By Trish Pearson
Insure Your Future
Trish Pearson
Medicare enrollees may change plans until March 31. There are certain requirements that must be met to make a switch. The Medicare open enrollment period allows people who are on a Medicare Advantage plan to switch to a different plan of the same type or to regular Medicare with a separate supplement and prescription drug plan.
Why change? You might switch if something unexpected occurs that will require significant medical care during 2026 or if you need to seek care out of state. In this instance, the premiums for a supplement and prescription drug plan may be less than the estimated copays.
You might also change if a medication is not covered by your current plan. All plans do not cover the same name brand-name medications, and it is preferable to be in a plan that includes the drug in their formulary. In this case it would be advisable to change to a different insurance carrier that offers similar medical benefits but includes the prescription.
If either of these situations applies to you, contact a broker who can assist with choosing the right plan.
The special enrollment period for individual plans through the health exchange will likely end in April. The enrollment period applies to individuals who had a plan in 2025 but did not renew because they lost the tax credits or did not apply because they were not eligible but are now eligible to receive some assistance.
People who now qualify for increased premium assistance may also choose a different plan. For example, if someone enrolled in a bronze-level plan with a high deductible, they may now switch to a silver plan that allows for copays for most medical care without being subject to a deductible. To see if you qualify for the special enrollment period, contact Access Health CT or a certified broker who can assist with the enrollment process.
The latest proposals to change the Obamacare plans for next year would shift more health care costs to enrollees with much higher deductibles: $15,000 for an individual and up to $31,000 for families. This is eight times the average for someone who is on employer-sponsored insurance.
This could result in larger medical bills and make care unaffordable. It’s supposed to be the “Affordable Care Act,” but there is nothing affordable about a $15,000 deductible that has to be met before there is any cost sharing by the insurance company.
A record number of people in Connecticut enrolled in plans on the health exchange in 2026. It is working, providing affordable health insurance to many of our residents. Nationally, millions of people who depended on the tax credits that lowered their premiums were hit with monthly premiums that were double what they paid in 2025.
The premise behind this proposal is to encourage patients to “shop around for the best deal.” We should choose providers based on their reputation and expertise, not the fees they charge. With so much at stake, it brings new meaning to the term “buyer beware.”
Trish Pearson is a licensed independent insurance agent and certified long term care specialist. Contact her at 203-640-5969 or trishpearson281@gmail.com.