Do you need health care but think you cannot afford insurance?
Are you enrolled in a public insurance plan like the ACA Health Insurance Marketplace (Obamacare), Medicare or Medicaid?
Most health insurance plans only allow changes and new enrollments during a time of the year called "Open Enrollment”. This is the time of year when many programs offer Open Enrollment. If you answer YES to any of the questions below, click the link to go directly to the applicable section.
Are you:
- In need of Health Insurance but think you cannot afford it? Section A
- Enrolled in the Health Insurance Marketplace (ObamaCare) and want to change? Section A
- A DACA enrollee who needs health insurance? Section A
- Enrolled in Medicare, including a Medigap plan? Section B
- Enrolled in Medicare Pharmacy Coverage through Medicare Advantage or a Part D Plan? Section C
- Enrolled in a Medicaid Managed Care and would like to choose a different plan? Section D
Section A: ACA Health Insurance Marketplace (Obamacare)
The ACA Health Insurance Marketplace offers low-cost health insurance for low- and moderate-income adults. You can choose a plan from many local options based on your budget and health needs. DACA enrollees are now eligible to enroll in ACA Marketplace health insurance.
Open Enrollment for the Marketplace plans begins November 1 and ends January 15. If you need insurance to start in January you must enroll by December 15.
You can learn about the plans and enroll through the website https://www.healthcare.gov. But insurance can be complicated and free help is available through specially trained people called Navigators. They offer unbiased information to help you understand your options and can help you enroll. The Federal Government pays for this service, so they have no incentive to push you toward a specific plan.
The Marketplace is for adults, but the Navigators know about health insurance for children. They can help families learn about Medicaid and Kid Care.
The Suwannee River Area Health Education Center Navigator program serves Alachua County and 14 surrounding counties. You can get help from them by phone or in person. You can make an appointment by calling 386-230-9400 or you may email them at Navigator [at] srahec.org. Their website is available at https://srahec.org/navigators/.
Section B: Enrolled in Medicare
Open Enrollment for Medicare is October 15 to December 7. It is a good idea to review and decide if you want to continue or change your current coverage. Changes made during this period go into effect on January 1.
You may do your own research by going to https://www.medicare.gov. You can learn more about Medicare through the online classes offered by Elder options. You can register for these classes at this link: https://www.floridashine.org/Community-Events/3.aspx?q=Alachua.
Another option for learning more about Medicare is personal, one-on-one counseling from a trained SHINE volunteer. SHINE stands for Serving Health Insurance Needs of Elders. SHINE volunteers provide free, unbiased, and confidential health insurance counseling. SHINE Counselors empower Florida seniors and eligible enrolled people with disabilities to make informed healthcare choices.
SHINE counselors are available at many sites around Alachua County. You can find them by going to: https://www.floridashine.org/Counseling-Sites/Alachua.aspx. You do not need an appointment, just walk in at any of locations, unless it is a holiday, in which case you should confirm they will be there. You may contact SHINE at shine [at] agingresources.org or call the Elder Helpline to arrange individual counseling at 1-800-963-5337.
Section C: Enrolled in Medicare Part D (pharmacy benefit) or in a Medicare Advantage Plan which includes pharmacy coverage
Beginning in 2025, all Medicare prescription drug plans (Part D plans), including Medicare Advantage plans with prescription drug coverage (MA-PDs), will be required to offer the option to enroll in the Medicare Prescription Payment Plan (MPPP). This is a great new benefit!
MPPP allows beneficiaries to pay out-of-pocket prescription drug costs in monthly installments over the course of the year, rather than paying the full cost when you pick up your prescription.
Also in 2025, a person’s out-of-pocket costs for Part D cannot exceed $2,000, provided prescriptions are filled at an in-network pharmacy. The MPPP is an “opt-in” program, so you will not be automatically enrolled, and you can opt in or out at any time. You enroll by contacting your Plan.
To learn more about MPPP go to: https://www.lung.org/policy-advocacy/healthcare-lung-disease/healthcare-....
Section D: Enrolled in Medicaid Managed Care
Shortly after enrolling in Medicaid, most people are assigned to a Managed Care Plan. Enrollees can change plans within the first 120 days of enrollment. After that you can only change plans for a “state approved cause” or during Open Enrollment. The timing of Open Enrollment for Medicaid is based on where you live. Alachua and many of the surrounding counties are in Region 3, which has Open Enrollment from December 1 to January 31. You can change plans by logging into your Medicaid Member Portal.
“State approved causes” for changing plans include poor quality of care, lack of access to necessary specialty services and unreasonable delay or denial of service
