalls to Avoid During Open Enrollment 5 Questions to Ask About Special Enrollment Periods