You can still enroll in the Affordable Care Act/ObamaCare

Special Enrollment Period (SEP) is a designation for persons who have a change of circumstance that allows them to enroll and qualify for Affordable Care Act/Obamacare insurance at any time.

Circumstances such as one of the following:
-Marriage or Divorce
-Change of Employment
-Change of Address
-Now Self-Employee
-Starting a New Job
-Lost Job
-Birth of Child
-Released from Prison 
It provides an extra enrollment opportunity to avoid a penalty for the rest of 2017.


We’ve Moved!

After 18 years of servicing our clients from our office on Main Street – Sarasota Health & Financial is proud to announce that we have moved our office.  Our new office is conveniently located on Stickney Point Road at Gateway Avenue, has plenty of parking, and is in a much more updated building.  We are in “The Office Park” in Building B (Back Building) on the second floor – near the elevator.  Please feel free to stop by, say hello, and let us show our new space!

2477 Stickney Point Road, Suite 217B

Sarasota, FL 34231

Part C: Medicare Advantage Plans (MAPD)

A Medicare Advantage plan (like an HMO or PPO) is another way to get your Medicare coverage. When you enroll in a Medicare Advantage plan, you still have Medicare.  You’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage through the Medicare Advantage Plan, not Original Medicare.  Medicare Advantage Plans, also called “Part C” or “MAPD Plans” are offered by private insurance companies that Medicare approves.

All Medicare Advantage plans offer an out-of-pocket maximum.  Many plans offer extra coverage, such as vision, hearing, and general checkups and other health and wellness programs; most plans include Medicare prescription drug coverage.  In order to be eligible to enroll in a MAPD, you must be entitled to Part A and enrolled in Part B of Medicare.

The costs of Medicare Advantage Plans vary depending on the services they provide. In addition to the standard monthly payment for Medicare Part B coverage ($104.90 in 2015); some plans charge a premium, while others are a zero premium. Many plans have deductibles, copayments and yearly limits on patient out-of-pocket expenses that vary from those offered by standard Medicare. It is important to remember when you enroll in a Medicare Advantage Plan – you will need to use the plan’s network of Doctors and Hospitals.

65+ Medicare Supplement or MediGap

Original Medicare Part A (Hospitalization) is Free. Medicare Part B (physician services, outpatient, tests, & supplies) cost each of us $104.90 (in 2015).

If you only have Original Medicare, your potential financial exposure is significant at over $60,000 in Part A, and at minimum 20% in Part B.

With Medicare you have two choices to transfer your medical expense risks to another entity:

  1. Original Medicare plus a “Supplement” (Insurance Company) (and plus a Part D prescription Plan)
  2. Medicare Part C (Medicare Advantage Plan) in lieu of original Medicare (Insurance Company)

A person must be enrolled in both parts A and B in order to enroll in a Medicare Supplement.

There are ten standardized Supplements (Medigap) policies. Each policy of the same letter designation (A, B, C, D, F, G, K, L, M, & N) are exactly the same (by law) regardless of carrier, even though premiums differ between carriers.

The most comprehensive Medicare coverage available is MediGap (Supplement) Plan F.  Basically Plan F covers all Medicare Approved care that Parts A and B do not cover.  No deductibles. No Networks. No Gatekeepers. No copays. No coinsurance.  If affordable, Plan F provides the most comprehensive coverage.

All Medicare Supplements allow you to manage your own care: no networks, no gatekeepers, and generally few policy copays, co-insurance, or deductibles other than Medicare’s requirements on items a supplement may not cover.

Turning 65? Let us help with your Medicare Options

Medicare Basics

Medicare is the federal health insurance program for people age 65 and older, under 65 with certain disabilities, and people of any age with End Stage Renal Disease.   The Centers for Medicare and Medicaid Services (CMS) administers the program for the federal government.   There 4 parts of Medicare:  Part A, B, C and D. Parts A and B together are known as “Original Medicare”.  All parts of Medicare have cost sharing or “gaps” such as deductibles, copayments or coinsurance.

Part A (Hospital Insurance):  Inpatient care in hospitals; skilled nursing hospice and home health care (this is limited)

Part B (Medical Insurance):  services from doctors and other healthcare providers, hospital outpatient care, durable medical equipment; preventative services

Part C (Medicare Advantage):  Includes all benefits and services covered under Parts A and B.  Is run by Medicare-approved private insurance companies.  Usually covers Prescription Drug Coverage (Part D) as part of the plan.  May included extra benefits and services.

Part D (Prescription Drugs):  helps cover the cost of outpatient prescription drugs.  Run by Medicare-approved private insurance companies

Special Enrollment Period

Special Enrollment Period

The Centers for Medicare and Medicaid Services (CMS) announced on February 20, 2015 that there will be a special enrollment period for individuals and families who did not have health insurance in 2014, and now have to pay the penalty for not having coverage.   This new enrollment period will begin March 15, 2015 and ends April 30, 2015.

This special enrollment period allows those individuals and families who were not aware that they would receive a penalty for not having “minimum essential coverage” to enroll themselves in a health insurance plan.

In order to take advantage of this special enrollment period, you must:

  • Not be currently enrolled in 2015 coverage.
  • Confirm that when you filed your 2014 taxes, you paid the penalty for not having coverage.
  • You must be able to attest that you were not aware of the penalty until you filed your 2014 taxes.

If this applies to you – give us a call today, and we will go over your options!

Can I still get coverage?

For those of you under the age of 65, Annual Enrollment runs from November 15th 2014 thru February 15th 2015.  The deadline to get a January first effective date has passed.  However, you can still enroll in a plan.  We have until January 15th 2015 to submit your application for a February 1st effective date.  After that we have until February 15th to submit your application for a March 1st effective.

It is more important than ever for you to have insurance. If you choose to not have insurance in 2015, the penalty will be $325 per adult and $162.50 per child, or 2% of your household income; whichever is greater.

At Sarasota Health and Financial, we understand that Health Insurance can be confusing and at times frustrating. We are here to help guide you, and to select a plan that is right for you and your family.  We are proud to be celebrating our 35th year of servicing Sarasota and Manatee Counties.  It would be our pleasure to add you to our list of satisfied customers!

Affordable Care Act Enrollment

Now that Annual Enrollment for the Affordable Care Act is closed, can I still get coverage?

If you are under the age of 65, Annual Enrollment is now closed until November 15th. However you still have options to get health insurance for you and your family. The first option you have is to purchase a Short Term Medical Plan. Short Term Insurance can be an affordable way to protect yourself until Annual Enrollment opens again in the Fall. We have several different policies with a range of deductibles, payment options and coverage terms that allow you to customize a plan that suits your needs. Short term plans can be effective the next day, and help bridge the gaps in times of transition. (more…)