Homework…. Getting Ready for the Fall Enrollment Season

 Keep in mind that your health insurance is all about YOU. Your Needs, Your values and Your budget.

September is a great time to prepare for “AEP / OEP “ - Annual / Open Enrollment Period. This is when you may make changes to your Medicare and ACA Marketplace plans.

AEP – Medicare: Window Shopping October 1. Make changes from October 15 to December 7, 2025.

For Medicare folks, you will receive an “Annual Notice of Change” (ANOC) in September. This details changes to the exact Medicare Advantage or Part D – Rx plan you currently have.

OEP – ACA Marketplace: Make changes from November 1 to January 15, 2026.

And YOU have some homework to be ready.

Homework if you have a Medicare Supplement

• Review your current premium.

• What was the increase this last year?

• Are you looking to make a change?

Homework if you have a Part D – Rx plan.

• Review your current plan and what it is changing to next year (ANOC).

• Are all your prescriptions covered; i.e. on the plan formulary?

• If brand name RX, what’s the Copay and Rate Tier?

• Is your pharmacy “preferred“ for that plan?

Homework if you have a Medicare Advantage Plan

• For the Medical

• Review your current plan and what it is changing to next year (ANOC).

What is the copay for Primary Doctor and Specialists?

What is the Daily Rate for Hospitalization and number of days you have to pay?

What’s the Maximum Out Of Pocket (MOOP) for medical expenses?

• For the Prescription part - same as Plan D RX above.

• For Networks of contracted Doctors and Providers

Is your Primary Care Physician and Specialists in the network?

Hospital System? Is the plan an HMO, POS or PPO?

For the Extras

• What is the Dental Benefit?

• Vision & Hearing?

• Is membership to your gym or fitness club covered?

• Is there a “Giveback“ on your Part B premium ?

Type of Medicare Eligibility

• Do you have both Medicare and Medicaid?

• Do you qualify for “Low Income Subsidy”

• Have you a covered diagnosis like diabetes, heart disease or lung issues?

Homework if you have an ACA / Marketplace Plan

• Review your current plan, net premium, subsidy and the 2025 income estimate you used.

• Is your family changing next year? Dependent turning 26? spouse eligible for Medicare?

• On your 2024 1040, what was “line 11“? Add your Social security if already or will be taking.

• Will your income for 2026 be greater than 400% of federal poverty level - $63,000 single, $85,000 family of 2, $128,000 family of 4?

At Trout Insurance, we listen carefully and then work with you to Discover Your Options.

Dave Trout

Trout Insurance

Full Service, Local, Independent

29 N Main St. Weaverville, NC

828-279-4681

dtroutinsurance@aol.com