Health Insurance, including ACA, Medicare & Travel
Looking for health insurance?
For those of you under age 65:
2020 Open Enrollment begins - 11/1/2019 thru 12/15/2019, for a 1/1/2020 effective date.
There are special enrollment periods available during the year based on certain life changes and special circumstances ... i.e. marriage, birth, loss of health insurance (not including failure to pay premiums), newly ineligible for subsidies.
Having health insurance gives you peace of mind. Health insurance protects you from high out-of-pocket medical care costs. An accident or illness can happen at any time. Visits to the doctor or hospital and medical treatments can be expensive. Don't be unprepared.
Having health insurance means knowing many of your health expenses will be covered.
Health Care Reform Key Mandates
- There are a few exceptions (such as temporary medical), if you purchased your plan prior to March 23, 2010, your plan is grandfathered and you don't need to buy a new ACA (Affordable Care Act) plan. As long as you keep that plan paid up and unchanged, you can keep it as long as you like.
- The ACA guarantees that no one can be denied coverage or charged higher premium because of their health.
- There are core essential benefits that must be included
- Preventative services must be offered at no charge.
Plans are categorized in metal levels
|What Health Plan Pays
What You Pay
Monthly premium rate is a separate cost and is not included in these calculations.
If you are a Maryland resident and you buy your own health insurance, you may be eligible for a subsidy (calculator) or view chart. The subsidy is based on current year household income, so if your income changes during the year, you can log back into the exchange and update your information. If you are eligible for either a premium or cost sharing subsidy, you must buy your health plan through the Maryland Health Exchange. Please contact Baygroup for assistance with this. We will provide you with our Consumer Assistance Worker number and help you navigate your the website to select coverage appropriate for you and your family.
If you are not eligible for a subsidy, you can buy the same plans for the same premium outside of the exchange.
Travel Insurance - Regardless of age, you may find travel health insurance provides a safety net and peace of mind. You can explore some options here
If you are 65 or older
As you are turning age 65 soon or are past age 65 and your employer coverage is ending, health care coverage may need to be reviewed. Medicare enrollment is not automatic, unless you are currently receiving Social Security Benefits due to age or are eligible for and receiving Social Security Disability Benefits. Welcome to Medicare 2019 booklet
When Medicare enrollment is automatic:
- A packet of information and the Medicare card is sent 3 months before your 65th birthday or 3 months before the 24th month of receiving Social Security Disability Benefits (SSDI).
- You will be enrolled in both Medicare A and B if you take no further action. It will start the first day of the month you turn 65 or the 25th month of being on SSDI.
- Signing up for Part A or signing up for Social Security triggers enrollment in Part A. Please note, you may no longer contribute to a H.S.A.
- If you don’t have group health insurance, you may want to consider a Medicare Supplement and Medicare Part D.
When Medicare enrollment is not automatic:
- If you are not receiving Social Security benefits, contact the Social Security Administration 3 months before you turn 65:
- Call SSA 1-800-772-1213 for the location near you and apply in person for Medicare and Social Security.
- Initial Medicare Enrollment Period to sign up Part A or Parts A and B:
- 3 months before, the month of, and 3 months after 65th birthday
- Complete CMA 40-B, Application for Enrollment in Medicare-Part B (Medical Insurance), take or mail it to your local Social Security office. You cannot apply online.
What if I have employer coverage (employee or spouse) because either my spouse or I am still working?
- Can delay Medicare A and B. Before electing this option, understand if employer will assume coordination of benefits with Medicare. If Medicare is primary payer, the employee could have to pay the expenses that Medicare would have paid out of your own pocket.
Do I need Part B (doctors and diagnostic services)?
- Not if you or your spouse is actively working for an employer and has employer/union health coverage (business has 20 or more employees). See previous bullet “What if I have employer coverage (employee or spouse) because either my spouse or I am still working?
- If you do not need Part B, there is a post card to return to Social Security Administration to decline it now.
- There is an 8 month special enrollment period (SEP) when you no longer have employment-related health plan (this does not mean retiree, COBRA, individual or family plan). After that period, there is a penalty for late enrollment.
- If you missed the special enrollment, there is a general enrollment period each year from Jan 1 to March 31. Coverage then begins July 1. A penalty would apply in this case.
Do I need Part A (hospitalization)?
- If you or your spouse is actively working and has employer health coverage there is no reason not to take Part A
- If you have worked 40 quarters you have already paid for the benefit
- Part A will be primary and your group insurance will be the supplemental.
Medicare Part D (drug) Coverage
- Available to all people with Medicare A and/or Part B or both
- If you have employer provided drug coverage, that is credible coverage, you will not need a Part D plan. Keep your documentation that you received from your insurance company.
- Initial enrollment period is 3 months before, during, and 3 months after the month of eligibility
- There is a penalty for late enrollment.
- Annual open enrollment is from October 15th to December 7th. Each year you should review your prescriptions and determine which policy is the best for you.
The principals at Baygroup Insurance are can help you find individual, Medigap (Medicare Supplement) and Medicare Part D. We are a health insurance brokerage, which means we can shop many carriers to find a policy that is the best value for you. The insurance companies pay us, it does not cost you anything extra to have our guidance.
For more information about health insurance, visit our FAQ page.