Four weeks remain in insurance open enrollment

Written by on November 18, 2019

The open enrollment period for obtaining health insurance through the Health Insurance Marketplace is underway, and the deadline for signing up for a plan this year is Sunday, Dec. 15.

The enrollment period, which was cut in half last year, began again Nov. 1 this year, so Americans have just less than four more weeks to find insurance. For those eligible for Medicare, the open enrollment period ends Dec. 7 — meaning this is the time of year that New Mexicans with continuing coverage must make any desired changes to their insurance plans, and those who need to buy new insurance need to visit bewellnm.com to shop for a plan. To find out if you qualify for Medicaid benefits, visit www.yes.state.nm.us. 

Individuals who lose their insurance due to a “life event” — like a change in job or income — are able to sign up for Marketplace insurance or Medicaid outside of the open enrollment period through a 60-day waiver, but for everyone else, this is the only time of year to obtain health insurance. 

For many New Mexicans, navigating the Health Insurance Marketplace can be a dizzying experience, and this year many people are finding that their premiums have gone up. An individual who last year paid a $135-per-month premium for a health insurance plan may find, depending on his or her particular circumstance, that a comparable plan — identical plans aren’t necessarily available from year to year — will cost about $100 more per month this year. 

The higher premium costs are still offset by a healthy tax subsidy based on your projected income, and there is no longer a tax penalty for not carrying insurance.  

According to U.S. Rep. Xochitl Torres Small, increased premium costs are due to the prevalence of so-called “junk plans” flooding the Marketplace — health insurance plans that don’t offer much coverage and have high copays and deductibles.  

“We need to stabilize the Affordable Care Act,” she said. “Allowing junk plans to be on the market, that don’t actually cover preconditions and do all the things they say, to compete with the plans that provide full coverage — that’s driving up costs.” 

Torres Small said she is working to help right the “Obamacare” ship before it capsizes. 

“We’ve passed legislation that gets rid of junk plans in the House that hasn’t been taken up by the Senate,” she said. “It’s over-politicizing a problem we all need to see fixed.”

A good source for information about Medicare is the Social Security Administration website, at www.ssa.gov/benefits/medicare. If you’re about to turn 65, you should sign up for Medicare as soon as you’re eligible in order to avoid a late enrollment penalty. 

For many Medicare recipients, finding a plan that covers all of their prescriptions is difficult. Janice Miller, a disabled woman from Hurley, said the government “needs to change it, so Medicare can accept my prescriptions — so my insurance will allow me to get all my prescriptions.” 

Miller currently pays out-of-pocket for many of her prescriptions, a situation that many Medicare recipients will sympathize with — and at a time when prescription drug prices are soaring for all Americans, regardless of the type of health care coverage they have. 

Marilyn Alcorn of Silver City — a retired teacher who opted to use the insurance available to her as a veteran, despite the U.S. Department of Veterans Affairs being “difficult to deal with” — said her husband’s prescription drug costs under Medicare Part D were set to double this coming year. 

“He’s now looking for supplemental insurance,” she said, “and we’ve got three different major health care situations going on in our family. Every year at this time, you’ve got to become an expert in health insurance!” 

Torres Small said that bringing down prescription drug prices and making them more affordable under Medicare is something the House of Representatives is working on. 

“The House has already passed legislation to end some of the dangerous practices where patents for the exclusive rights for drugs are extended — which makes them much more expensive,” she said. “We’re working on new legislation that would allow Medicare to negotiate for some of the most expensive drugs. We are one of the biggest purchasers for prescription drugs — we should be able to negotiate a fair price for them.”

Alcorn thinks the country needs to move toward a single-payer system, which would eliminate the byzantine system of plans and rules — and serious gaps in coverage — that have become a fact of daily American life. 

“People shouldn’t work their whole lives, and then have to spend all their money on their health care when they get older,” she said. 

Alcorn’s adult son, Justin, agreed. Because he receives disability benefits through the Social Security Administration, he qualifies for Medicare, though he is far shy of the 65 years of age usually required to receive Medicare coverage. His gaps in coverage, however, are significant, and he thanked Hidalgo Medical Services in Silver City for filling in some of the holes in his health insurance. 

“Thanks to HMS for their dental department,” Justin said, adding that he doesn’t qualify for any vision care, under any circumstances, because his disability disqualifies him from receiving Medicaid — which would provide both vision and dental benefits, along with rock-bottom costs for everything else. For now, under his Medicare coverage, he said he pays 80 percent of the cost “for most hospital stuff.”

While New Mexicans can go directly to bewellnm.com or call 833-862-3935 for assistance in navigating the Marketplace, the aforementioned Hidalgo Medical Services also offers year-round assistance to those in need of health care. Not only do they have a sliding scale — for doctor and specialist visits as well as for dental visits — for those individuals with incomes below the federal poverty level guidelines, they also provide help for people who feel overwhelmed at the prospect of navigating the Health Insurance Marketplace on their own. 

“I did three today already,” said Yvonne Gomez, an outreach and enrollment specialist in the Family Support Services Department in Silver City. Gomez said many of the individuals or families she is helping to sign up for health care coverage this year are finding that their premium costs have gone up. “For some, the premium plan price has nearly doubled, but it’s different for everyone. The plans change from year to year.”

For enrollment help from HMS, appointments are necessary, and you should plan on spending up to two hours on the process. Call 888-271-3596 for more information. Providing documentation — tax returns, pay stubs, etc. — comes later in the process, after you have signed up and chosen insurance. As long as you know what your annual income is likely to be in 2020, Gomez or bewellnm can help you. The sign-up process through bewellnm.com may take more like an hour, but lacks the in-person assistance. 

Finally, for all types of health insurance needs, some might consider consulting a health insurance broker, like Silver City’s Tom Blanchard. Health insurance brokers deal with nearly all of the complexities involved in buying health insurance, or changing insurance, and can give more personalized advice based on an individual’s needs. 

Most plans purchased during the open enrollment period will begin coverage Jan. 1. 

Geoffrey Plant may be reached at geoff@scdaily press.com.

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