Medicare
When does Open Enrollment begin and end?
October 15th through December 7th
When does Open Enrollment begin and end (for 2026)?
November 1st through January 15th
This document, required annually, summarizes a plan's benefits and coverage in a standardized format so employees can compare plans.
Summary of Benefits and Coverage
Yes, state retirees can add, switch, or drop their health plans during open enrollment. State retirees must also review their Part D prescription drug plans during open enrollment to ensure they are enrolled in a policy that's right for them.
Does a consumer have to wait until open enrollment to sign up for Medicaid?
No, they do not. A consumer can enroll in Medicaid at any point throughout the year!
Can a consumer switch their Medicare Supplement plan during Open Enrollment?
No, a consumer cannot switch their Medicare Supplement plan during Open Enrollment. A consumer may only add, remove, or switch their Medicare Advantage plan or Part D policy.
Beginning in 2027, which immigrant populations (statuses) will still be eligible for financial assistance?
Lawful Permanent Residents (LPRs or green card holders), Cuban and Haitian noncitizens, and Compact or Free Association (COFA migrants). If you are unsure whether an individual would be eligible for financial assistance, please connect the consumer to the MHC Call Center or a local Navigator.
What is the term that describes when a provider bills a patient for the difference between the provider's charge and the allowed amount (most common when going out of network)?
Balance billing
If a consumer dropped their state retiree benefit, can they sign back up during open enrollment?
Yes. State retirees can use open enrollment to add, drop, or switch policies.
Will the changes from HR1 affect everyone on Medicaid?
No. The changes to Medicaid affect those considered as the 'ACA expansion' population, which are individuls who are low-income adults (ages 19–64) who would not be eligible for Medicaid by other means (e.g., pregnant women, children, or those with severe disabilities).
Can a consumer change the Medicare Advantage plan they purchased during Open Enrollment if it no longer works for them?
Yes, from January 1st to March 31st, a consumer can switch or drop their Medicare Advantage plan and go to Original Medicare.
Can a consumer receive Advanced Premium Tax Credits (APTC) for the upcoming plan year if they have failed to file and reconcile their APTCs in the prior year?
Yes. Consumers have two years to file and reconcile their APTCs.
What is the type of plan that requires members to choose a primary care physician and get referrals to see specialists?
HMO (Health Maintenance Organization)
How does the Health Reimbursement Account work for state retirees?
The difference between the State plan’s current Retiree out-of-pocket maximum and the Medicare Part D out-of-pocket maximum will be deposited into an HRA for you to use toward your prescription drug costs.
Only available for retirees who were hired on or before 6/30/11, or retired from State service on or before January 1, 2020
What immigration statuses will be eligible for Medicaid after October 1, 2026?
Can a consumer sign up for Part B during Open Enrollment if they missed their Initial Enrollment Period?
No. The General Enrollment Period for Part B is January 1 to March 31.
Can a consumer who has not met the '5-year bar' be eligible for financial assistance or otherwise known as Advanced Premium Tax Credits (APTC)?
No. The Marketplace Integrity Rule eliminated eligibility for enhanced subsidies for those who do not meet the 5-year bar for being lawfully present. This applies to individuals under the 100% federal poverty level (FPL).
What are the 3 reasons continuation coverage (COBRA) might end before the minimum 18-month coverage period?
the employee fails to make a timely payment
the individual becomes eligible for another group health policy (e.g., starts a new job)
the individual terminates coverage
the employer stops offering group health benefits
the individual obtains individual health insurance (during open enrollment)
The employee becomes entitled to Medicare
When a consumer switches to the state retiree health benefit plan, does Medicare become primary or the state retiree plan?
Medicare becomes primary when an individual switches to the state retiree plan
What are "work requirements"?
Effective January 1, 2027, certain adults on Medicaid (aged 19-64 years old) will be required to meet at least one of the following criteria: