2020 Medicare and Health Care Planning Guide


MEDICARE’s Annual Enrollment Period begins on October 15, 2019 and ends December 7, 2019. It is during this time that all individuals Aged 65+ should evaluate and review their health care needs for the upcoming new year. If already enrolled, you will receive a letter from your current carrier that will include an Annual Notice of Change (ANOC), which will give you a side by side comparison of what the plan you are on in 2019 will do in 2020. You will want to consider cost, doctor networks, co-pays, deductibles, Maximum out of Pocket amounts and your Prescription Drug tiers. If you simply pay the January 2020 updated premium, you will automatically be renewed with the plan updates.

Our office is available to discuss plan changes, updates and options available to you in 2020. If you are happy with your plan and do not anticipate any changes, simply pay your updated premium for January 2020. If your needs have changed and you wish to re-look at your options, please contact us as soon as possible so we can help you evaluate for 2020. Please be prepared with your list of providers and any RXs you are taking (include the exact spelling of the RX, the dosage level, and frequency taken). Our Benefits team is certified in 2020 with Regence, Providence, Health Net, United Healthcare/AARP, Pacific Source, Humana, MODA, and ATRIO Health Plans and are happy to review your options with you. Any changes you wish to make will need to be done by December 7, to be effective January 1, 2020.


OPEN ENROLLMENT into the Individual/Family Plans for 2020 will start November 1, 2019. Open Enrollment will end on DECEMBER 15, 2019. If currently enrolled, your carrier will be sending you a letter on what your plan is doing for 2020. If you would like additional information on your plan choices for 2020, please contact us and we can discuss your options. If interested in a quote, please be prepared to provide your address, income information, and any details specific to your situation.


Pacific Source (+4.3% increase) • Providence (0% change) • Regence (+5.5% increase) • Kaiser (+5.7% increase) • Moda (-3.2% decrease) • Bridgespan (+1.4% increase)

IF YOU DO NOTHING – Your carrier will renew your plan automatically and will initiate payment if you have not stopped it. The plan you have for 2020 will be the plan that they have MAPPED you to and you will be charged that premium for January 2020.

IF YOU WANT TO CHANGE PLANS or CARRIERS – Please contact us as soon as possible to review your options.

IF YOU ARE ON THE EXCHANGE WITH TAX CREDITS and/or COST SHARING – You MUST update your “Estimated Adjusted Gross Income” (AGI) for 2020 and review and secure your plan option. Please contact us for assistance.

IF YOU WANT TO CANCEL your plan because you no longer need coverage, you MUST contact the carrier to terminate.

If you are interested in receiving a quote or hearing available plan options for 2020, please contact our Certified Benefits Consultant, Jamie L. Smith, at 971-233-8559 or jsmith@premiernw.net OR click on the following link:



Oregon health insurer to shutter, advises 15,000 customers to find other plans

If you are currently one of the 15,000 people affected by this news and need assistance finding replacement coverage, please contact our office. We have many plan options available and can help walk you through the complicated enrollment process.


Health Republic Insurance, one of two federally created Consumer Operated and Oriented Plans in Oregon, won’t offer plans in 2016 and is winding down operations, it announced today.

The decision comes after the federal government announced if would pay only 12.6 percent of what is owed to insurers under the “risk corridor” program. The decision has a negative financial impact of more than $20 million on Health Republic, CEO Dawn Bonder said, in a statement.

All current Health Republic individual and small group policies “remain in full effect through the end of 2015,” the company announced. The Lake Oswego-based health insurer has nearly 15,000 members, including employees from more than 800 small businesses.

“Since our inception in 2013, Health Republic designed and priced all our plans in reliance upon the risk sharing guarantees of the Affordable Care Act,” Bonder said, in a statement. “This has placed us in a difficult financial position that could jeopardize our members and partners. As a result, we believe the most ethical step is for Health Republic to refrain from entering the market in 2016 and begin an orderly wind down of business.”

Health Republic said it will work with the Oregon Insurance Division to “ensure a smooth transition” and will pay all claims through 2015.

The risk corridor program, which came up far short of the money insurers are owed, also hit Moda Health particularly hard.

One-third of the CO-OPs created under the ACA have failed, including those in Iowa, Nebraska, Kentucky, West Virginia, Louisiana, Nevada, Tennessee, Vermont, New York and Colorado.

There were 23 CO-OPs created in 2011 at a cost of $2.4 billion in order to ensure that consumers had plenty of choices and a direct voice in their insurance plans. Oregon was the only state with two CO-OPs, Health Republic and Oregon’s Health CO-OP.

Even with other CO-OPs around the U.S. starting to fail over the summer, Bonder wasn’t too worried.

“My pro formas had us always using money first two and a half years,” Bonder said in late August. “I scratch my head to figure out why it’s such a shock to folks that CO-OPs aren’t making money.”

And in late September, she said the company was “growing steadily and sustainably.”



Are you ready for Open Enrollment?

It’s that time of year again! If you haven’t started thinking about your health insurance…now is the time. Open Enrollment is fast approaching.

If you are interested in receiving a quote for Benefits for yourself or your business, please contact our agency or click on the following links:

Individual Quote: http://premiernw.net/request-a-quote/individual-health-quote/

Group Quote: http://premiernw.net/request-a-quote/group-health/print-group-health-form/

“The Open Enrollment period for 2015 coverage is November 15, 2014 to February 15, 2015.

If you haven’t enrolled in coverage by then, you generally can’t buy Marketplace health coverage for 2015 until the next Open Enrollment period for coverage the following year.

If you’re enrolled in a 2014 Marketplace plan, your benefit year ends December 31, 2014. To continue health coverage in 2015, you can renew your current health plan or choose a new health plan through the Marketplace during the 2015 Open Enrollment period.

If you don’t have health coverage during 2015, you may have to pay a fee. The fee in 2015 is higher than it was in 2014 — 2% of your income or $325 per adult/$162.50 per child, whichever is more.

Enrollment and Coverage Start Dates

During Open Enrollment, if you enroll:

Between the 1st and 15th days of the month, your coverage starts the first day of the next month.
Between the 16th and the last day of the month, your coverage starts the first day of the second following month. So if you enroll on January 16, your coverage starts on March 1.

You may buy Marketplace insurance outside Open Enrollment only if you qualify for a Special Enrollment Period due to a qualifying life event such as marriage, birth or adoption of a child, or loss of other health coverage. Learn more about how you qualify for a Special Enrollment Period.

You can enroll in Medicaid or the Children’s Health Insurance Program (CHIP) any time. There is no limited enrollment period for these programs. You can apply any time. If you’re qualified, you can enroll immediately.

If you own or operate a small business, you can start offering coverage to your employees at any time.”

Source: HealthCare.gov https://www.healthcare.gov/marketplace-deadlines/2015/