Open Enrollment refers to the yearly period when people can enroll in a health insurance plan. The enrollment periods for commercial plans are typically in November and December, Medicare plans are from Oct. 15 to Dec. 7, and the last open enrollment period for the Health Connector is Dec. 23 to Jan. 23.
The Health Connector provides access to both subsidized plans and nonsubsidized plans for individuals. To be eligible for a subsidized plan, you cannot have access to an employer-provided plan or qualify for Medicare or Medicaid. There is also an income limit to qualify for a subsidized plan through the Health Connector.
“People, especially if they’re self-employed, may think they make too much money,” said Rocy Turner, Patient Financial Counselor at the hospital, “but after deductions, they may actually be eligible.”
One question Turner gets frequently at this time of year is about Medicare Advantage plans, sometimes called Senior Care plans.
“One thing people may not realize about Martha’s Vineyard Hospital,” said Ed Olivier, CFO at the hospital, “is that we’re a Critical Access Hospital, a class of hospital developed to ensure that Medicare beneficiaries have access to healthcare in rural areas — there are only three hospitals in the state in that category.” And the insurance reimbursement system works differently in Critical Access Hospitals.
“For Critical Access Hospitals,” Olivier said, “Medicare pays for the cost of care, either emergency or elective care. Plans such as Medicare Advantage are permitted to pay an estimate of cost for emergency care, but elective care (including a visit to your primary-care physician) is subject to a contract between the insurance company and hospital.”
“If you find that your elective care at the hospital is not covered by insurance,” said Mary Lou Piland, Manager of Patients Access, “it’s because your insurance, for example the Medicare Advantage plan, likely was unwilling to negotiate a contract with us.”
“So when an insurance company says you can get one plan to cover everything, it sounds like a great deal until you realize you cannot use it at your local hospital,” Turner said.
Should you find that you don’t have the right coverage, the Medicare Advantage Disenrollment Period allows you to disenroll from a Medicare Advantage plan and return to traditional Medicare. This period runs from Jan. 1 to Feb. 14. The traditional Medicare coverage ensures that you have access to all services provided at MVH.
“Everyone’s situation is different,” Turner says. “Talk to me to make sure you get the right plan.”