Medicare open enrollment is underway and it is also the time of year when other public health coverage programs and employer-sponsored plans carry out their sign-ups.

Wisconsinites are being encouraged to weigh their options. Advisers said reducing health care costs involves more than focusing on monthly premiums. You should also compare a plan's copays and deductibles.

Adam VanSpankeren, navigator program manager for Covering Wisconsin, which helps people understand and sign up for publicly available health insurance and similar programs, said reading notifications this time of year is vital because a small, subtle difference could end up being a big shock.

"You might be used to going to your doctor year after year, and then find out that they're actually not covered by your plan anymore," VanSpankeren explained. "That's got to be the most kind of disheartening and surprising thing. And people often discover that when they go to get care."

As for Medicare, original plans do not cover prescription drugs, so what's known as the Part D plan is needed for medications. Starting in 2025, the plan will include a $2,000 cap on what you pay out-of-pocket for prescription drugs covered by your plan.

Health policy analysts said there can be trade-offs when deciding between a traditional Medicare coverage option and a Medicare Advantage plan.

Dr. Rhonda Randall, chief medical officer and executive vice president of UnitedHealthcare Employer and Individual, noted Advantage plans tend to cost more, but are worth considering for the benefits they provide.

"Things like dental, vision and hearing," Randall outlined. "Many Medicare beneficiaries might be surprised to know that original Medicare doesn't cover most of those things, but many Medicare Advantage plans do. I also recommend people to check for mental health coverage."

About 56% of Wisconsinites signed up for Medicare have advantage plans. Program enrollment runs through Dec. 7. UnitedHealthcare offers an online guide for navigating Medicare. Meanwhile, people with employer-sponsored health plans are also entering their enrollment season and sign-up through the health insurance exchange under the Affordable Care Act begins Nov. 1.

Since Hurricanes Helene and Milton devastated Florida, more than 49,000 insurance claims have been denied, leaving thousands of residents in financial uncertainty as they attempt to rebuild.

According to data from the Florida Office of Insurance Regulation, many companies denied claims related to flood damage, a peril not typically covered under standard homeowners' insurance policies.

Mark Friedlander, corporate communications director for the Insurance Information Institute, explained many denied claims are tied to Florida's requirement for a separate flood insurance policy.

"Standard home, condo and renters policies do not include flood damage," Friedlander pointed out. "If you're filing a flood loss with your property insurer, it's going to be denied. Another issue is not meeting the deductible; that's another big category of denials."

For instance, he noted if you have a $10,000 windstorm deductible and your damage is $8,000, there will be no claim payout. He added the threshold has led many homeowners to find themselves without compensation for damages falling just short of deductible limits. He emphasized property owners should consider purchasing separate flood-insurance policies to be fully financially protected.

For residents whose claims were denied, Friedlander advised considering Federal Emergency Management Agency assistance as a partial alternative. He revealed some homeowners intentionally file claims they know will be denied to meet FEMA requirements.

"In order to qualify for FEMA emergency grants, you must prove to FEMA that you did not have insurance coverage for the loss," Friedlander stressed. "The only way to do that is to get a denied claim. You need to show the letter from your insurer to FEMA as part of the application process for the grant."

Florida's high cost of property insurance added another layer of difficulty, with annual premiums averaging $5,527 dollars for a home valued at $300,000. The premium is more than twice the national average, creating a financial strain for many. Despite the recent hurricanes, Friedlander reassured residents Florida's insurance market remains resilient, crediting recent legislative reforms.


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Critics of recent court cases they say allow corporations to evade responsibility are pointing to legislation in Congress that could fix this issue. Large companies often urge arbitration in cases where legal disputes arise, such as for a couple in New Jersey that was injured when an Uber driver ran a red light. The couple sued Uber but was rebuffed because their daughter checked the company's terms and conditions agreement which says riders will settle disputes through arbitration rather than in court.

Jagjit Nagra, head of Oregon Consumer Justice, said these agreements can often appear dishonest.

"These mandatory clauses that are buried in the fine print - they're there to evade accountability, and what it does is it funnels disputes into a private system that more often than not favors corporations over individuals rather than it playing out in a court of law," Nagra added.

A similar case recently played out in a wrongful death case against Disney, and the Oregon Supreme Court ruled in a 2022 case in favor of employers that require arbitration to settle employment-related disputes. Companies with arbitration clauses have argued the process is quicker and less costly than court. But Nagra said the Forced Arbitration Injustice Repeal, or FAIR Act in the U.S. Senate would take this process off the table. The bill has support from Oregon Senators Ron Wyden and Jeff Merkley.

Nagra added the FAIR Act would apply in a variety of cases, including employment, consumer, antitrust, and civil rights disputes. He says the court process is more transparent, which is good for the public.

"Say there's an unsafe product or a fraudulent practice, what have you. This allows folks to be able to hold these corporations and other bad actors accountable in a public process," he said.

Nagra noted the arbitration process has different rules than court, concerning evidence, for example, and added evidence can be admitted in arbitration that is irrelevant or based on hearsay.

"Something that would be anathema in a court of law can take place there because they're private proceedings. And the judges are privately paid for judges by the arbitration company," he continued.

Several Connecticut groups are partnering to help people claim COVID relief money.

The Get Your Refund Campaign aims to help more than 45,000 families statewide get the enhanced tax benefits they were entitled to in 2021. Internal Revenue Service data show $120 million in unclaimed federal Earned Income Tax Credits for 2019.

Juan Berrios, executive director of the tax assistance nonprofit SimplifyCT, said there are a few key reasons for people failing to collect what's owed them.

"I think it's really just about the level of information and misinformation that was out there during that timeframe," Berrios recounted. "If you recall, our government moved very swiftly, right, so the very first stimulus package was passed and then within a couple of weeks, people were actually getting their checks."

Some people could receive up to $6,700 from the federal Earned Income Tax credit alone, available to anyone who earned $64,000 or less in 2021. The expanded child tax credit is available for any family with children who have a valid social security number. The last day to claim or file for these 2021 missed credits is April 15, 2025.

Campaign feedback has been positive with many families grateful to claim the benefits. Berrios noted some have been leery of claiming the refunds since the credits typically apply to people who do not file their taxes but he added collecting refunds will not affect their benefits.

"Filing taxes does not affect government-provided benefits," Berrios emphasized. "The Child Tax Credit, the Earned Income Tax Credit and the third stimulus payment, they're not counted as income. They do not affect your other benefits that an individual or a family receives. And, also, it's very important to note that immigrants can also file taxes."

Berrios added given the chaotic state of the world in 2021 due to the pandemic, local tax preparers might not have been open or returns were done virtually. He acknowledged some might fear filing because they owe the IRS money or fear being penalized for not filing but if you're due a refund, you will not be penalized.


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