Health Insurance Open Enrollment

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Medicare

Open Enrrolment! Book an Appointment

What it is: U.S. federal health insurance program.

Who it covers:

Adults 65 and older.

People under 65 with qualifying disabilities (after waiting period).

Individuals with End-Stage Renal Disease (ESRD) or ALS (special rules).

Guaranteed coverage: Eligible individuals cannot be denied based on age, health status, or pre-existing conditions.

Core Parts of Medicare

Part A (Hospital Insurance): Inpatient care, skilled nursing, home health, hospice.Usually premium-free (10+ years work history).Deductibles + daily copays apply.

Part B (Medical Insurance): Doctor visits, outpatient, preventive care, labs, DME.Monthly premium (income-based), annual deductible, 20% coinsurance.

Part D (Prescription Drugs): Private drug plans.Each plan has own formulary, tiers, network, costs.Late penalty if you delay without credible coverage.

ACA Marketplace

Open Enrrolment! Book an Appointment

What it is: Online platform (HealthCare.gov or state exchange) for individuals/families to buy health insurance.

Guaranteed coverage: No denials for pre-existing conditions.

All plans must cover 10 Essential Health Benefits: Doctor & hospital care, ER, maternity/newborn, mental health & substance use, prescriptions, labs, pediatric (incl. dental/vision), rehab/habilitation, preventive care, chronic disease management.

Financial Help

Subsides

Premium Tax Credit (PTC):

Lowers monthly premium based on income & household size.

Available up to ~150–400%+ of Federal Poverty Level (FPL).

Many qualify for very low.

Cost-Sharing Reductions (CSR):

Extra savings on deductibles, copays, OOP max.

Only on Silver plans & for incomes ~100–250% FPL.

Reconciliation at tax time: IRS adjusts subsidy based on actual income.

Original Medicare (A + B)

Option 1

Add-ons: Part D (drugs) + Medigap (supplement).

Pros:

Nationwide access, no networks or referrals.

Predictable costs with Medigap.

Best for frequent travelers & multiple specialists.

Cons:

Multiple premiums (B, D, Medigap).

No built-in extras (dental, vision, hearing, transportation, gym, etc)

Medicare Advantage (Part C)

Option 2

Private plans bundling A + B + usually D.

Extras included: dental, vision, hearing, OTC, transportation, gym, flex cards.

Types: HMO, PPO, PFFS, SNP (e.g., D-SNP, C-SNP).

Pros:

One card, extra benefits.

Out-of-pocket max protection.

Often low.

Cons:

Networks + prior authorizations.

Benefits can change yearly.

Travel limits outside service area (except emergencies).

Medicare + Other Coverage

Option 3

Some people combine Medicare with other benefits:

Employer/Union Coverage: Retiree health benefits alongside Medicare.

VA / TRICARE for Life: Military or veterans’ health coverage coordinating with Medicare.

Dual Eligible (Medicare + Medicaid): Access to Special Needs Plans (D-SNP).

Metal Plan

Levels

Bronze: Lowest premiums, highest costs when you use care. For minimal users.

Silver: Mid premiums, access to CSR savings.

Best value for subsidy-eligible.

Gold: Higher premiums, lower cost-sharing.

Good for frequent care users.

Platinum: Highest premiums, very low cost-sharing.

Rare, best for heavy care users.

Networks & Plan Types

HMO: Lowest cost; in-network only; referrals needed.

EPO: In-network only; usually no referrals.

PPO: More flexibility; some out-of-network coverage; higher premiums.

⚠️ Tip: Always check if your doctors, hospitals, and pharmacies are in-network.

MEDICARE AEP

Annual Enrollment Period

ACA AEP

Annual Enrollment Period

STILL NOT SURE?

Frequently Asked Questions

Medicare AEP

👉What if I miss the deadline?

If you don’t make changes during AEP (Oct 15 – Dec 7), you’ll usually have to wait until next year, unless you qualify for a Special Enrollment Period (SEP) (e.g., moving, losing coverage, Medicaid eligibility, certain health conditions). Your current coverage will continue into 2026 if no changes are made.

👉 Can I change my plan more than once?

Yes. You can submit multiple requests during AEP, but only the last one before Dec 7 will take effect on Jan 1. If you have a Medicare Advantage plan, you also have the MA OEP (Jan 1 – Mar 31) to make one more change or go back to Original Medicare + Part D.

👉 What can I change during AEP?

Switch between Original Medicare and Medicare Advantage. Change from one MA plan to another.

Join, drop, or switch a Part D drug plan.

👉 When do changes take effect?

All AEP changes start on Jan 1 of the following year.

👉 What if I have Medicaid or Extra Help?

You may qualify for Special Enrollment Periods and can change plans multiple times during the year.

ACA MARKETPLACE AEP

👉 What if I miss the deadline?

If you don’t enroll or renew during Open Enrollment (Nov 1 – Jan 15), you can only get coverage if you qualify for a Special Enrollment Period (SEP) (e.g., loss of other coverage, moving, marriage/divorce, birth/adoption, income changes). Otherwise, you’ll need to wait until the next year.

👉 Can I change my plan more than once?

Yes. You can change plans as many times as you want during Open Enrollment; only the last plan selected before Jan 15 will take effect. After Jan 15, changes are only allowed with a SEP.

👉 When does my coverage start?

Enroll by Dec 15 → Coverage starts Jan 1.

Enroll Dec 16 – Jan 15 → Coverage starts Feb 1.

👉 Can I get financial help?

Yes. Most people qualify for tax credits and cost-sharing reductions based on income and household size.

👉 What info do I need to enroll?

Income details, household members, immigration documents (if applicable), list of preferred doctors and prescriptions.

👉 What if I don’t pay my first premium?

Your coverage won’t begin until you make the first payment.