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HealthPlanning Analysis and Enrollment Overview

Glossary:

Jump to: Understanding Your HealthPlanning Analysis for Medicare

Jump to: Understanding Your HealthPlanning Analysis for The Marketplace

Jump to: How to Enroll in the Marketplace

Understanding Your HealthPlanning Analysis

It’s time to celebrate: you got your customized HealthPlanning Analysis! 🎉

But now that you have it in front of you, you might need help digesting all the information presented within it. This guide will walk you through the different sections, what they mean, and how to interpret the data shown.

HealthPlanning Analyses for Medicare Coverage:

Front Page

This page shows your basic information and the date of your HealthPlanning Analysis. This front page also has a glossary to make it easy to find specific sections of the HealthPlanning Analysis.

Overview

The overview shows the information you provided during the HealthPlanning Analysis process. It summarizes how many medications you use, how much you currently spend on healthcare, and any health conditions, upcoming procedures, or new treatments you listed.

You’ll also see a link to a more detailed report of your current healthcare expenses. If you click the hyperlinked text after “For clients:” you’ll be taken to your HealthPlanner dashboard where you can view your Healthcare Financial Summary.

This section breaks down your current healthcare expenses based on the information you provided. It will show how many health coverage plans your household is currently enrolled in, how much you spend on premiums each year, your financial exposure per year, your current overall healthcare expenditure, whether or not you have medical tax deductions available and how much, and your Health Savings Account (HSA) information (and associated tax savings!) if you have an HSA. Next to each of these components of the Healthcare Financials section is a question mark you can hover over to learn more about the component you’re looking at. For example, if you were to hover over the question mark next to “Financial Exposure”, it would tell you this is the maximum amount you could pay in a year in out-of-pocket costs on your current health coverage plan/s.

Summary Comparison Chart

Based on the information you provided in your profile, these are the health plans found that best fit your needs shown in the Summary Comparison Chart. You’ll also see your current health plan in the comparison. In this section, you can see the different costs between each of these plans to help you determine which (if any) you’d like to enroll in. This chart isn’t a recommendation of which plan to enroll in, but rather an example baseline comparison of an option available in the market and a direct comparison to what you’re paying now.

You’ll also have a section showing your Part A & Part B enrollment status.

Deciding On Your Coverage

This section details key information that will help inform your healthcare coverage decision.

Important Dates

This section shows the different enrollment periods you’ll want to keep in mind based on the type of healthcare coverage you’re looking at and the personal information you provided during the HealthPlanning Analysis process. This part is especially important as it sets key dates by which you’ll need to make a decision about your coverage! It relies on any information that you’ve provided in your profile, such as a target retirement or moving date.

Cost Preference

This section is a breakdown of how the different premium prices will affect the overall performance of the insurance plan. If a plan has lower premiums, the actual protection (how much medical care they’ll cover) given by the plan is usually lower than the plans with higher premiums. When you choose a plan with a lower monthly premium, you’re choosing to potentially pay more in out-of-pocket costs, and vice versa for higher monthly premiums.

Understanding IRMAA

This section explains what IRMAA (Income Related Monthly Adjusted Amount) is, and shows what you would pay per month on Medicare Part B and Medicare Part D. Simply find the row that lists your MAGI (IRMAA is based on your MAGI from two years prior) to see what your costs/surcharges for Medicare Part B and Medicare Part D would be. For example, if your MAGI two years ago was $92,000, you would look in the second row for your Part B and Part D costs/surcharges.

Below this chart, you’ll see a detailed comparison between Original Medicare and Medicare Advantage. This chart shows the differences and similarities between the two Medicare options. This is important as it can be challenging to reverse this decision once it’s been made.

OPTION 1: Choosing Original Medicare

This section explains that if you choose Original Medicare you’ll be automatically enrolled in Medicare Parts A and B, but you can choose which Medigap plan you’d like and which Part D plan you’d like. We’ll look at Medigap first.

Adding Supplemental (“Medigap”) Coverage

This section contains a chart explaining what Original Medicare doesn’t cover and how various Medigap plans fill in those gaps. The plans shown are based on the zip code you provided. You’ll also see at least one Medigap plan highlighted. Any highlighted Medigap plans are highlighted because they align well with the preferences you listed during the HealthPlanning Analysis process.

Snapshot of Medigap Plans Available

The above chart showed you the different “types” of Medigap plans available. Within each of those types though are specific carriers with their own costs. In the example of the snapshot below, you’ll see how Plan Gs can differ based on who the insurance carrier is.

Adding Prescription Drug “Part D” Coverage

This section contains a summary of how many Part D plans are available in your zip code, as well as a snapshot of the ideal Part D plans for you based on the information you provided in your profile. If you have 23 plans to choose from, you can select any of them, but the snapshot shows the plans that best fit your prescription list and noted pharmacy. The snapshot is also broken down by the overall cost-effectiveness of the drug plan (premium, deductibles, pharmacy network, coverage of medications, combined copays). The first column will always outline the plan with the lowest overall costs for a given year.

OPTION 2: Choosing Medicare Advantage

This section explains that if you choose Medicare Advantage, you get an “all-in-one” solution for Medicare, as opposed to Original Medicare. It will show the total number of plans available in your zip code.

Snapshot of Medicare Advantage Plans Available

This chart shows a side-by-side comparison of the optimal Medicare Advantage plan options available to you. These plans are being highlighted because they match well with the preferences you listed on your profile. The plans will also have short descriptions above them to further explain the ins and outs of each plan.

And that’s it! If you still have questions about your HealthPlanning Analysis after reading this guide, please don’t hesitate to reach out to us via the Inbox in your HealthPlanner account.

HealthPlanning Analyses for Marketplace Coverage:

Front Page

This page shows your basic information and the date of your HealthPlanning Analysis. This front page also has a glossary to make it easy to find specific sections of the HealthPlanning Analysis.

Overview

This section breaks down your current healthcare expenses based on the information you provided. It will show how many health coverage plans your household is currently enrolled in, how much you spend on premiums each year, your financial exposure per year, your current overall healthcare expenditure, whether or not you have medical tax deductions available and how much, and your Health Savings Account (HSA) information (and associated tax savings!) if you have an HSA. Next to each of these components of the Healthcare Financials section is a question mark you can hover over to learn more about the component you’re looking at. For example, if you were to hover over the question mark next to “Financial Exposure”, it would tell you this is the max amount you could pay in a year in out-of-pocket costs on your current health coverage plan/s.

Summary Comparison Chart

Based on the information you provided, this is the health plan (or health plans) found that best fits your needs. You’ll also see your current health plan in the comparison. In this section, you can see the different costs between each of these plans to help you determine which (if any) you’d like to enroll in.

Deciding On Your Coverage

This section details key information that will help inform your healthcare coverage decision.

Important Dates

Adding ACA Marketplace Coverage

This section gives you important information about the plan options you’ll review and if you qualify for any Premium Tax Credits. Premium Tax Credits are applied to your monthly premium amount, which lowers your out-of-pocket cost for the health plan’s premium.

Cost Preference

This section shows a breakdown of how monthly premiums affect the overall performance of an insurance plan. If a plan has lower premiums, the actual protection (how much medical care they’ll cover) given by the plan is usually lower than the plans with higher premiums. When you choose a plan with a lower monthly premium, you’re choosing to potentially pay more in out-of-pocket costs, and vice versa for higher monthly premiums.

Snapshot of Available Plans

Your chart will highlight the plans that align best with the preferences you listed during the HealthPlanning Analysis process. This chart will also show which “metal tier” the plan is. In the Marketplace, plan types are categorized in “metal tiers”: bronze, silver, gold, and platinum. Bronze is the lowest cost but isn’t considered as “high quality” as the metal tiers above it, and platinum costs the most but has the “highest quality.”Platinum plans are not always a metal tier available in every location.

Plan Option Details

The first part of the chart shows side-by-side comparisons of each plan’s costs, a link to its summary of benefits, metal tier, plan type, and star rating.

The next part of the chart shows whether or not your preferred pharmacy and doctors are in-network. Below that is how each plan aligns with the preferences you listed. For example, if you want to be able to see a specialist without a referral, there will be a row that shows you whether or not each plan meets that preference.

And that’s it! If you still have questions about your HealthPlanning Analysis after reading this guide, please don’t hesitate to reach out to us via the Inbox in your HealthPlanner account.

How to Enroll in Medicare

If you’re receiving Social Security benefits before your turn 65, enrolling in Medicare will automatically be done for you. For everyone else, you’ll want to follow the steps in this guide. Three months before your 65th birthday, you should receive some form of communication from the Social Security Administration in the mail confirming that you have worked for at least 40 quarters within the United States and have paid into Social Security for each of those quarters. This is also your confirmation that you qualify for Premium-Free Medicare Part A. Attached to this letter should be a return letter with a choice for you to select how you want to pay for Medicare Part B (auto-deduction from Social Security or billed monthly).

If you are one of the people who didn’t automatically get enrolled in Medicare, the process is still quite simple. You will need to visit ssa.gov or call the Office of Social Security at 1-800-772-1213 to begin your enrollment process. There can be very long wait times on the phone with Social Security, so the quickest way to complete the enrollment is online at their website.

Once you enter the website, the front page will greet you with this:

From here, you can check pretty much everything regarding your enrollment status.

When you are initially applying, click “Sign up for Medicare.” It will take you to this page.

Once there, click on “Start application” which will take you to a form where you will fill out information regarding your income, date of birth, address, marital status, and more to make sure you qualify for Medicare.

You will need to click the “I understand and agree to the above statements.” Then hit next and away you go! From this point forward, everything is very straightforward and coached.

Once you have completed the online form, you will have an online account for Social Security. You can check on your application status at any time by going here and signing in. If you are someone who was or is active in the military, you can also sign in with ID.me and if you are a government worker, you can sign in with login.gov just as easily.

It can take weeks or even months for your status to be recognized by Social Security and Medicare, so be patient with this process. Your enrollment period begins three months before your 65th birthday, and we would advise you to start the process as early as possible so that you’re able to gain access to Medicare benefits as soon as the start of the month you turn 65.

Once you have Medicare Part A and Part B, you can add additional coverage through either Medigap (Medicare Supplement) or Medicare Advantage (Part C). If you choose to enroll in additional coverage through Medigap, you will also need to enroll in a Part D plan.

Learn more about enrolling into Medicare via the Caribou Learn Center Articles where you can find other helpful information about a wide array of healthcare topics.

How to Enroll in The Marketplace

To enroll in a marketplace plan, you have a few different options. You can always preview the plans available here by plugging in information about your household — including income, doctors, medications, and healthcare facilities (hospitals and pharmacies).

Depending on your state, you may be redirected to another website to further continue your search for the right plan for you. If you are redirected, the steps are slightly different but still straightforward.

Once you get to the preview page, it will ask you for your zip code. This is only asked so that they look for plans that you are actually eligible for.

Once you input your zip code, you will be prompted to answer questions about your household.

Click the “Start” button. It will take you to a page that will ask if you know the Plan ID for your current plan. This is not a necessary step unless you want to have a comparison available at the end of your browsing. If you already know what plan you are going to enroll in because you received your HealthPlanning Analysis from our team at Caribou, you can search for that specific plan by Plan ID to have it pop up right in front of you. Otherwise, you can click “Skip”.

On the next page, you will find a prompt asking about the members of your household. Even if the individuals don’t all need coverage, you will want to include all of them. After that, it will ask if you are married. It will then ask if you are claiming any dependents on your federal tax return. Once you hit continue, it will ask your age and if any of the following statements apply to you.

Once you complete those questions, it will ask you about your expected income for the year. These questions act as a makeshift underwriting tool to help price your premiums.

After completing the questionnaire, you will be shown all of the available plans for you in your specific location. You can filter the plans based on certain criteria by clicking the green “Add filters” button. Once you click that button, you will be prompted with many different filters to choose from.

From here, you can add your medical providers, prescription drugs, premium ranges, and more to help find a plan that best fits your needs. If you already know what plan you are going to enroll in because you received your HealthPlanning Analysis from our team at Caribou, you can search for that specific plan by Plan ID to have it pop up right in front of you.

After choosing the plan that is best for you, click the “Plan Details” button. Underneath the name of the plan and Plan ID will be a button that says “Like this plan? Take the next step”. Once you click that button, you will be prompted to either log in or create an account through healthcare.gov. From there you’ll be on your merry way to enroll in your ideal plan.