Getting your Trinity Audio player ready...

By Kirk Lyman-Barner

The Covid pandemic taught us about the importance of having health insurance.  Our prayers go out to everyone impacted by these challenging times.

It was inevitable that insurance carriers and providers would make adjustments and it is necessary to understand how these adjustments will impact your options.

Under 65 Plans

For under 65, the Marketplace Open Enrollment will occur from November 1 through January 15th.  It is important to sign up before December 15^th for a January 1^st start date. If you sign on December 16^th through January 15^th, you will have a February 1^st start date.

There is good news.  More carriers coming into Georgia which will create more competition. Sumter County will have access to Ambetter, Alliant and Aetna which will be branded as Coventry.

Look for the best coverage, the best network, the best customer service and then look at cost.

Ambetter has grown to the be the leader in Marketplace plans.  Phoebe Sumter Hospital and Phoebe Physicians will all be in-network.  This is critical as the HMO (Health Maintenance Plans) will cover care.  Out of Network care will not be covered unless it is for an emergency.

Aetna/Coventry is a known brand, but the filed with the insurance commissioners pricing that is higher than Ambetter.

Alliant is still developing as a local carrier.  The offer at PPO (Preferred Provider Organization) that will cover out of network coverage, but it comes with a higher deductible and cost sharing arrangement.

The 2022 rates are now posted on Healthcare.gov and our software allows us to search all options for existing clients and folks shopping.

Some plans offer dental and vision, but it is often a mistake to pay extra for those benefits. Sumter County does not have many dentist who accept Marketplace plans.  Most come with long waiting periods for major work so we encourage folks to purchase a separate dental plan that they will keep as opposed to changing each year. Moving from one plan to another resets the long waiting periods. Once you meet your waiting periods, you are done for the life of the plan.

Life insurance has become a hot topic due to the pandemic.  Guaranteed issue plans often have a two year waiting period, so look for alternatives.  Talk with a trusted insurance agent about what you are trying to cover, basic funeral costs, income replacement, to pay off a mortgage for your house, or put the children through college. Once your needs are met, there are many good options.

Over 65 Medicare Plans

You are the most marketed group of all the insurance programs. This creates great confusion.  A well trained and experience agent can help you separate and clarify the options.

Medicare’s AEP takes place annually from October 15 through December 7. During these couple of months, you can change your Medicare Advantage or Med picare Partoff D plans.

Traditional Medicare with a Medicare Supplement and a Prescription Drug plan offers the most comprehensive coverage which is important to folks with pre-existing health issues. It is often more expensive and if you our outside the guaranteed issue period, supplement plans can be medically underwritten which is difficult for folks with pre-existing health issues.

Medicare Advantage plans shift the coverage from Medicare to insurance carriers.  The often advertise a lot of whistles and bells such as dental, vision, hearing aids, Silver Sneakers and sometimes over the counter meds or food assistance.  There are also programs that offer to reimburse you for your Medicare Part B cost which is averaging about $149 per month.   These plans are good, but they cost shift a lot of your care to you.  The whistles and bells are often reimbursement plans.  For example if you get a pair of glasses or have a dental implant done, you have to pay for it up front and then submit the bills to the carrier to get reimbursed up to their allowable limits.

For Sumter County residents there are important changes that you need to be aware of. Silverscript/CVS plans need to know that CVS bought Aetna.  This means that their pharmacy pricing favors CVS Pharmacies over independent providers such as the Clinic Drug Store and Doctor’s Pharmacy. We are advocating for a change in this position. Generations of clients of the independent pharmacies have been served well by the local experts in care. We want folks to get the individualized care provided by our local prescription care experts.  We understand the capitalism drive to push folks to utilize CVS, but it is simply wrong to cut out our trusted providers.

Another big concern for our Medicare clients is that Phoebe Sumter and Phoebe Physicians have only negotiated in-network coverage with Aetna and Clover Health (a new option in the local market).

This is extremely concerning for those who have Humana and United Healthcare plans. Some of the plan still are in-network such as Humana’s PPO and the Medicaid Dual Eligible United Healthcare Planw.

There has never been a more important time to review your current plan.  Seek out a well trained agent to help you with a review.