Fall Enrollment

What You Need to Know About Your Health Benefits

September 2020 Issue
by Brelynn DuMortier

Believe it or not, fall is officially here this month!

And what does fall bring? Health insurance events:
You’ve got Open Enrollment (Nov 1-Dec 15) for those under 65 on a Marketplace plan; Annual Enrollment Medicare beneficiaries (Oct 15-Dec 7); and most employer sponsored health insurance renews in the upcoming months. All these events allow you to review and often change your insurance coverage. But how do you know if it is worth the time, effort, blood, sweat and tears to switch coverage?  

A couple months before your renewal or enrollment period you will receive information on the upcoming changes. I know you’d probably rather read a washing machine user manual than information on your insurance coverage, but it really is critical. So much can change, and it’s import to know ahead of time how you will be impacted.

Here are FIVE things to review:

Prescription coverage:
You may not have much choice on the Marketplace, or through your employer, but during Medicare’s Annual Enrollment, you can switch prescription plans. Regardless, it’s a good idea to look at the formulary for your plan to see how much your prescriptions will cost, if there is a deductible and maybe a mail order option that is cheaper. Also, look to see who the preferred pharmacies are so you can pay as little as possible.

Price: If you have plan options to choose from, weigh the price increase to the benefits you are receiving. It may be worth it to pay a little more per month if your doctor visits are cheaper and you go often. It may also be worth it to pay a little less if you never go to the doctor and rarely use your coverage.

Deductibles, copays, coinsurance: These can vary widely so compare plans if you have the option, weighing your ability to meet the deductible and how much the premium is per month. Most plans won’t cover x-rays, ER visits, surgery, brand name drugs, etc. until after the deductible is met, and then will cover a percentage of the remaining bills (coinsurance). So, make sure you understand what your financial responsibility would be if any of these situations arise.

Networks: Your doctor/clinic/pharmacy can change their mind at any time and decide not to be in network anymore. Now is a good time to double check their current status if you haven’t for a while. Out of network visits and procedures can cost a whole lot more than in-network, and sometimes, like for the current Marketplace plans, there is no out of network coverage at all.

Make sure to meet Deadlines: Changes are usually only accepted during the above time frames. For instance, if you decide to change your Medicare prescription coverage on December 8, you are out of luck for a whole year.  

So, give your health insurance at least a quick look, then move on to more fun things, like your washing machine user manual!


Brelynn DuMortier is a principal, agent and broker at Coastal Benefits, Inc.; 4000 Coral Park Drive, Brunswick. The agency, in business since 2001, specializes in Medicare options, employee benefits and health insurance consulting. You can reach Brelynn at 912-265-6909 ext. 303 or This email address is being protected from spambots. You need JavaScript enabled to view it..

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