Are you enrolled in a health insurance plan?

Individual open enrollment for 2019 health insurance is November 1 through December 15. Here are a few tips from  director of health and benefits Justin Kulhanek of Fortiphi Insurance:

Individual open enrollment occurs once per year. Individuals (for those who previously missed open enrollment) can either apply for a new policy or change plan benefits on an existing policy.

There are two options to buy individual plans – either directly through a carrier, or through Washington Healthplanfinder,  where you can potentially qualify for a premium subsidy or tax credits based on household income.

With different plan and carrier changes and average rates going up 14 percent this year, it will be important to understand how to appropriately renew your policy and to know how to check if you qualify for premium subsidies. There are still competitive plans to be found, but you have to get your elections in by the December 15. The individual mandate is going away January 2019, so that means no tax penalty for not having a plan.

Medicare open enrollment is October 15 through December 7. It’s the same basic enrollment concept as the individual market. This will be for anyone looking to make changes to their existing  medicare plan or for those who missed their initial enrollment during the previous year. To preface, and this is very important, you are required to have Part B in hand prior to enrolling in any MedAdvantage or Medigap plan.

Medicare plans can be purchased two different ways – Medadvantage (menu-style purchasing through a private carrier like Kaiser Permanente or Premera – physician, hospital and prescription all-inclusive.) This is an easy and economical way to procure a solid benefit. Average prices range from $50-$100. They look and feel pretty close to a private medical or group policy with copays and an out of pocket maximum.

Then you have Medigap – I like to refer to them as your “alphabet soup” plans, so Plans F, G, N and Part D, for example. Medigap plans will cost a bit more, but they cover just about 100 percent of what original Medicare doesn’t – you then pair that with a stand alone Part D (for prescriptions). All in, you are looking at about $200 to $230 a month for premiums, but it is truly amazing coverage.

For anyone who has a group benefits plan available, you should be very thankful and appreciative. They typically have lower deductibles and out of pocket maximums than individual and exempt plans and provide financial security and stability in the event of a catastrophic event. Also, in most cases, they’ll have great upfront benefits for office visits and pharmacy and even 100 percent wellness coverage.

Providing group coverage is becoming increasingly affordable for a lot of small business owners. In the past, tons of small business owners provided a COLA as a private alternative for their employees, but they simply couldn’t keep up with inflation as individual rates continued to rise by double digits each year. We’ve seen a shift within the last year with the stabilization of small group market coupled with the new tax incentives for employers who offer plans. It’s a favorable time to consider a small group plan here in Whatcom County.

Speaking of group benefits, we’ve been having a lot of discussions with employers regarding disability insurance, also known as income replacement. To some extent, group disability has really been a lost leader for ancillary group benefits. We always think about insuring our health, life, auto and homes, but it can be easy to forget about your income.

Whether it’s the recent medical or dental school graduate with tremendous debt, single income earner or newly married couple, accidents/disabilities do not discriminate. In fact, unexpected disabilities resulting in the inability to return to work are the leading cause for bankruptcies in America, and yet most employers report they do not offer an employer paid or voluntary group disability plan.

While social security disability may be available, it can be extremely challenging to qualify for benefits and the process of obtaining benefits can take months or even years. That’s in part because social security benefits are based on an “any occupation” definition of disability. This means that you must be able to prove that you are unable to work in any occupation for which you are otherwise qualified by your education and experience.

Courtesy of Justin Kulhanek  at Fortiphi. To learn more, visit or 360/424-5507.

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