ACA & Medicare Frequently Asked Questions 

Medicare questions may feel overwhelming; however, when you work with an experienced consultant with the Alpine Agency, we provide you with the most current Medicare FAQs to help streamline the process.

Our team is dedicated to helping you find the best coverage at the most affordable cost. 

 

What is the difference between Medicare AEP and OEP? 

The primary differences between the Medicare Annual Enrollment Period and the Medicare Advantage Open Enrollment Period are timing, eligibility, allowable changes, and effective date. 

Annual Enrollment Period (AEP): 

Dates: October 15-December 7 

Eligibility: All Medicare beneficiaries 

Allowable changes: Unlimited changes are allowed.

Effective date: Changes begin on January 1st of the following year. 

Medicare Advantage Open Enrollment Period (OEP): 

Dates: January 1-March 31 

Eligibility: Only available to individuals already enrolled in a Medicare Advantage plan. 

Allowable changes: You are only allowed to make one change. 

  • Switch to a different Medicare Advantage plan. 
  • Disenroll from Medicare Advantage and return to Original Medicare, with the option to add a standalone Part D plan 

Effective Date: Coverage typically begins on the first day of the month after the plan receives your request. 

Can I keep my doctor if I change Medicare plans? 

You may be able to keep your doctor, but it depends on the types of plans you’re switching to. 

  • To Original Medicare: You can see any doctor nationwide who accepts Medicare. 
  • To a Medicare Advantage Plan: Typically, you’re only permitted to see doctors inside that specific plan’s network. 
  • To a Medigap Plan: As an Original Medicare supplement, you can keep any doctor who accepts Medicare. 

What happens if I do nothing during Medicare AEP? 

Your current Medicare Advantage or standalone prescription drug plan automatically renews for the next year if you do nothing during the AEP. 

Keep in mind, however, that changes may occur annually, such as premiums, deductibles, provider networks, and covered medications. You could pay more overall or lose specific prescription coverage. 

Top 3 Likely Possibilities 

  1. Plan Automatically Renews: Your plan may still be offered and covers your provider. If so, your coverage simply rolls over. You will receive a new ID card and a document called the Annual Notice of Change (ANOC) detailing any modifications. 
  2. Plan Is Discontinued: If your current plan is discontinued, you will revert to Original Medicare on January 1st. In this scenario, you won’t have drug coverage (Part D) and will be responsible for the 20% coinsurance.
  3. Upgrades Missed: You could miss out on new, cheaper plans or extra benefits (like dental, vision, or fitness perks) added to competing plans if you miss the enrollment window. 

Who qualifies for ACA health insurance subsidies? 

To qualify for Affordable Care Act health insurance subsidies, specific parameters must be met. 

  • Income between 100% and 400% of the federal poverty level
  • No access to employer-provided coverage
  • Don’t qualify for government-funded plans
  • Must be a U.S. citizen, U.S. national, or a legal immigrant
  • File a joint return if married
  • Not claimed on another person’s tax return
  • Not currently incarcerated

How can I lower my monthly ACA health insurance premium?

There are a few ways to help ensure you receive the lowest premium available. 

  • Immediately report decreased income.
  • Move from a Silver or Gold Plan to the Bronze Tier. 
  • Contribute to a pre-tax account like a Health Savings Account or an IRA. 

Does it cost money to work with Alpine Agency? 

It doesn’t cost you anything to work with Alpine Agency. Our zero-cost consultations help you find, compare, and enroll in health or Medicare plans that best fit your unique situation.

Why should I use Alpine Agency instead of enrolling on my own? 

Alpine Agency provides expert guidance on selecting the right insurance plan. We offer personalized assistance while eliminating the guesswork when selecting individual or family insurance options. 

Give us a call or complete our online form to get you started with a zero-cost consultation for health insurance in South Carolina. 


Q&A for Individual ACA Coverage

Q1. When can I enroll in a healthcare plan?

Normal open enrollment is from November 1st to December 15th. 

If you enroll before December 15th, your plan will be effective January 1st.

Q2. Can I enroll in a healthcare plan outside of open enrollment?

You can only enroll in healthcare outside open enrollment if you have a significant life change that provides you with a qualified Special Enrollment Period. These life changes included the following: Losing other coverage, getting married, or having a baby.

Check with a local agent if you believe you may have a qualifying event to create a Special Enrollment opportunity. There are specified limitations to creating Special Enrollment Periods.

Q3. Do insurance companies ask health questions for an ACA policy? Can they deny me coverage? 

No. If you qualify for an ACA plan and you have a valid enrollment, insurance companies cannot deny you coverage. There are no health questions with an ACA policy.

Q4. I don’t qualify for a Special Enrollment Period. Is there anything else I can do to protect myself?

Yes. There are opportunities to purchase a short-term plan. These plans have designated times of coverage, i.e., 30 days, 60 days, 90 days, 180 days, 330 days.

These plans do ask you to answer health questions. The carriers can deny providing insurance coverage based on these health questions and pre-existing conditions.

Q5. What are tax credits, and how do I qualify? 

Tax credits provide financial relief for health insurance premiums. These are available to individuals whose household income is between 100% and 400% of the Federal Poverty Level.

These credits are broken down into different levels. Depending on your household size and income level, you could receive a reduction in your premium. You must declare your household income and file taxes to maintain the tax credits. Failure to file taxes will cause you to lose your tax credits.

If you underproject your income, you could be subject to returning the premium tax credits received when you reconcile your taxes. It is important to be accurate and adjust throughout the year if your income level changes.

Q6. How does my health insurance policy work?

It depends on which plan you chose. You should consult an experienced agent to make sure you are getting what you want out of your plan. Many plans have co-pays/co-insurance on doctor and hospital visits. The cost of these varies depending on the plan you purchase. Other plans have high deductibles, which are the amounts you would be responsible for before the insurance plan pays.

You will want to make sure your plan covers your doctors and hospitals. You also will need to decide if you need coverage outside of South Carolina. Some plans work with only specific hospital networks.

All of these factors influence the cost structure of your plan. Talking with a local agent helps you ensure you have the best plan for your needs.

Q7. Does my plan cover prescription drugs?

Whether or not your plan covers prescription drugs depends on the specific plan. All ACA plans do have prescription drug coverage. Short-term plans do not provide prescription drug plans. Some plans cover prescription drugs with a co-pay amount, while others provide coverage after the plan’s deductible is met. So, be sure to ask your agent if your prescriptions are covered on the plan you choose.

Q8. Do all hospitals treat all medical plans the same?

No. Hospitals that are in-network for plans provide the best coverage. If the hospital is out-of-network, the consumer will pay a higher percentage or even all the cost of treatment in that plan. Hospitals determine which insurance carriers they contract with. You will want to make sure your local hospitals are in-network.

Q9. How do I ensure I have the best plan and the best coverage for me?

Contact an Alpine Agent to ensure you’re getting the best plan and coverage for you. They work exclusively in the healthcare market, and they have the most up-to-date information that allows them to work with thousands of South Carolinians on their plans.

An agent’s services should not cost you anything. Insurance companies compensate agents directly for placing business, so their services are provided at no cost to you.Call 803-432-4960 to get a live representative to help you understand the health insurance and Medicare market.

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