By Trish Pearson
Insure Your Future
Trish Pearson
The short answer to the question of who manages your health is: you do.
Many insurance companies have engaged private contractors to reach out to their members for a variety of reasons. They may want to create a “profile” based on medications you are taking, height, weight, vital readings such as blood pressure, cholesterol levels, etc. This is information that your medical providers need to know, or you can see in MyChart, but does not need to be shared with the insurance carrier.
Another reason they might reach out would be to offer to have a nurse come and do a health and safety assessment. This generally involves an in-person visit where a nurse checks your blood pressure, reviews medications, determines if there are fall risks and recommends safety measures.
A third reason can be to notify you about changes to the plan’s network, preferred mail order pharmacy or other benefits.
These services are all optional, not required. If it is not something with which you are comfortable, politely but firmly decline the offers and ask to be taken off the call list. If the unwanted calls persist, contact member services and request them to stop the calls.
What is helpful in managing the relationship between you and the insurance company is setting up an online account. An online account allows you to see the status of prescription refills, authorization requests, claims processing and payments. It will save you time on hold while a service rep researches your issue. It also provides information about vendors that handle eyecare, dental and over-the-counter benefits.
One change that is now impacting those on Medicare Advantage prescription drug plans is the fitness benefit provider. Some insurers have switched from Silver Sneakers to Silver and Fit. Both companies provide similar benefits, but not all gyms accept both plans. One major difference is that Silver and Fit is accepted at the YMCA, LA Fitness and several other gyms. The complete list is available at SilverandFit.com.
The enrollment deadline for Access Health Connecticut plans has been extended because of emergency funding provided by the state, dubbed “2026 temporary premium assistance.” The impact will increase the income range to qualify for a tax credit against health insurance premiums on the health exchange.
The extension applies to people who did not renew or apply for a plan for 2026 because they did not qualify for a tax credit under new rules imposed by the federal government, or they chose a less expensive plan. The special enrollment period also applies to those whose income is 100 percent to 200 percent below the federal poverty level but not enrolled in CoveredCT. These customers will receive temporary increased premium assistance.
If you think you qualify for this special enrollment, contact Access Health CT, which can also refer you to certified brokers who can assist you.
Trish Pearson is a licensed independent insurance agent and certified long term care specialist. Contact her at 203-640-5969 or trishpearson281@gmail.com.