Plan Ahead for the Best Results As we head into fall, it's time to think about an important Medicare milestone: the Annual Enrollment Period. If you're on Medicare, this is your chance to review your coverage and make changes if your needs have shifted, or if there will be changes to your current plan that you don’t like. Key Dates for Annual Enrollment in 2026 October 1, 2026: Plan details for 2027 go live. You can start comparing Medicare Advantage (Part C) and prescription drug (Part D) options in your area, though you can't make changes yet. October 15 – December 7, 2026: Enrollment is officially open. This is when you can: • Join a Medicare Advantage or Part D plan • Switch to a different plan • Drop coverage or switch back to Original Medicare January 1, 2027: Any changes you made take effect. Make sure you review your new plan documents so you understand your coverage and costs. What About Medigap? If you have a Medicare Supplement (Medigap) plan, it works differently. The rules for joining or switching a Medigap plan are more complicated than those for Medicare Advantage and Part D plans. Reach out to us to discuss your options. How to Get Ready Now Between now and October, set aside some time to prepare. • Gather recent medical bills and receipts • Make or update your complete list of current medications and doses • List the doctors and hospitals you have used most over the past year • Check your current plan's summary of coverage • Watch for your Annual Notice of Changes (ANOC) from your health insurance company (usually arrives in late September)—this tells you what's changing in your coverage, costs, provider and pharmacy network, and benefits for 2027 • Schedule a review session with our team starting October 1—slots fill up fast The more organized you are, the easier it will be to make confident choices. Let's Plan Ahead Whether you want to stick with what you have or explore new options, we can help you understand your current plan, see what else is available, and make sure your doctors and prescriptions and other benefits are covered. Schedule now to meet with us starting October 1st. If you have questions now about the process and what to expect, reach out anytime. We're here to help make the process as straightforward and successful as possible.
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When people sign up for a new health insurance plan—whether it’s an employer-sponsored plan or one purchased through the Affordable Care Act (ACA) exchange—they are often confused about when coverage starts, what services are covered, and how much they will need to share in the cost of care. The Kaiser Family Foundation recently compiled a list of seven takeaways from stories about people who ended up paying large out-of-pocket expenses for medical care. Reviewing these tips can help health plan enrollees better understand their coverage and avoid unexpected financial surprises. 1. Most insurance coverage doesn’t start immediately Many new plans include waiting periods, so it’s important to maintain continuous coverage until your new plan takes effect. Usually, health insurance starts on the first of the month and ends on the last day of the month. There are special circumstances when someone loses job-based health coverage. In that case, they may elect COBRA or purchase a plan through the ACA marketplace. With COBRA, once payment is made, coverage applies retroactively—even for care received while someone was temporarily uninsured. Losing employer coverage qualifies someone for an ACA Special Enrollment Period , which generally allows them to enroll in a Marketplace plan up to 60 days before or 60 days after their employer coverage ends. If someone enrolls before their job-based coverage ends, their new plan can usually begin right away and help prevent a gap in coverage. If someone enrolls after their job-based coverage ends, Marketplace coverage usually begins on the first day of the month after enrollment, so they could experience a short coverage gap before the new plan starts. 2. Check coverage before checking in Some health plans include restrictions that may not be obvious at first. These restrictions can affect coverage for services such as contraception, immunizations, and cancer screenings. Before receiving care, enrollees should contact their insurance company (or for job-based insurance, their human resources or retiree benefits office) to confirm coverage. Ask whether there are exclusions for the care you need, whether there are limits per day or per policy period, and what out-of-pocket costs you should expect. 3. “Covered” doesn’t always mean insurance will pay right away It’s important to read the fine print about network gap exceptions, prior authorizations, and other insurance approvals. These requirements may apply only to certain doctors, services, or dates. In addition, even if a service is covered, the insurance company may not pay for it until you have met your deductible or other cost-sharing requirements. 4. Get estimates for non-emergency procedures Before scheduling a non-emergency procedure, patients may be able to compare prices among different providers. Request written estimates whenever possible. If the cost seems too high, it may be possible to negotiate the price before receiving care, or find an alternate provider. 5. Location matters The cost of care can vary significantly depending on where services are performed. For example, if blood work is required, ask your doctor to send the order to an in-network lab. Sometimes a doctor’s office affiliated with a hospital system will automatically send samples to a hospital lab, which may result in higher charges if the lab is out of network. 6. When hospitalized, contact the billing office early If you or a loved one is admitted to the hospital, speaking with a billing representative early in the process can help prevent confusion later. Consider asking questions such as: Has the patient been fully admitted, or are they under observation status? Has the care been classified as “medically necessary”? If a transfer to another facility is recommended, is the ambulance service in-network—or can one be selected? 7. Ask for a discount Medical charges are often higher than the rates insurers typically pay, and providers frequently expect some level of negotiation. Patients may also be able to negotiate their own bills. In addition, uninsured or underinsured patients may qualify for self-pay discounts or financial assistance programs such as charity care. If you need assistance with your health insurance in California, contact Benefits By Design Insurance Services in San Diego. www.benefitsbydesignca.com or email admin@benefitsbydesignca.com.