Category Archives: annual enrollment period

Why You Should Contact HICAP for Help Choosing a Medicare Prescription Drug Plan

Choosing a Medicare Prescription Drug Plan (PDP), which is also known as Part D, can feel overwhelming. With dozens of plans available, each with different premiums, deductibles, copays, and pharmacy networks, it’s easy to make a costly mistake.

As a Medicare Supplement (Medigap) insurance agent, I often get questions from clients who also want help selecting a Part D plan. While I’d love to help, I recently learned that helping someone choose or enroll in a Part D plan without proper certification could put my insurance license at risk. However, there’s a better option that is free, unbiased, and comprehensive through the Health Insurance Counseling and Advocacy Program (HICAP).

Many Insurance Agents Have Stopped Selling Prescription Drug Plans

If you’ve noticed that fewer independent agents are offering Medicare Prescription Drug (Part D) plans, you’re not imagining things. Over the past couple of years, the Centers for Medicare & Medicaid Services (CMS) has introduced an increasing number of onerous regulations that have made it extremely difficult for many agents to continue offering these plans, especially independent agents who value personal service and client relationships.

For example, CMS recently began requiring insurance agents to record every marketing, sales, and enrollment call related to Medicare Prescription Drug Plans (Part D). This means any discussion involving benefits, costs, or plan comparisons must be recorded, both inbound and outbound, and those recordings must be securely stored for 10 years. Agents don’t like this and many Medicare beneficiaries don’t want their conversations recorded.

While these rules were intended to protect consumers from misleading marketing, the burden of compliance has become overwhelming for many professionals in the field. For more detailed information, please click here to check out my other blog called “Why Many Insurance Agents Have Stopped Selling Prescription Drug and Advantage Plans,” and click here to to check out another related blog called “Why You May Be Better Off Choosing Your Own Medicare Prescription Drug Plan (Part D).”

Why an Insurance Agent Might Not Be Enough

Many insurance agents are only certified to sell PDP’s from certain insurance carriers, which means:

  • They may not have access to every plan available in your area.
  • Their guidance could be influenced by commissions or appointments, even unintentionally.
  • You may not get a complete picture of your options, which can lead to higher costs or gaps in coverage.

That’s where HICAP comes in.

What is HICAP and How It Helps

The Health Insurance Counseling and Advocacy Program (HICAP) is a free, state-run program in California that provides free, confidential one-on-one counseling, education, and assistance to individuals and their families on Medicare, Long-Term Care insurance, other health insurance related issues, and planning ahead for Long-Term Care needs.

HICAP also provides legal assistance or legal referrals in dealing with Medicare or Long-Term Care insurance related issues. HICAP counselors are trained in Medi-Cal and Medicare and can help you understand the complex insurance options to find the best fit for you.

HICAP counselors:

  • Can show all available Part D plans in your area.
  • Provide completely unbiased guidance, with no sales pressure.
  • Help you compare costs, deductibles, co-pays, and pharmacy networks.
  • Walk you through the Medicare Plan Finder tool or help you understand your plan options.

What HICAP Services Are Available?

HICAP can help you with the following:

  • Have questions on prescription drug coverage, co-pays, or eligibility rules?
  • Wondering how to sign up for Medicare now that you are almost 65?
  • Confused about all the different parts to Medicare, do you need A, B, C, D?
  • Need help filing an appeal or challenging a denial?
  • Considering long-term care insurance?
  • Need a speaker for a community education event?

How a HICAP Session Works

Whether over the phone or in person, the process is simple:

  • Prepare your information: Have a list of all your prescriptions, your preferred pharmacy, and your zip code.
  • Enter your own prescriptions: You input your medication information into Medicare.gov.
  • Guided support: The HICAP counselor explains your options, interprets plan details, and answers questions.
  • Compare plans: They help you see which plan offers the best coverage for your needs.
  • Enrollment: You complete the enrollment yourself online or by calling the plan.

Who Can Get These Services?

Counseling is provided to the following individuals:

  • Persons 65 years of age or older and are eligible for Medicare
  • Persons younger than age 65 years of age with a disability and are eligible for Medicare
  • Persons soon to be eligible for Medicare

Why HICAP is the Best Choice

HICAP counselors provide a full picture of your options, which an insurance agent cannot always do. Their guidance is independent, comprehensive, and free. This ensures you make an informed decision about your prescription coverage without missing important details or paying more than necessary.

Check Out My Video — How to Sign Up for a PDP on the Medicare Website

This past year, I created a step-by-step YouTube video that shows you how to use the Medicare Plan Finder tool. Nothing has changed since last year. Instead of contacting a HICAP counselor, you should be able to watch the video and be able to select a PDP and enroll on your own. It’s really very easy! Please click here to watch the video. It’s only 14 minutes long.

Next Steps

If you’re ready to compare Medicare Prescription Drug Plans for 2026:

  • Click here to watch my Youtube video that explains how to to use the Medicare Plan Finder tool to select a PDP and enroll on your own.
  • Call HICAP at 1-800-434-0222 or click here to find a local office in California.
  • In other states besides California, you can get help at your local State Health Insurance Assistance Program (SHIP). Their phone number is 1-877-839-2675 or click here to find a local office outside of California.

And if you have questions about Medicare Supplement (Medigap) plans, I’m here to help guide you through your options.

Conclusion

Choosing a Part D plan doesn’t have to be stressful. By using HICAP’s free, unbiased services, you can get all the information you need to make the best decision for your health and budget, while staying in control of the process.

About the Author

As an independent Medicare Supplement insurance specialist, I work with most of the major insurance carriers throughout California, Nevada, Arizona, and several other states. I shop around for my clients every year during their 60-day annual open enrollment period under the California Birthday Rule to help them save money on their Medicare Supplement premiums. Many of my clients have saved hundreds, even thousands of dollars on the same exact plan and coverage! Please click here to see what my clients have to say about my services.

There is no charge for my services as I’m compensated by the insurance carriers, not my clients. My goal is to help you find the lowest premiums and provide the best personal service possible, year after year. Unlike many agents, I won’t do a magic act and disappear after you sign up! 🙂

If you enjoyed this blog and found it helpful, please leave your comments, questions, or feedback below and feel free to share this article with your friends!

Thank you!

Ron Lewis
Ron@RonLewisInsurance.com
www.MedigapShopper.com
(760) 525-5769 – Cell
(866) 718-1600 – Toll-free

Why Many Insurance Agents Have Stopped Selling Prescription Drug and Advantage Plans

If you’ve noticed that fewer independent agents are offering Medicare Advantage (Part C) or Medicare Prescription Drug (Part D) plans, you’re not imagining things. Over the past couple of years, the Centers for Medicare & Medicaid Services (CMS) has introduced an increasing number of onerous regulations that have made it extremely difficult for many agents to continue offering these plans, especially independent agents who value personal service and client relationships.

While these rules were intended to protect consumers from misleading marketing, the burden of compliance has become overwhelming for many professionals in the field. Here’s a closer look at what’s changed and why it’s causing so many agents to step back.

The Call Recording Requirement

Perhaps the biggest change came when CMS began requiring agents and brokers to record every marketing, sales, and enrollment call related to Medicare Advantage plans (Part C) and Medicare Prescription Drug Plans (Part D). This means any discussion involving benefits, costs, or plan comparisons must be recorded, both inbound and outbound, and those recordings must be securely stored for 10 years.

That might sound simple, but for independent agents, it’s a major operational and financial challenge. Recording, encrypting, and storing every call securely requires specialized technology, data security systems, and compliance audits. If even one recording goes missing, an agent could face serious penalties. For small agencies and independent brokers, this rule alone has made it nearly impossible to operate efficiently.

Please click here for more specific details regarding marketing policies and FAQs for selling Medicare prescription drug and Medicare Advantage plans.

Increased Compliance and Oversight

CMS now classifies many independent agents and marketing organizations as Third-Party Marketing Organizations (TPMOs). Under these rules, agents must read lengthy government disclaimers at the start of every call or meeting, document every contact, and ensure all marketing materials are CMS-approved before use.

This includes websites, flyers, emails, and even social media posts that mention Medicare Advantage or Medicare Prescription Drug plans. Every piece of material must be filed through a formal process for review, which can take weeks. This makes it difficult for agents to respond quickly to client questions or market changes during the short Annual Election Period (AEP), which goes from October 15th through December 7th each year.

More Work, Less Reward

Despite the added workload and responsibility, commissions have not increased to reflect these changes. Agents still receive modest compensation for enrolling people in Medicare Prescription Drug plans and Medicare Advantage plans. So now, agents face hours of compliance documentation, call recording, and potential liability without a corresponding increase in pay. For many, it simply isn’t worth the time, risk, or stress. For more details, please click here to read my other blog called “Why You May Be Better Off Choosing Your Own Medicare Prescription Drug Plan (Part D)”

The Risk of Liability

Another issue driving agents away is the potential legal exposure. With every recorded call and piece of marketing material subject to audit, a single accidental error, like forgetting to read a required disclaimer, can lead to fines or the loss of certification.

Most agents take pride in helping clients find the best coverage possible, but with these new rules, even honest mistakes can be costly. It’s a high-stress environment for people who genuinely care about their clients.

A Shift Back to Personalized Service

Because of all this, many experienced agents are now focusing primarily on Medicare Supplement (Medigap) plans. These plans are not part of the CMS marketing system that governs Medicare Advantage and Prescription Drug plans, which means agents can provide clients with more individualized service and guidance without jumping through as many regulatory hoops.

With Medigap plans, clients get lifelong coverage that works seamlessly with Original Medicare, and agents can continue to provide the personalized advice and service that has always been the heart of this profession.

What This Means for You

If you are a Medicare beneficiary, you might notice fewer agents offering to review your Medicare Prescription Drug plans or Medicare Advantage plans this year. It’s not because they don’t care… it’s because the rules have made it nearly impossible to do so efficiently or profitably while still providing the level of service clients deserve.

The good news is that you can still review and compare these plans directly on the Medicare.gov website. The site allows you to enter your prescriptions, preferred pharmacies, and ZIP code to find the most cost-effective options in your area.

IMPORTANT: Medicare Prescription Drug plans and Medicare Advantage plans are annual contracts and they can change from year to year. What’s good this year may not be so good next year and it’s important to shop around every year!

Shopping for and signing up for a prescription drug plan isn’t difficult. I made a short video this past year that explains how to choose and sign up for a prescription drug plan. If you’d like to watch the video, please click here.

Final Thoughts

The Medicare program is complex and constantly changing. Most agents truly want to help people understand their options, but the ever-growing CMS compliance burden has pushed many out of this side of the business.

Although I’m an independent insurance agent focusing primarily on Medicare Supplement insurance, if you’re looking for unbiased help reviewing your options, please don’t hesitate to reach out. Even though I don’t sell Medicare Prescription Drug plans or Medicare Advantage plans, I’m happy to help you understand how they work and guide you toward resources that can help you make the best decision for your needs.

In my next post, I’ll explain why many Medicare beneficiaries are actually better off by NOT using an insurance agent to help them select their Medicare Prescription Drug plan and how they can easily and safely select a drug plan on their own using the Medicare.gov website.

About the Author

As an independent Medicare Supplement insurance specialist, I work with all the major carriers throughout California, Nevada, and several other states. I shop around for my clients every year during their 60-day annual open enrollment period under the California Birthday Rule to help them save money on their Medicare Supplement premiums. Many of my clients have saved hundreds—even thousands—of dollars on the same exact plan and coverage! Please click here to see what my clients have to say about my services.

There is no charge for my services; I’m compensated by the insurance carriers, not my clients. My goal is to help you find the lowest premiums and provide the best personal service possible, year after year. Unlike many agents, I won’t disappear after you sign up!

If you enjoyed this blog and found it helpful, please leave your comments, questions, or feedback below and feel free to share this article with your friends!

Thank you!

Ron Lewis
Ron@RonLewisInsurance.com
www.MedigapShopper.com
(760) 525-5769 – Cell
(866) 718-1600 – Toll-free

Why You May Be Better Off Choosing Your Own Medicare Prescription Drug Plan (Part D)

If you’ve ever tried to compare Medicare Prescription Drug Plans (PDPs), also known as Medicare Part D, you know how confusing it can be. There are dozens of options, and each plan has its own list of covered drugs (called a formulary), preferred pharmacies, and cost structure. What looks like a small difference in co-pays or premiums can easily add up to hundreds of dollars over the course of a year.

Why Most Agents No Longer Sell Prescription Drug Plans

You might assume that a licensed insurance agent can help you find the best plan, and in the past, many could. However, today’s system makes that much more difficult. Because of how Medicare’s certification and contracting rules work, most independent agents are not certified with every drug plan available in your area. They can only recommend or enroll you in a limited number of specific plans they are contracted with and certified to sell.

If another company offers a plan with lower co-pays or better coverage for your medications, your agent may not even be allowed to discuss it with you. Why? Because they don’t get paid for selling plans they’re not certified or contracted to represent. Even if they know a different plan would save you money, compliance rules and commission structures prevent them from showing it to you.

The Hidden Time and Cost Burden on Agents

Before an agent can help anyone with a PDP or a Medicare Advantage (MA) plan, they must complete extensive training and certification every year. This starts with the AHIP certification exam, which takes many agents 10–20 hours of study time to complete. The AHIP exam covers topics such as Medicare compliance, plan rules, CMS marketing guidelines, etc.

But that’s only the beginning. Agents must also spend time studying and taking individual certification exams for EVERY insurance company whose plans they want to sell. Each carrier’s certification process is different. Some require several hours of training, testing, and annual renewal. Altogether, a well-rounded agent could easily spend 50+ hours each year just keeping up with certifications before they can even begin helping clients.

Then there are the CMS compliance rules, which now require all sales calls related to PDPs and MA plans to be recorded and stored securely for 10 years! The added administrative burden and potential liability make it even less practical for agents to offer these plans, especially since commissions for prescription plans are typically under $100 per year per client. Many agents have simply decided that it’s not worth the time and effort.

How You Can Shop and Enroll in a Drug Plan On Your Own

Fortunately, Medicare makes it easy for you to shop around on your own and sign up for a prescription drug plan at www.Medicare.gov by using the exact same tool that agents use.

This past year, I put together a short video that explains how to shop for and sign up for a Medicare prescription drug plan using the Medicare Plan Finder tool. It’s actually very easy, and there aren’t any significant changes since last year. Please click here to watch the video.

The Medicare Plan Finder is available 24/7 and it is updated every fall with the latest plan information. It allows you to make an informed decision without pressure or bias, and without worrying whether your agent is certified to sell a particular plan.

Review Your Coverage Each Fall

Even if you’re happy with your current PDP, it’s important to review your coverage each year during the Annual Election Period (AEP), which goes from October 15th through December 7th each year. PDPs are annual contracts, and drug prices, plan premiums, and pharmacy networks can change every year. What’s good this year may not be so good next year.

It only takes about 15 to 20 minutes to shop around and review your PDP options, and it could save you literally hundreds of dollars and ensure you have the right coverage for your specific prescriptions.

The Bottom Line

Most Medicare agents are honest, hardworking professionals who want to help their clients, but the system is stacked against them when it comes to prescription drug plans. Between certification costs, compliance rules, and low commissions, many agents have chosen to focus on Medicare Supplements, Medicare Advantage plans, or other types of insurance products instead.

By learning how to shop for your own prescription drug coverage at Medicare.gov, you can take control of your health care costs, stay informed, and make sure you’re always getting the best prescription drug plan every year.

About the Author

As an independent Medicare Supplement insurance specialist, I work with all the major carriers throughout California, Nevada, and several other states. I shop around for my clients every year during their 60-day annual open enrollment period under the California Birthday Rule to help them save money on their Medicare Supplement premiums. Many of my clients have saved hundreds, even thousands of dollars on the same exact plan and coverage! Please click here to see what my clients have to say about my services.

There is no charge for my services as I’m compensated by the insurance carriers, not my clients. My goal is to help you find the lowest premiums and provide the best personal service possible—year after year. Unlike many agents, I won’t disappear after you sign up!

If you enjoyed this blog and found it helpful, please leave your comments, questions, or feedback below and feel free to share this article with your friends!

Thank you!

Ron Lewis
Ron@RonLewisInsurance.com
www.MedigapShopper.com
(760) 525-5769 – Cell
(866) 718-1600 – Toll-free

Medicare Advantage Plans – Do the Advantages Outweigh the Disadvantages?

The Annual Election Period (AEP) is from October 15th through December 7th each year. During this annual open enrollment period, you can sign up for or change your Medicare Advantage (MA) plan or your Prescription Drug Plan (PDP). Medicare Advantage and prescription drug plans are annual contracts, and they can change from year to year. Therefore, you should shop around and compare plans every year.

NOTE: If you have a Medicare Supplement, the AEP does not apply to you unless you want to enroll in or change your PDP.

If you have an MA plan and you want to change to a different MA plan, or if you want to leave your MA plan and switch back to Original Medicare, Part A (Hospital insurance) and Part B (Medical insurance), you would normally do so during the AEP. The new coverage will begin on January 1st of the following year. In most cases, you must stay enrolled in your MA plan for the calendar year beginning in January or on the date your coverage begins. However, in certain situations, you may be able to join, switch, or drop an MA plan during a Special Enrollment Period (SEP), such as if you move out of your plan’s service area, etc.

open-enrollment

Pros and Cons – Medicare Supplements Versus Medicare Advantage Plans

When it comes to Medicare Advantage (MA) plans, I’m going to be totally honest and admit to you that I am biased because I don’t like them! Unless you can’t afford to pay the monthly premium for a Medicare Supplement (aka Medigap), I would NEVER recommend or advise someone to give up their Original Medicare rights (Part A and Part B) and sign up for an MA plan!

If you currently have an MA plan, or if you are thinking about signing up for one, I would strongly recommend that you read this article first so that you can make an “informed decision” about whether an MA plan is right for you and in your best interest.

There are pros and cons to each, but the benefits of having a Medicare Supplement plan far outweigh the benefits of having an MA plan. Please click here for a detailed comparison between Original Medicare and Medicare Advantage plans.

medicare-advantage-vs-medigap-boxes

MA Plan Advantages

Here are some of the benefits of having an MA plan:

  • MA premiums can be very low, and some plans have no monthly premiums at all.
  • Some MA plans include Medicare prescription drug coverage (Part D).
  • Maximum out-of-pocket (OOP) costs are limited. Plans vary, but in 2025, the most you can pay for in-network OOP costs is $9,350 per calendar year. If you go out of network, you would normally pay all costs! (I wouldn’t really call this a benefit since $9,350 is a lot of money, and the most you would pay in OOP costs with a Plan G Medicare Supplement is the Medicare Part B deductible, which is currently $240 per calendar year in 2024! The Medicare Part B deductible for 2025 is projected to be $257. However, the Centers for Medicare & Medicaid Services (CMS) will not finalize the deductible until fall 2024.)
  • Some MA plans offer additional benefits such as vision, hearing, dental, and other health and wellness programs. (Some Medicare Supplement plans also offer additional benefits such as free gym memberships, vision, and hearing aid benefits.)

Medicare Supplement Plan Advantages

Here are some of the benefits of having a Medicare Supplement plan:

  • You have much more FREEDOM of choice with a Medicare Supplement than you do with an MA plan because you can go to ANY doctor, hospital, specialist, care facility, etc. in the United States as long as they accept Medicare, and most do, about 93%. (You can’t do that with an MA plan.)
  • You have much for financial stability with a Medicare Supplement than an MA plan because there are no unexpected expenses for deductibles, co-payments, hospitalizations, surgeries, chemotherapy, etc.
  • With a Plan G Medicare Supplement, other than your premiums, your maximum OOP cost in the 2025 calendar year will be no more than the Part B deductible, which is currently projected to be around $257. With an MA plan, your in-network maximum OOP “in-network” costs can be as high as $9,350! If you go out of network, your costs can be significantly higher.

NOTE: The Medicare Part B deductible is payable only one time per calendar year. If you’ve already met that deductible, you won’t have any other costs for Medicare-approved charges for the rest of the year.

  • You are not limited to a specific geographic region or a restrictive network of doctors, hospitals, specialists, care facilities, etc. like you are with an MA plan. Most MA plans are HMO’s and you will normally pay all costs if you go out of network.
  • With a Medicare Supplement, you can go directly to the specialist of your choice, ANYWHERE in the United States, as long as they accept Medicare. Most MA plans require you to go through a primary care doctor first and get permission to see a specialist within the local, geographic network.
  • Unlike MA plans, there are no HMO or PPO plans or networks with Medicare Supplements. You can go to any doctor or specialist in the US as long as they accept Medicare.
  • If you want to go to a renowned treatment center such as the MD Anderson Cancer Treatment Center in Texas, you can do so with any Medicare Supplement, as long as they accept Medicare. You can’t do that with most MA plans.
  • If you move to another part of the country, you can keep your Medicare Supplement, but you cannot keep your MA plan if you move out of your network.
  • There are only 10 “standardized” Medicare Supplement plans to choose from,  (Plan A through Plan N). Since Medicare Supplements are standardized, the coverage and benefits for every Plan G, etc. is exactly the same with every insurance carrier, so it’s much easier to shop around and compare “apples with apples.” MA plans are not standardized, and the co-payments, deductibles, out of pocket costs, etc. vary between MA plans, and they change every year making them unnecessarily complicated and confusing.
  • A Medicare Supplement plan cannot be cancelled as long as you pay your premiums. MA plans are annual contracts, and they can be cancelled or benefits changed at the end of each calendar year.
  • There is no Annual Election Period (AEP) for Medicare Supplements, and you don’t have to shop around every year and make sure that your coverage, co-payments, co-insurance, deductibles, and benefits haven’t changed since the previous year. If there are any Medicare changes from one calendar year to the next, your Medicare Supplement will automatically pay the difference.
  • Medicare Supplements are “portable” meaning that you can keep them and take them with you if you travel to another state or if you move to another state, and your Medicare Supplement cannot be cancelled for leaving your “service area.” With most MA plans, if you travel outside of the MA plan’s service area for more than six months, you could be dis-enrolled from the plan.
  • With a Plan G Medicare Supplement, there are no co-payments when you go to the doctor. With most MA plans, you have to pay co-payments every time you see a doctor.
  • You can switch Medicare Supplement plans or Medicare insurance carriers any time of the year as long as you meet minimum health and underwriting requirements. With an MA plan, you can only join or leave an MA plan during the AEP or a SEP. Otherwise, you are locked into your MA plan for the entire calendar year.

NOTE: In California, there is a law called the California Birthday Rule. Under this law, if you have a Medicare Supplement, you can change it every year during the 60 days following your birthday to any other Medicare Supplement plan with “equal or fewer” benefits. For example, if you have Plan G, you can switch to Plan G with any other insurance carrier, regardless of your health. If you have Plan G, you can also switch to Plan N because Plan N has fewer benefits than Plan G, etc. Under the birthday rule, you just can’t switch from a plan with fewer benefits to greater benefits.

As you can see from the facts mentioned above, the benefits of having a Medicare Supplement far outweigh the benefits of having a Medicare Advantage plan.

Are Some Medicare Advantage Plans Really Free?

Because some MA plans have very low monthly premiums or no monthly premiums at all, some unscrupulous individuals promote them as “FREE” Medicare insurance plans, which is inaccurate, misleading, and, in my opinion, unethical. During the AEP, there are a lot of commercials for MA plans on TV. If you listen carefully, the one thing you’ll NEVER hear them mention is the maximum out-of-pocket costs for those plans. In 2025, in-network OOP costs can be as high as $9,350, and if you go out of network, you can pay significantly more!

Also, regardless of whether you have an MA plan or a Medicare Supplement plan, you still have to pay the monthly Medicare Part B premium, which is currently $174.70 per month for most people in 2024. The Medicare Part B premium in 2025 hasn’t been released yet, but it is estimated to be around $185.00 per month.

medicare-advantage-pig

You Can Always Get a Medicare Advantage Plan But You Can’t Always Get a Medicare Supplement Plan

MA plans are adequate as long as you are healthy, but if your health should change and you develop a serious illness, you will wish that you had a Medicare Supplement instead of an MA plan because you will have much more freedom of choice and control over your health care with a Medicare Supplement!

Original Medicare (Part A and B) only cover about 80% of medical and hospital costs and Medicare Supplements pick up most of the remaining 20%. During the AEP, you can always switch from a Medicare Supplement to an MA plan, regardless of your health, and you can always switch from an MA plan back to Original Medicare (Part A and Part B), regardless of your health. However, if you switch back from an MA plan to Original Medicare during the AEP, there is no guarantee that you can get a Medicare Supplement as you must be in good health, answer health questions, and be medically underwritten to be approved. If you have any serious health issues, more than likely, you won’t be able to get a Medicare Supplement.

NOTE: There are some situations where you can switch from an MA plan to a Medicare Supplement as a “guaranteed issue” without answering any health questions or going through medical underwriting. If you are in this situation, please let me know.

Also, if you are in the first year of your MA plan, you are guaranteed the right to switch back to a Medicare Supplement during the first 12 months. This is called a trial right. The trial period gives you a year to try an MA plan and see if it’s right for you. If you decide it’s not, you are guaranteed the right to switch back to original Medicare (Parts A and B) and purchase a Medicare Supplement plan.

The Maximum Out of Pocket Cost for MA Plans Can Be Twice As Much As You Think

Depending on which MA plan you have, the most you would pay for in-network out-of-pocket (OOP) costs in 2025 is $9,350 per calendar year! If you go outside of your plan’s network, you will pay even more than that!

Now suppose that you get really sick and need expensive treatment in the second half of the year. You could end up paying up to $9,350 (or whatever your plan’s maximum OOP cost is) by the end of the calendar year, but your OOP maximum zeros out in January, and it starts all over again! You could potentially end up paying your OOP TWICE in a 12-month period!

Conclusion

If you have an MA plan, you give up your Original Medicare (Part A and Part B) rights and you compromise your freedom of choice to go to the best doctors, specialists, hospitals, care facilities, etc. throughout the United States. Unless you are impoverished and can’t afford to pay the monthly premium for a Medicare Supplement, I would never recommend an MA plan to a friend or family member as you are always better off with a Medicare Supplement.

I’m an independent insurance agent, not a captive agent, and I work with most of the major insurance carriers. I shop around for my clients, every year, and I will shop around for you too! If you have any questions or if you have an MA plan and would like for me to help you switch to a Medicare Supplement plan, please let me know! And if you have a Medicare Supplement, I’m happy to shop around for you to save you money on your premiums!

There’s no such thing as free Medicare insurance! As the old expression goes… “You get what you pay for!”

you-get-what-you-pay-for

If you liked this blog and found it informative, please click the “Like” button, and please send me your questions, comments, or feedback! And please feel free to share this article with your friends!

Thank you!

Ron Lewis
Ron@RonLewisInsurance.com
www.MedigapShopper.com
(760) 525-5769 – Cell
(866) 718-1600 – Toll-free

The California Birthday Rule

If you are a California resident and you have a Medicare Supplement, aka a “Medigap” plan, I have good news for you! Under a law called the California Birthday Rule, you have 60 days of “open enrollment” following your birthday each year when you can change your Medigap plan, REGARDLESS OF YOUR HEALTH. During this period, there are no health questions to answer, no medical underwriting or waiting periods, and YOU CANNOT BE TURNED DOWN FOR COVERAGE! To qualify, the new plan must have “equal or fewer” benefits as your current policy.

For example, if you have Plan G, you can switch to Plan G with any other insurance carrier or you could switch to Plan N since Plan N has fewer benefits than Plan G. You just can’t switch from Plan N to Plan G, etc. under the birthday rule because Plan N has fewer benefits than Plan G.

NOTE: In California, most insurance carriers will let you apply during the 30 days before your birthday up to 60 days after your birthday, so in reality, you have a 90-day open enrollment period each year.

You can change your Medigap plan any time of the year, but if you do so around your birthday, it’s a lot easier because you don’t have to answer any health questions on the application and you can’t be turned down for coverage.

The Annual Election Period

There is another open enrollment period called the Annual Election Period (AEP) that goes from October 15th through December 7th every year. This open enrollment period has nothing to do with Medigap plans. It’s only for people with Medicare Advantage (MA) plans and/or Prescription Drug Plans (PDPs). If someone has an MA plan or a PDP, the AEP is the time to shop around and change those plans. The new coverage would begin on January 1st of the following year.

During the AEP, you can always switch from a Medigap plan to an MA plan, but there is no guarantee that you can switch from an MA plan to a Medigap plan. If someone has an MA plan, they are guaranteed the right to switch back to Original Medicare, which is Medicare Part A (Hospital insurance) and Part B (Medical insurance). However, they are not guaranteed the right to get a Medigap plan unless they are in a special enrollment period (SEP) that allows them to do so.

For example, if someone had an MA plan for the first time and they have had it for less than one year, they would be in a SEP, and they could still get a Medigap plan. Otherwise, they would have to answer health questions, be medically underwritten, and they could be turned down for certain types of health conditions.

NOTE: Medicare Part A and Part B cover approximately 80% of medical and hospital costs, so most people will get a Medigap plan to pick up most of the remaining 20% of the costs that are not covered by Medicare.

Most States Don’t Have a Birthday Rule

Most states don’t have a birthday rule, so the California Birthday Rule is definitely very beneficial for California residents because if your health should change, or if your rates go up significantly, or if you are not happy with your plan or insurance carrier, etc., you can always change to a different plan or insurance carrier, REGARDLESS OF YOUR HEALTH, every year around your birthday. In contrast, for those living in a state without a birthday rule, you could be stuck with your current Medigap plan, insurance carrier, high monthly premium, etc.

NOTE: Some states have recently added their own version of a birthday rule such as Idaho, Illinois, Louisiana, Maryland, Nevada, and Oregon. Besides the birthday rule, other states offer guaranteed issue protections for changing Medigap plans including Connecticut, Maine, Massachusetts, Missouri, New York, Rhode Island, and Washington. Each of these states have their own rules and requirements for changing Medigap plans, which are beyond the scope of this article.

When is the Best Time to Apply For New Coverage Under the California Birthday Rule?

In California, Medigap rates are based primarily on your age and zip code. Other factors that can affect the rate is if you use tobacco products and whether you live alone or with someone else in the household. Under the California Birthday Rule, most insurance carriers base their rates on your age after your birthday, but a couple carriers base their rates on your age on the date your application is submitted and signed. This one year age difference can make a big difference in the rate so for this reason, I normally recommend checking Medigap rates during the 30 days before your birthday each year.

Under the birthday rule, the new effective date is usually the 1st of the month following your birthday. For example, if your birthday is June 3rd, the new effective date would normally be July 1st, etc.

IMPORTANT: I shop around for my clients every year around their birthday to take advantage of the California Birthday Rule. If you aren’t a client of mine, and you would like for me to shop for you too, please let me know. As an independent agent, I work with all the major insurance carriers, and there’s no charge for my service!

10 Standardized Plans To Choose From

Nationwide, there are 10 standardized Medigap plans to choose from with lettered names, Plan A through Plan N. The term “standardized” means that the coverage and benefits for every Plan F, Plan G, Plan N, etc. are exactly the same no matter what carrier you are with. In other words, Plan G with Anthem Blue Cross is exactly the same as Plan G with Blue Shield of California, etc. Plan G is Plan G, Plan N is Plan N, Plan F is Plan F, etc.

As of January 1st, 2020, Medigap plans purchased by individuals who are turning 65 or who are new to Medicare can no longer cover the Part B deductible, which is currently $240 in 2024. (That amount can change from year to year.) Because of this, Plan C and Plan F aren’t available to people who are new to Medicare on or after January 1st, 2020.

NOTE: If you turned 65 before January 1st 2020 or you were eligible for Medicare before then, you can still get Plan F and Plan C. Those plans just aren’t available for those individuals who turned 65 after January 1st, 2020, etc.

Medigap Plans Are Standardized but Medigap Premiums Are Not Standardized

Although the coverage and benefits for all Medigap plans are standardized, the premiums for these plans are not standardized, and the rates vary significantly from one insurance carrier to another for the same identical plan and coverage.

For example, for a 72 year old female living in Encinitas, CA in the 92024 zip code, Plan G rates currently range from $178 to $280 per month for the same exact plan and coverage! That’s a difference of $102 per month or $1,224 per year! Since the monthly premiums vary significantly between insurance carriers, it’s important to shop around periodically.

The Application Process

Today, almost all Medigap insurance carriers in California use online applications that the agent completes. I work with clients throughout California and in several different states, so it’s not necessary to meet in person. The application process is simple, and it usually takes less than 15 minutes to complete.

In addition to the application, under the California Birthday Rule, most insurance carriers require some kind of proof that you currently have a Medigap plan. A copy of your Medicare Supplement card or a recent bill showing which plan you currently have (Plan G, etc.) is sufficient. Once the application has been submitted, the entire application process normally takes a couple of days to a week to complete since there is no medical underwriting. Underwritten applications usually take longer. After you are approved, you should contact your current Medigap insurance carrier to let them know that you will be canceling your old policy when your new policy begins.

CAUTION – Some Insurance Carriers Are Better Than Others!

In addition to finding an insurance carrier with competitive rates, you also have to be careful to choose a good insurance carrier because not all carriers are the same. Although the coverage and benefits for Medicare Supplement plans are standardized and the same, not all insurance carriers are the same; some are better than others!

For example, some insurance carriers will give you a 12-month rate lock and some don’t. Some have better financial ratings than others. Some will give you up to a 12% household discount if you live with someone else in your household, and some don’t. Some have much better customer service than others. Some have call centers in the US and some are overseas. Some provide free gym memberships and some don’t, etc. Price is important, but there are also other factors to consider when choosing a Medigap plan.

For More Information

As an independent insurance agent, I work with the major insurance carriers in California, Nevada, Arizona, and Washington state. I’m not limited to one particular insurance carrier. I shop around for my clients, every year, to find them the best rates, and I’m happy to shop for you too!

If you have any questions about the California Birthday Rule, etc. or if you would like a free, no-obligation Medicare Supplement quote, please don’t hesitate to let me know. There is no charge for my services as I am compensated by the insurance carriers, not my clients!

My contact information is below, and please click here to check out what my clients have to say about me. If you feel that the information in this blog would be helpful to a friend or family member, please feel free to pass it on and please feel free to add your comments below!

Thank you!

Ron Lewis
CA agent #0B33674
NV agent #3822123

Ron@RonLewisInsurance.com
866.718.1600 (Toll-free)
760.525.5769 (Cell)
www.MedigapShopper.com

If You’re Losing Your Scripps Medicare Advantage Coverage… Don’t Panic!

Scripps Will No Longer Accept Medicare Advantage HMO Plans In 2024

Scripps recently began notifying about 32,000 Medicare beneficiaries that beginning on January 1st, 2024, the Scripps Clinic and Scripps Coastal medical groups will no longer accept Medicare Advantage (MA) HMO plans from carriers such as Anthem Blue Cross, Blue Shield of California, Health Net, UnitedHealthcare (UHc), etc. However, doctors from Scripps Clinic and Scripps Coastal will continue to accept Original Medicare Part A (Hospital insurance) and Part B (Medical insurance) as well as Medicare Supplement insurance, aka Medigap.

NOTE: Although Scripps will no longer accept MA HMO plans, I called and asked if they will accept MA PPO plans. I was told that individuals with MA PPO plans can still go to Scripps and see their doctors with those plans, BUT they will be billed as “out of network” instead of “in network” meaning that those individuals could have very high out-of-pocket costs if they continue going to Scripps with MA PPO plans.

If you have to pay out-of-network costs for your MA PPO plan, they are very expensive. In the 92024 zip code, there are 66 MA plans offered in 2024. Of those plans, 56 are HMO’s, and 10 are PPO’s, which are shown below. As you can see, the in-network and out-of-network costs are very expensive for all of the MA PPO plans.

In and Out of Network Costs for 2024 MA PPO Plans Offered In the 92024 (Encinitas) Zip Code:

AARP Medicare Advantage from UHC CA-0035 (PPO)
$9,550 In and Out-of-network
$4,500 In-network

Aetna Medicare Choice Plan (PPO)
$8,950 In and Out-of-network
$5,500 In-network

Aetna Medicare Core Plan (PPO)
$8,900 In and Out-of-network
$3,900 In-network

Aetna Medicare Eagle Plus Plan (PPO)
$9,500 In and Out-of-network
$6,700 In-network

Alignment Health AVA (PPO)
$8,950 In and Out-of-network
$3,900 In-network

Blue Shield Select (PPO)
$8,950 In and Out-of-network
$4,200 In-network

Humana USAA Honor (PPO)
$9,550 In and Out-of-network
$5,900 In-network

Humana USAA Honor with Rx (PPO)
$9,050 In and Out-of-network
$6,100 In-network

HumanaChoice H5525-076 (PPO)
$7,000 In and Out-of-network
$3,900 In-network

HumanaChoice H5525-077 (PPO)
$8,900 In and Out-of-network
$5,900 In-network

If you get seriously sick with one of these MA PPO plans, you can still end up with very high out-of-pocket costs, even if you stay in-network!

The Problem

More than half of the nation’s seniors have MA plans, but many hospitals and care facilities throughout the country are dropping MA plans altogether. Some of the most common reasons are because of excessive prior authorization denial rates and slow payments from insurers. Also, some MA insurers have faced allegations of billing fraud from the federal government, and they are being investigated by lawmakers over their high denial rates. Please click here to read “Kaiser Permanente Sued By Federal Government Over Alleged Medicare Fraud.”

According to Chris Van Gorder, president and CEO of Scripps Health, “It’s become a game of delay, deny and not pay. The health system is facing a loss of $75 million this year on the MA contracts, which will end Dec. 31 for patients covered by UnitedHealthcare, Anthem Blue Cross, Blue Shield of California, Centene’s Health Net and a few more smaller carriers. If other organizations are experiencing what we are, it’s going to be a short period of time before they start floundering or they get out of Medicare Advantage. I think we will see this trend continue and accelerate unless something changes.” For more information, please click here to read “Hospitals are dropping Medicare Advantage left and right” by Jakob Emerson.

Scripps Health released a statement explaining the reason for their decision. “Scripps has long served seniors and others in our community who are enrolled in Medicare and Medicare Advantage plans. Scripps and health systems across the country are facing unprecedented financial pressures. We are looking at all we do and, when necessary, making difficult decisions to ensure that we can continue to meet the needs of the community we serve. The revenue from Medicare Advantage plans is not sufficient to cover the cost of the patient care we provide.”

Understandably, many Scripps’ patients with MA plans are upset and panicking. If they keep their MA plans, they will no longer be able to keep the the same doctors and specialists they have been going to at Scripps, and they will have to go somewhere else and find new doctors. For those who are undergoing serious procedures such as cancer treatment, etc., this is not a viable option.

Scripps’ Patients Have Three Choices

If you are a Scripps patient with an MA plan, you have three choices for 2024:

  • You can keep your MA HMO plan (or switch to a different MA HMO plan), but if you do, you will not be able to go to Scripps Clinic or Scripps Coastal in 2024, and you must find new doctors.
  • You can keep your MA PPO plan (or switch from a MA HMO to a MA PPO plan, and continue going to Scripps and seeing your regular doctors, but you will incur very high out-of-pocket in-network and out-of-network costs.
  • The third and best option, in my opinion, is to switch back to Original Medicare (Part A and Part B) and get a Medicare Supplement plan.

With the third option, you can continue going to Scripps in 2024 and you can still go to the same doctors, specialists, etc. that you have been going to in the past. For those who are undergoing any serious medical procedures, such as cancer treatment, etc., you will continue in January 2024 with no changes or interruption in service or treatment.

When To Make These Changes

The time to make any of these changes is during the upcoming Annual Enrollment Period (AEP), which begins on October 15th and ends on December 7th every year.

If you want to keep your current MA plan, you don’t have to do anything (as long as it is still being offered in 2024). If you have an MA plan and want to switch to a different MA plan, you must do so during the AEP. You can also apply for or change your Prescription Drug Plan (PDP) or switch back to Original Medicare (Part A and Part B) during the AEP.

NOTE: If you have a Medicare Supplement, the AEP does NOT apply to you unless you want to enroll in or change your PDP. You can change your Medicare Supplement any time of the year.

The Solution

If you would like to continue seeing your doctors at Scripps in 2024, your only option is to drop your MA plan, switch back to Original Medicare, and get a Medicare Supplement. Normally, when you switch from an MA plan to a Medicare Supplement, you must answer health questions and go through medical underwriting. If you have a serious health condition such as cancer, etc., you will not be approved for coverage.

And Now For The Good News!

For all Scripps’ patients that have any kind of a Medicare Advantage plan (HMO or PPO), you can get a Medicare Supplement beginning on 1/1/24 to replace your MA plan REGARDLESS OF YOUR HEALTH! Because of this current situation with Scripps, you will be in a “Guaranteed Issue” situation meaning that you can get the best Medicare Supplement plan available, Plan G, without answering any health questions or being medically underwritten! As a Guaranteed Issue, YOU CANNOT BE TURNED DOWN FOR COVERAGE!

NOTE: With a Plan G Medicare Supplement, your only out-of-pocket cost for the entire calendar year is the Medicare Part B deductible, which will be $240 for all of 2024!

For example, with a Plan G Medicare Supplement, if you have multiple doctor visits, a couple of surgeries, and a hospital confinement in 2024, all you would pay is the $240 Part B deductible and that’s all! That’s a lot better and cheaper than the in-network and out-of-network maximums with MA plans!

Plus, with a Medicare Supplement, you can go to any doctor, specialist, care facility, hospital, etc. ANYWHERE in the US as long as they accept Medicare, and most do, about 93%. If you want to see a specialist, you can go directly to any specialist you want, anywhere in the country. With an MA plan, you must go to your primary care doctor first and get permission to see a specialist that’s in your local network, etc. You have much more freedom of choice with a Medicare Supplement than you do with an MA plan.

Other Guaranteed Issue Situations

There are other Guaranteed Issue situations that will qualify anyone with an MA plan to be able to bypass underwriting and get a Medicare Supplement as a guaranteed issue, REGARDLESS OF THEIR HEALTH. Regardless of your situation with Scripps, everyone with an MA plan should have received their Annual Notice of Change (ANOC) by now. The ANOC is a notice you receive from your Medicare Advantage or Prescription Drug Plan (PDP) every year in late September. The ANOC provides a summary of any changes in the plan’s costs and coverage that will take effect on January 1st of the following year.

If your MA plan did any of the following, you are in a guaranteed issue situation, which will allow you to get a Medicare Supplement, regardless of your health:

  • If your MA plan increased your premium or co-payments by 15% or more from this year to next year.
  • If your MA plan reduced any of your benefits next year from what they are this year.
  • If your MA plan terminated its relationship with your medical provider or the certification of the organization or plan has been terminated, such as Scripps.

Are Medicare Supplement Plans Expensive?

Many people are under the incorrect impression that Medicare Supplement plans are very expensive. I guess that’s kind of a relative question. In California, rates are based primarily on age and zip code, and rates normally go up as we get older.

Nationwide, there are 10 standardized Medicare Supplement plans to choose from, Plan A through Plan N. The term “standardized” means that coverage and benefits for every Plan G, Plan N, etc. are exactly the same, regardless of what insurance carrier you are with. In other words, Plan G is Plan G, Plan N is Plan N, etc. Although these plans and coverage are standardized (exactly the same), the rates are not standardized and prices vary significantly from one insurance carrier to another. For example, in the 92024 zip code (Encinitas), the Plan G rate for a 70 year old ranges from $158.29 per month with Cigna up to $262.04 per month with Humana!

As mentioned before, Plan G is the best Medicare Supplement plan offered today because your only out-of-pocket cost for the entire year is the Medicare Part B deductible, which will be $240 in 2024. As an independent agent, I work with all the major insurance carriers, and I shop around for my clients, every year, to find them the best rates as well as the best insurance carriers.

Do You Want to Change Your MA Plan to a Medicare Supplement Plan?

If you would like to switch from your MA plan to a Medicare Supplement in 2024, I can help you! Please call, text, or email me. My contact information is below. Please send me your birth date, zip code, and whether you live alone or if you have lived with someone else for longer than a year, and I can let you know what the best Medicare Supplement rates are for your age and zip code.

NOTE: Some carriers will give you a household discount (HHD), up to 12%, just for living with someone, even if they don’t have a plan. If this applies to you, please let me know their exact age.

If you’d like to apply for a Medicare Supplement, I can handle everything for you, and there is no charge for my service. If you have any questions or would like a no-obligation quote, please don’t hesitate to let me know.

Thank you!

Ron Lewis
CA agent #0B33674
NV agent #3822123

Ron@RonLewisInsurance.com
866.718.1600 (Toll-free)
760.525.5769 (Cell)
www.MedigapShopper.com

Medicare Prescription Drug Plans

When Is the Best Time To Sign Up For a Medicare Prescription Drug Plan?

If you are eligible for Medicare, you can generally sign up for Medicare Part D, also known as a Medicare Prescription Drug Plan (PDP) during the Initial Enrollment Period (IEP), which is the 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

In addition, you can also sign up for a Medicare PDP during the Annual Enrollment Period (AEP), which runs from October 15th through December 7th each year. During this period, you can join, switch, or drop your Medicare PDP.

NOTE: The AEP is the annual open enrollment period to change prescription drug plans and Medicare Advantage plans, not Medicare Supplement plans. If you have a Medicare Supplement, you can change it any time of the year. If you change your Medicare PDP or your Medicare Advantage plan during the AEP, the new coverage will begin on January 1st of the following year.

If you don’t enroll in a Medicare PDP during your IEP or when you first become eligible for Medicare, you may be subject to a late enrollment penalty if you later decide to enroll in a plan.

What Happens If I Don’t Sign Up For a Prescription Drug Plan During the Initial Enrollment Period?

If you miss your IEP to sign up for a Medicare PDP, you generally have to wait until the AEP to sign up for a plan unless you qualify for a Special Enrollment Period (SEP). A SEP is a time outside of the IEP or AEP when you can make changes to your Medicare coverage.

Here are some examples of events that may qualify as a SEP:

  • Moving to a new address: If an individual moves outside of their Medicare Advantage plan’s service area, they may be eligible for a SEP to enroll in a new plan.
  • Losing other health coverage: If an individual loses coverage from an employer, union, or other health plan, they may be eligible for a SEP to enroll in a Medicare Advantage plan or a Medicare Part D prescription drug plan.
  • Gaining new health coverage: If an individual gains coverage from an employer, union, or other health plan, they may be eligible for a SEP to disenroll from their Medicare Advantage plan or their Medicare Part D prescription drug plan.
  • Becoming eligible for Medicaid: If an individual becomes eligible for Medicaid, they may be eligible for a SEP to enroll in a Medicare Advantage plan or a Medicare Part D prescription drug plan.
  • Moving into or out of a nursing home or long-term care facility: If an individual moves into or out of a nursing home or long-term care facility, they may be eligible for a SEP to enroll in or change their Medicare coverage.

Not all events will qualify an individual for a Medicare SEP, and the rules and timelines for each SEP can vary. It’s always a good idea to check with Medicare or a licensed insurance agent to confirm eligibility and understand the options available. If you do qualify for a SEP, you have a limited time period to enroll in a Medicare PDP. The length of the SEP varies depending on the reason for the SEP. If you don’t qualify for a SEP, you will have to wait until the next AEP to sign up for a Medicare PDP.

When Do I Need to Sign Up For a Prescription Drug Plan When Coming Off An Employer Health Plan?

If you are coming off an employer health plan that included “creditable” prescription drug coverage and you enroll in a Medicare PDP within 63 days of losing your employer coverage, you generally will not be subject to a late enrollment penalty. Creditable coverage is prescription drug coverage that is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage. Your employer should notify you each year if your prescription drug coverage is creditable.

If you do not enroll in a Medicare PDP within 63 days of losing your employer coverage, you will be subject to a late enrollment penalty if you later decide to enroll in a plan. The penalty would be calculated based on the number of full months you were eligible for a Medicare PDP but did not have creditable prescription drug coverage.

Important: If you enroll in a Medicare Prescription Drug Plan after the 63-day period, you may also have a gap in coverage, which could result in higher out-of-pocket costs for your prescription medications.

What Is the Medicare Prescription Drug Plan Late Enrollment Penalty?

The Medicare PDP late enrollment penalty is a fee that may be imposed on individuals who enroll in a Medicare PDP after their IEP has ended, and who do not have creditable prescription drug coverage from another source (such as an employer).

The penalty is calculated based on the number of months that an individual went without creditable coverage, and is added to the monthly premium for the Medicare PDP. The penalty amount may increase each year, and the penalty is paid for as long as the individual is enrolled in a Medicare PDP. There are some exceptions to the penalty, such as if an individual had a valid reason for delaying enrollment, such as being covered under a spouse’s health insurance plan, etc.

How To Calculate the Medicare Prescription Drug Plan Late Enrollment Penalty

The Medicare PDP late enrollment penalty is calculated by multiplying 1% of the “national base beneficiary premium” ($32.74 in 2023) by the number of full, uncovered months that an individual did not have creditable prescription drug coverage.

The national base beneficiary premium is the average monthly premium for a Medicare prescription drug plan in the United States, as determined by the Centers for Medicare & Medicaid Services (CMS). The amount of the penalty may increase each year, as the national base beneficiary premium changes.

Here’s an example of how to calculate the penalty:

In 2023, the national base beneficiary premium is $32.74. If an individual goes without creditable prescription drug coverage for 12 months (a full year) after their IEP has ended, the penalty would be 1% of $32.74, or approximately $0.33 per month. Therefore, the penalty amount would be $3.96 ($0.33 x 12 months = $3.96), and this amount would be added to the individual’s monthly premium for their Medicare PDP.

If an individual goes without creditable prescription drug coverage for a shorter period of time, the penalty amount would be lower, based on the number of full, uncovered months, etc. The late enrollment penalty is added to your monthly premium for as long as you have Medicare PDP coverage.

NOTE: The penalty is permanent and may increase each year based on changes to the national base beneficiary premium.

To avoid the late enrollment penalty, it’s important to enroll in a Medicare PDP during your IEP, or when you first become eligible for Medicare, or within 63 days of coming off of an employer health plan, even if you don’t currently take any prescription medications. In California, you can get a Medicare PDP for as low as $4.50 per month!

How Do I Know If I Have to Pay a Penalty?

After you join a Medicare PDP, the plan will tell you if you have to pay a penalty and what your premium will be. In general, you’ll have to pay this penalty for as long as you have a Medicare drug plan.

What If I Don’t Agree With the Late Enrollment Penalty?

You may be able to ask for a “reconsideration.” Your drug plan will send information about how to request a reconsideration. Complete the form, and return it to the address or fax the number listed on the form. You must do this within 60 days from the date on the letter telling you that you have to pay a late enrollment penalty. Also send any proof that supports your case, like a copy of your notice of creditable prescription drug coverage from an employer or union plan.

Do I Have to Pay the Penalty Even If I Don’t Agree With It?

By law, the late enrollment penalty is part of the premium, so you must pay the penalty with the premium. You must also pay the penalty even if you’ve asked for a reconsideration. Medicare PDP’s can dis-enroll members who don’t pay their premiums, including the late enrollment penalty portion of the premium.

How Soon Will I Get a Reconsideration Decision?

In general, Medicare makes reconsideration decisions within 90 days. They will try to make a decision as quickly as possible. However, you may request an extension. Medicare may sometimes take an additional 14 days to resolve your case.

If Medicare decides that all or part of your late enrollment penalty is wrong, Medicare will send you and your drug plan a letter explaining its decision. Your Medicare PDP will remove or reduce your late enrollment penalty. The plan will send you a letter that shows the correct premium amount and explains whether you’ll get a refund. If Medicare decides that your late enrollment penalty is correct, Medicare will send you a letter explaining the decision, and you must pay the penalty.

To Make a Long Story Short…

To avoid the Medicare late enrollment penalty…

  • When you are turning 65, the best time to sign up for a Medicare PDP is during the 7-month IEP.
  • If you or your spouse is coming off of a creditable employer health plan, the best time to sign up for a Medicare PDP is during the 63 days after your employer coverage ends.

About Me

I hope that you have found this information to be interesting and informative. I’m an independent insurance agent with over 15 years of experience specializing in Medicare Supplement insurance, primarily in California. As an independent agent, I work with most of the major insurance carriers including Mutual of Omaha, Cigna, Blue Shield of CA, Anthem Blue Cross, Health Net, Aetna, etc. I have hundreds of clients, and I shop around for them every year around their birthday. Please click here to see some of my client testimonials.

If you have any questions, or if you know anyone that is turning 65 or starting Medicare, or if you would like for me to shop around for you, I’m happy to help, and there is no charge for my service!!! Please feel free to contact me! Also, please feel free to forward this blog on to anyone you know who may be interested.

Thank you!

Ron Lewis
CA agent #0B33674
NV agent #3822123

Ron@RonLewisInsurance.com
866.718.1600 (Toll-free)
760.525.5769 (Cell)
www.MedigapShopper.com

How to Sign Up for Original Medicare (Part A and Part B)

Signing up for Medicare can seem like a confusing and daunting task, but it’s really not that bad. This article will hopefully answer any questions you have and make the Medicare maze easy to navigate.

What is Medicare?

Medicare is the federal health insurance program for:

  • People who are 65 or older
  • Certain younger people with disabilities
  • People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)

Who is Eligible For Medicare?

You are generally eligible for Medicare if you are 65 or older, a U.S. citizen or permanent legal resident, and have lived in the U.S. for at least five year

What Are the Four Parts of Medicare?

Medicare is composed of four parts:

  • Part A (Hospital insurance)
  • Part B (Medical insurance)
  • Part C (Medicare Advantage plans)
  • Part D (Prescription drug plans)

NOTE: Medicare Parts A and B are also referred to as “Original Medicare.”

What Does Medicare Part A Cover?

Part A covers things like inpatient hospital stays, home health care and some skilled nursing facility care.

What Does Medicare Part B Cover?

Part B covers things like doctor visits, outpatient services, X-rays and lab tests, and preventive screenings.

What Does Medicare Part C Cover?

Part C is also known as Medicare Advantage (MA). An MA plan is a Medicare-approved plan from a private company that offers an alternative (replacement) to Original Medicare (see note below) for your health and drug coverage. These “bundled” plans include Part A, Part B, and often Part D. In most cases, you must only use doctors who are in the plan’s network. Most MA plans are HMO’s and are restrictive and limit your options to what doctors, specialist, hospitals, and care facilities you can go to.

IMPORTANT: A much better option to Part C, in my opinion, is a Medicare Supplement plan, also known as “Medigap” because it picks up the gap in coverage not covered by Medicare. With a Medigap plan, there are NO networks, and you have much greater freedom of choice as to which doctors, specialists, care facilities, etc. that you go to. You can go to any doctor, specialist, care facility, etc. ANYWHERE in the US as long as they accept Medicare, and most do, about 93%.

What Does Medicare Part D Cover?

Part D covers the cost of prescription drugs (including many recommended shots or vaccines).

The Medicare Initial Enrollment Period (IEP)

If you are turning 65 and are eligible for Medicare, you can sign up for Original Medicare, aka Medicare Part A (Hospital insurance) and Part B (Medical insurance) during your Initial Enrollment Period (IEP), which typically starts three months before the month of your 65th birthday and ends three months after your birth month. For example, if your birthday is June 23rd, your IEP would begin on March 1st and end on September 30th of that year.

NOTE: Medicare normally begins on the 1st of the month of your 65th birthday. If you want your coverage to start then, you need to sign up for Medicare during the 3 months before the month of your birthday. Otherwise, your Medicare won’t start until sometime after your birthday month.

For most people, their Medicare normally begins on the 1st of the month of their 65th birthday. However, if your birthday is on the 1st of the month, your Medicare would begin on the 1st of the previous month. For example, if your birthday is June 1st, your Medicare would normally begin on May 1st.

NOTE: If your birthday is on the 1st of the month, your IEP begins and ends one month earlier as well. For example, if you turn 65 on June 1st, your IEP would begin on February 1st and end on August 31st.

Some People Are Automatically Enrolled in Medicare When They Turn 65 and Some Are Not

If you are currently receiving Social Security or Railroad Retirement Board benefits before you turn 65, you will normally be automatically enrolled in Medicare, and you’ll receive your Medicare card in the mail before your 65th birthday. You’ll still have an IEP, and during this seven-month window, you can still make Medicare coverage decisions such as signing up for a Medicare Supplement and a Prescription Drug Plan (PDP).

IMPORTANT: If you are not currently receiving Social Security or Railroad Retirement Board benefits before you turn 65, you’ll have to sign up for Medicare on your own. If that’s the case, be sure to write down your IEP dates on your calendar before you turn 65.

Three Ways to Sign Up for Medicare

There are the three different ways to sign up for Medicare:

  • You can apply for Medicare online at the Social Security Administration’s website (https://secure.ssa.gov/iClaim/rib).
  • You can call Social Security toll-free number at 1-800-772-1213 and sign up on the phone.
  • You can visit your local Social Security office.

I know that it doesn’t seem intuitive that you would contact Social Security to sign up for Medicare, but you do! When you apply for Medicare, you will need to provide personal and financial information including your name, Social Security number, birth date, income, etc.

After you apply for Medicare, you will receive a confirmation notice in the mail indicating whether your application has been approved, etc. If you have any questions or concerns about the Medicare enrollment process, you can contact Medicare directly at 1-800-MEDICARE (1-800-633-4227).

Do I Need to Enroll in Medicare If I’m Working After Age 65

For most people, Medicare Part A (Hospital insurance) is free because you or your spouse paid Medicare taxes long enough while working, generally at least 10 years. However, Part B (Medical insurance) is not free. There is a monthly premium for Part B, which is currently $164.90 each month for most people (or higher depending on your income).

You’ll pay a higher monthly premium for Part B if your modified adjusted gross income (MAGI), as reported on your IRS tax return from 2 years ago, is more than $97,000 in 2023 if you file an individual tax return or are married and file separately, or $194,000 if you are married and file a joint tax return. Please click here for more detailed information about the Part B premiums. Social Security will tell you if you have to pay a higher premium because of your income.

NOTE: If you are planning to continue working past age 65, you may be able to delay enrolling in Medicare Part B and avoid paying the Medicare Part B monthly premium. Since Medicare Part A is usually free, most people sign up for it even if they are working.

If you have “creditable” health coverage from your employer or are covered under a spouse’s employer plan, you may qualify for a Special Enrollment Period (SEP), and be able to delay enrolling in Part B without a penalty.

Medicare defines “creditable coverage” as coverage that is at least as good as what Medicare provides.

Here are some situations that will affect when you should begin your Medicare coverage:

  • If an employer has 20 or more employees, you can generally choose to delay Medicare enrollment, drop your employer coverage for Medicare, or have both Medicare and employer coverage.
  • If an employer has fewer than 20 employees, you will generally need to enroll in Medicare during your IEP.
  • If you have health coverage through a spouse’s employer, what you can do will depend on the employer’s rules. You may be able to delay signing up for Medicare or you may need to enroll at age 65.

IMPORTANT: When you are turning 65, if you aren’t sure if your employer plan provides creditable coverage, you should call Social Security to verify. Otherwise, you could end up paying a penalty.

What If I’m Coming Off An Employer Group Plan?

If you qualified to delay Medicare because you had creditable coverage from an employer, there is an 8-month Special Enrollment Period (SEP) for enrolling in Medicare Parts A and B.

IMPORTANT: Be careful because this SEP can be tricky. Although you have the entire 8 months to get Medicare Parts A & B, you only get the first 2 months to enroll in Part C or Part D without penalty. If you enroll after the two-month period, you’ll face late enrollment penalties for Part D (regardless of whether you end up with a stand-alone Part D plan or a Medicare Advantage plan that includes drug coverage).

What If I Don’t Enroll in Medicare On Time?

If you don’t sign up for Medicare Part A, Part B, or Part D on time, you will pay late enrollment penalties for life so make sure to sign up for Medicare coverage during your IEP unless you have other creditable coverage that’s comparable in value to Medicare, such as from an employer. Please click here for more detailed information.

It’s a good idea to start researching your Medicare options a few months before your 65th birthday to make sure you have enough time to enroll and choose the plan that’s right for you.

Original Medicare Will Not Cover All of Your Costs!

Original Medicare (Part A and Part B) does not cover 100% of your medical costs. Like most health insurance, Medicare generally comes with out-of-pocket (OOP) costs including co-payments, coinsurance, and deductibles. Medicare usually pays approximately 80% of allowable charges for covered services.

The Part A Deductible and Co-payments

If you’re a hospital inpatient, Medicare Part A generally covers your care for a limited time. A deductible or copay generally applies.

NOTE: The Part A deductible isn’t an annual deductible, it’s a “benefit period” deductible meaning there can be multiple Part A benefit periods and deductibles per calendar year. In 2023, the Part A deductible per benefit period is $1,600.

The Part A benefit period begins the day you go into a hospital or skilled nursing facility and ends when you have been out for 60 consecutive days in a row. It’s possible to have multiple benefit periods in a calendar year, and without a Medicare Supplement, you would have to pay the full deductible amount for each benefit period!

Most Medicare Supplements pay for all the Part A deductibles, co-payments, etc. With a Plan G Medicare Supplement, your only out-of-pocket cost for the entire year is the Part B deductible, which is currently $226 in 2023.

In 2023, after you pay the $1,600 Part A deductible for each benefit period, there are no hospital co-payments for the first 60 days, but there are co-payments if you are in a hospital for longer than 61 days. Most Medicare Supplements will cover all of these costs.

The Medicare Part B Deductible

In 2023, the Medicare Part B calendar year deductible is $226. Unlike Part A, the Part B deductible is payable only one time per calendar year.

What is the Maximum Out-of-Pocket Expense Limit Under Original Medicare?

Original Medicare (Part A and Part B) have no out-of-pocket maximum amount.

NOTE: A Plan G Medicare Supplement will pick up ALL Medicare-approved costs over and above the $226 Part B deductible!

10 Standardized Medicare Supplement Plans to Choose From

Nationwide, there are 10 “standardized” Medicare Supplement plans to choose from, Plan A through Plan N. These plans are standardized meaning that Plan G is Plan G, Plan N is Plan N, etc. The coverage and benefits are exactly the same with every Plan G, Plan N, etc. making it easier to compare “apples with apples,” etc.

Although these plans are standardized, the rates are not standardized, so it is important to shop around and compare because the rates vary significantly between insurance carriers for the same identical plan and coverage.

Since there are co-payments, coinsurance, and deductibles and no out-of-pocket maximum with Original Medicare (Part A and Part B), most people get a Medicare Supplement plan in addition to Original Medicare to pay for most of these costs.

The Plan G Medicare Supplement is the Most Popular and Cost-Effective Plan

Of the 10 standardized Medicare Supplement plans, the three most popular plans are Plan F, Plan G, and Plan N. Of the three plans, Plan G is the best plan and most cost-effective because your only OOP cost for the entire year is the Medicare Part B deductible, which is $226 for all of 2023.

NOTE: The Part B deductible can change from year to year, but historically, it has never increased significantly. Once you meet this small annual deductible, you normally won’t have any other costs for the remainder of the year.

How Much Do Medicare Supplement Plans Cost?

In California, rates are based primarily on age and zip code, so Plan G will cost less for someone who is age 65 rather than age 85. For example, in the San Diego area (zip code 92024), the rates for age 65 range from $100 per month to $203 per month! For age 85 in the same zip code, the rates range from $221 per month to $395 per month!

The California Birthday Rule

In California, you can change your Medicare Supplement plan any time of the year, but you would normally have to be in relatively good health to do so because you will have to answer health questions and be medically underwritten. However, California is one of only a few states with a birthday rule called the California Birthday Rule.

Under this law, if you currently have a Medicare Supplement, you can apply for a new Medicare Supplement with “equal or fewer” benefits during the 60 days following your birthday each year, and you cannot be turned down for coverage. For example, if you have Plan G, you can switch to Plan G with any other insurance carrier, REGARDLESS OF YOUR HEALTH and without answering any health questions on the application.

NOTE: Only six states currently have a Medicare Supplement birthday rule including California, Idaho, Illinois, Louisiana, Nevada, and Oregon. Before 2022, only two states had a birthday rule.

It’s Important to Shop Around and Compare Medicare Supplement Rates Every Year!

Since there is such a large discrepancy in pricing and because Medicare Supplement rates are constantly changing as we get older, it’s important to take advantage of the California Birthday Rule and compare prices and shop around every year or two.

About Me

I hope that you have found this information to be interesting and informative. I’m an independent insurance agent with over 15 years of experience specializing in Medicare Supplement insurance, primarily in California. As an independent agent, I work with most of the major insurance carriers including Mutual of Omaha, Cigna, Blue Shield of CA, Anthem Blue Cross, Health Net, Aetna, etc. I have hundreds of clients, and I shop around for them every year around their birthday. Please click here to see some of my client testimonials.

If you have any questions, or if you know anyone that is turning 65 or starting Medicare, or if you would like for me to shop around for you, I’m happy to help, and there is no charge for my service!!! Please feel free to contact me! Also, please feel free to forward this blog on to anyone you know who may be interested.

Thank you!

Ron Lewis
CA agent #0B33674
NV agent #3822123

Ron@RonLewisInsurance.com
866.718.1600 (Toll-free)
760.525.5769 (Cell)
www.MedigapShopper.com

Tips and Tricks to Save Money On Your Medicare Supplement

The purpose of this blog is to provide you with some tips and tricks that will help you save money on your Medicare Supplement insurance (aka Medigap), which is designed to cover most or all of the co-payments, deductibles, and co-insurance not covered by Medicare. This article primarily applies to individuals living in California. With that said, a lot of the information in this blog still applies to other states as well, so hopefully, you will find this information to be helpful regardless of where you live!

IMPORTANT: Don’t confuse Medicare Advantage (MA) plans, also known as Part C, with Medicare Supplement plans! The two plans are entirely different! This article does NOT apply to MA plans.

Some Key Differences Between Medicare Advantage and Medicare Supplement Plans

With a Medicare Supplement, you have much greater freedom of choice than an MA plan because you can go to ANY doctor, specialist, hospital, care facility, etc. in the US as long as they accept Medicare, and most do, about 93%. With MA plans, you are much more restricted and have less freedom because most MA plans are HMO’s and you can only go to doctors, specialists, hospitals, care facilities, etc. that are in your local geographic network, and you must see your primary care doctor first and then get a referral to see a specialist in your network! You cannot go directly to a specialist!

With MA plans, your annual co-payments and deductibles are significantly more expensive than traditional Medicare Supplement plans. In fact, depending on which MA plan you have, the maximum in-network out-of-pocket (OOP) costs can be as high as $8,300 in 2023! If you go out of network, you will pay even more!

With a Medicare Supplement Plan G, the most popular Medicare Supplement plan, your maximum OOP cost for all of 2023 is only $226, which is the Medicare Part B deductible. There are many other reasons why I always recommend Medicare Supplements over MA plans, but that is a separate topic, and it’s beyond the scope of this article.

10 Standardized Medicare Supplement Plans

Nationwide, there are 10 standardized Medicare Supplement plans to choose from, Plan A through Plan N. The term “standardized” means that the coverage and benefits are exactly the same with every Plan F, Plan G, Plan N, etc. In other words, Plan G is Plan G, Plan N is Plan N, etc. regardless of what carrier you are with, so it’s much easier to compare “apples with apples,” etc.

Although Medicare Supplement plans are standardized, the premium rates are not standardized, and they vary significantly from one insurance carrier to another!

The following chart shows the 10 standardized Medicare Supplement plans that are available throughout the US.

NOTE: As of January 1, 2020, Plans C, F and High Deductible F cannot be sold to those newly eligible for Medicare. Newly eligible is defined as anyone who: (a) attains age 65 on or after January 1, 2020, or (b) who first becomes eligible for Medicare benefits due to age, disability or end-stage renal disease on or after January 1, 2020. Those enrolled in Plans C, F and High Deductible F prior to January 1, 2020 may keep their plan. Those individuals who became eligible for Medicare prior to January 1, 2020 may keep or purchase Plans C, F and High Deductible F after December 31, 2019.

TIP: You should shop around and compare rates every year or two to save money on your premiums.

Which Medicare Supplement Plan Is Best?

Of the 10 standardized Medicare Supplement plans, Plan F, Plan G, and Plan N (in green) are the most popular plans. Of those three plans, Plan F is considered to be the best because you have no out-of-pocket costs. For that reason, Plan F is also the most expensive plan, and not the most popular plan.

NOTE: As mentioned above, Plan F is no longer available for those individuals who are newly eligible for Medicare on or after January 1st, 2020. Plan F is still available for those who were eligible for Medicare prior to January 1st, 2020. In addition to the plans in the chart, there is also a high-deductible Plan F and a high-deductible Plan G. The annual deductible for both plans is currently $2,700 in 2023.

Most people who started off with Plan F, including myself, have switched to Plan G. Both plans are identical in every way except Plan F pays for the Medicare Part B deductible (currently $226 for all of 2023) and Plan G doesn’t. That is the ONLY difference between the two plans! Once you meet that small deductible, there is no difference in the coverage or benefits between Plan F and Plan G! The only major difference between the two plans are the premiums; in most cases, the Plan G premiums are significantly lower than the Plan F premiums!

It’s kind of like your auto insurance or your homeowner’s insurance. You can have a zero deductible, like Plan F, or you can have a $500 deductible or a $1,000 deductible, etc. The overall coverage is the same, but you pay a lot more for a $0 deductible versus a $500 or $1,000 deductible.

TIP: If you can save more than $226 per year on your premiums by switching from Plan F to Plan G, Plan G ends up being more cost effective, and you should switch to Plan G to save money on your insurance premiums!

Again, with a Plan G Medicare Supplement, your maximum OOP cost for all of 2023 is the Part B deductible, which is $226 in 2023. For example, if you have multiple doctor visits during the year, have a couple of surgeries and are hospitalized, the most you would normally pay for all of 2023 is the $226 Part B deductible and that’s all! With a Medicare Advantage plan, your maximum in-network OOP costs can be as high as $8,300 in 2023! If you go out of network, your OOP costs will be even more!

The California Birthday Rule

In California, there is a law called the California Birthday Rule. If you have one of the 10 standardized Medicare Supplement plans, such as Plan F, Plan G, Plan N, etc. you are guaranteed the right to switch your insurance plan or insurance carrier during the 60 days following your birthday each year, REGARDLESS OF YOUR HEALTH, and without answering any health questions or medical underwriting.

During this 60-day open enrollment period, YOU CANNOT BE TURNED DOWN FOR COVERAGE as long as you switch to any other plan with “equal or fewer” benefits. For example, if you have Plan G, you can switch to Plan G with any other carrier. Or, you could switch to a lower plan, such as Plan N because Plan N has fewer benefits than Plan G, etc.

NOTE: Unlike MA plans or prescription drug plans, you can change your Medicare Supplement plan any time of the year, but if you do so around your birthday, it’s easier because you don’t have to answer any health questions, there is no underwriting, and you cannot be turned down for coverage!

Although the California Birthday Rule specifies that you can apply for coverage during the 60-day open enrollment period after your birthday each year, many insurance carriers will let you apply during the 30 days BEFORE your birthday up to 60 days AFTER your birthday meaning you really have a 90-day open enrollment period each year for your Medicare Supplement! Although the majority of insurance carriers base their rates on your age after your birthday, a couple of the insurance carriers that let you apply during the 30 days before your birthday base their rates on your age on the application date, so their rates will be less than if you apply after your birthday.

TIP: If you live in California and you have a Medicare Supplement, you can often save money on your premiums by applying for a new Medicare Supplement plan during the 30 days before your birthday rather than during the 60 days after your birthday.

Most states do not have a birthday rule or anything similar. In those states, if you have a Medicare Supplement plan and you want to switch to a different insurance carrier with a more competitively-priced plan, you must fill out an application, answer health questions, and be medically underwritten and approved. If you have serious health issues, you will not be able to change plans.

NOTE: There are currently six states that have a birthday rule including California, Idaho, Illinois, Louisiana, Nevada, and Oregon. Before 2022, only two states had a birthday rule.

Qualifying for the California Birthday Rule

To qualify for the California Birthday Rule, you must meet the following requirements:

  • Live in California
  • Currently have a Medicare Supplement plan
  • Switch to a plan with the same or fewer benefits
  • Apply during the 30 days before your birthday up to 60 days after your birthday

Guaranteed Rate Locks

When you sign up for a new Medicare Supplement plan, most insurance carriers will guarantee and lock your premium rate for the first 6 to12 months.

TIP: To avoid any unexpected rate increases, I normally recommend going with an insurance carrier that locks their rates for the first year, if possible.

After the initial guaranteed rate lock period expires, an insurance carrier can raise your rate at any time as long as they raise everyone’s rates. (You cannot be singled out.) Just like your auto and homeowner’s insurance, it’s important to shop around every year around your birthday because rates change and what is good this year may not be so good next year. For this reason, I shop around for my clients every year around their birthday.

New to Medicare? Get a $25 Per Month Discount For the First Year!

If you are turning 65 or if you will be new to Medicare Part B (Medical insurance), a couple of insurance carriers will give you a $25 per month “Welcome to Medicare” discount for the first 12 months! These rates are almost impossible to beat during the first year. After the first year, the $25 discount will end, but you can still switch to another carrier each year around your birthday if you want, regardless of your health and without answering any health questions on the application.

Would You Like a Free Gym Membership?

If you like to go to the gym, several insurance carriers offer “Silver Sneakers” and “Silver and Fit,” which are free gym memberships to local participating gyms such as 24-Hour Fitness, LA Fitness, etc.

TIP: If you are paying a monthly fee to belong to a gym, eliminate that fee by signing up for a Medicare Supplement with an insurance carrier that offers Silver Sneakers or Silver and Fit!

Medicare Supplements Are Standardized but Medicare Supplement Rates Are Not Standardized!

In California, most insurance carriers base their rates on your “attained age.” This means that Medicare Supplement rates usually increase as we get older. Although the 10 nationwide Medicare Supplement plans are “standardized,” meaning that the coverage and benefits are exactly the same for every Plan G, Plan N, etc., insurance premiums for these plans are not standardized, and the rates vary significantly from one insurance carrier to the next for the same identical plan and coverage!

For example, for a 70 year old living in the 92056 zip code, the current Plan G Medicare Supplement premiums range from $158 to $243 per month! That is a difference of $85 per month or $1,020 per year for the same identical plan and coverage!

TIP: Periodically check your rates every year or two to make sure they are still competitively priced.

You Can Apply for Medicare Supplements All Year Long!

Unlike MA plans that have an Annual Enrollment Period (AEP) from October 15th to December 7th every year for a January 1st effective date, you can apply for Medicare Supplement plans all year long.

If you apply for a Medicare Supplement plan at any time of the year other than during your 60-day annual open enrollment period under the California Birthday Rule, you will have to answer the health questions on the application and be medically underwritten. If you have certain health conditions, you can be turned down for coverage. If you are in relatively good health, you should not have any problem qualifying for a new Medicare Supplement plan.

TIP: If you have a Medicare Supplement plan and you have a serious health condition, take advantage of the California Birthday Rule and apply around your birthday. It’s always easier to apply for a Medicare Supplement around your birthday since you don’t have to answer any health questions and you cannot be turned down for coverage!

Household Discounts

Some carriers give you a household discount (HHD) and others don’t. If you qualify for a HHD, some give more than others, from 5% to 12%! To qualify for a HHD, some carriers require both parties in the household to have a Medicare Supplement with the same company, and others only require that you live in the same household with another adult to qualify for the HHD. For example, if you have a roommate or live with someone that does not have a Medicare Supplement, you can still get a full HHD with certain carriers!

TIP: If you are married or you have lived with another adult in the house for at least one year, some companies will give you up to 12% HHD on your insurance premiums, even if your spouse, roommate, etc. doesn’t have a Medicare Supplement policy!

About Me

I hope that you have found this information to be interesting and informative. I’m an independent insurance agent with over 15 years of experience specializing in Medicare Supplement insurance, primarily in California. As an independent agent, I work with most of the major insurance carriers including Mutual of Omaha, Cigna, Blue Shield of CA, Anthem Blue Cross, Health Net, Aetna, etc. I have hundreds of clients, and I shop around for them every year around their birthday. Please click here to see some of my client testimonials.

FINAL TIP: If you have any questions, or if you know anyone that is turning 65 or starting Medicare, or if you would like for me to shop around for you, I’m happy to help, and there is no charge for my service!!! Please feel free to call me or send me an email! Also, please feel free to forward this blog to anyone you know who may be interested.

Thank you!

Ron Lewis
CA agent #0B33674
NV agent #3822123

Ron@RonLewisInsurance.com
866.718.1600 (Toll-free)
760.525.5769 (Cell)
www.MedigapShopper.com

Upcoming Medicare Supplement Changes Beginning on July 1st, 2020

As of July 1st, 2020, under Senate Bill No. 407, the California Birthday Rule will be changing. Under the current law, for those individuals that have a Medicare Supplement, also known as Medigap, you can change your current plan to any Medigap plan that offers benefits “equal to or lesser than” your current plan during the 30 days following your birthday each year.

Under the new law, you will have the same opportunity to change plans, but the 30 day period has been extended to 60 days.

July-1st Use

Nationwide, there are 10 standardized Medigap plans to choose from, Plan A through Plan N. The term “standardized” means that every Plan F, every Plan G, every Plan N, etc. has the same exact coverage and benefits no matter what insurance carrier you have your coverage with. In other words, Plan F is Plan F, Plan G is Plan G, Plan N is Plan N, etc. Because Medigap plans are standardized, it is much easier to compare “apples with apples.”

Medigap Plans Are Standardized but Rates Aren’t

Although Medigap plans are standardized, Medigap rates are not standardized, and they vary widely between insurance carriers. For example, in the 92009 zip code in San Diego, for a 72 year old male, Plan G rates range from $165.78 per month to $223.47 per month. That’s a difference of $57.69 per month or $692.28 per year for the same identical plan and coverage!

Medicare-Supplement-Plan-Chart

Medigap rates are based primarily on your age and zip code, and whether you use tobacco or not. In California, rates usually increase every year as we get older. An insurance carrier that has competitive rates this year may increase rates and not be as competitive next year. For this reason, it is very important to take advantage of the California Birthday Rule and shop around every year to make sure that you aren’t paying too much money for your Medigap insurance premiums.

This is a free service that I provide to all of my California clients every year around their birthday.

NOTE: You can change your Medigap plan or insurance carrier any time of the year, but if you do so other than around your birthday, you will have to answer health questions on the application, and your application will be medically underwritten, and you could be turned down for coverage. If you have a serious health condition, you should definitely take advantage of the California Birthday Rule and apply around your birthday. That way, you cannot be turned down for coverage, REGARDLESS OF YOUR HEALTH.

Innovative Medigap Plans Are Also Changing On July 1st

There is another significant change that will be occurring beginning on July 1st under Senate Bill No. 407. Several insurance carriers have recently introduced new “Innovative” Medigap plans that are the same as the standardized plans, but they also include some additional non-medical coverage for such things as hearing and vision.

For example, Blue Shield of California replaced their “standardized” Plan F with a different plan called “Plan F Extra.” Anthem Blue Cross offers two different Plan F Medigap plans, Plan F and “Plan F Innovative,” which also includes some additional coverage for vision and hearing. And Health Net now offers two different Plan F supplements as well, Plan F and “Plan F Innovative.” Blue Shield currently offers two Plan G Medigap plan, Plan G and “Plan G Extra,” and Health Net offers Plan G and and a “Plan G Innovative” plan as well.

As you can see, the recent introduction to these newer innovative plans has made the Medigap marketplace confusing and defeated the purpose of having standardized Medigap plans. It is no longer so easy to compare Medigap plans and benefits because the “extra” and “innovative” benefits are all similar yet slightly different from each other.

The real problem however, is that when someone wants to take advantage of their open enrollment period under the California Birthday Rule, Blue Shield and Anthem Blue Cross do not allow someone with a “regular” Plan F or Plan G to switch to one of their “Extra” or “Innovative” plans. Both of these companies claim that their innovative plans have “richer” benefits, and they do not qualify under the California Birthday Rule.

birthday-rule candles

Furthermore, Blue Shield no longer offers their “regular” Plan F, only their Plan F Extra, so this has prevented anyone with Plan F with a different insurance carrier to switch to Blue Shield’s Plan F during their annual open enrollment period under the birthday rule. And you would think that someone with Blue Shield’s Plan F Extra could switch to Anthem’s Plan F Innovative plan under the California Rule or vice versa around their birthday, but no. Neither carrier will accept these plans during someone’s 30 day open enrollment period because they consider their plans superior to the other carrier’s plan.

NOTE: Health Net has always allowed someone with the “regular” Plan F or Plan G to switch to their Plan F Innovative or Plan G Innovative plans.

As of July 1st, 2020, Blue Shield of California, Anthem Blue Cross, and all insurance carriers are now required to accept any Plan F or Plan G Medigap plans for any of their innovative Medigap plans under the California Birthday Rule! For example, if you have Plan F with Mutual of Omaha, you can now switch to Blue Shield’s Plan F Extra or Anthem’s Plan F Innovative plan under the birthday rule.

Which is Better, Plan F or Plan G?

Many people with Plan F have switched to Plan G because both plans are identical except Plan F covers the Medicare Part B deductible, which is currently $198 per calendar year, and Plan G does not cover the Part B deductible. Other than that, both plans are identical in coverage.

NOTE: The Medicare Part B deductible can change from year to year, but historically, it has never increased significantly.

plan-f-and-plan-g

Since the only difference between Plan F and Plan G is the $198 Medicare Part B deductible, if you can save more than $198 per year on your premiums by switching from Plan F to Plan G, then Plan G ends up being more cost effective.

If you are saving exactly $198 per year, you are breaking even, and you’re better off staying with Plan F. If you are saving $300 or more per year by switching, it will definitely cost you less money by switching from Plan F to Plan G.

NOTE: If you decide to switch from Plan F to Plan G, and you have already met the $198 Medicare Part B deductible for the current year, you would not have to pay that deductible again until the following year.

Conclusion

As of July 1st, 2020, your annual open enrollment period under the California Birthday Rule is increasing from 30 to 60 days after your birthday. Most carriers will let you apply for coverage during the 30 days prior to your birthday, but the effective date of your new policy would normally be the 1st of the month following your birthday. And if you have Plan F or Plan G with another insurance carrier and you want to switch to an “Innovative” plan under the birthday rule with Blue Shield of CA, Anthem Blue Cross,  Health Net, etc., you can now do so.

Since rates vary significantly between insurance carriers for the same identical plan and coverage, it is important to shop around, EVERY YEAR, to make sure that you aren’t paying too much.

As an independent insurance agent specializing in Medicare Supplement (Medigap) insurance, I work with all the major insurance carriers in California and several other states. If you have any questions or if you would like for me to shop around for you to save you money on your Medicare Supplement insurance, please don’t hesitate to let me know.

Ron Lewis
CA Lic# 0B33674
760.525.5769 (Cell)
760.718.1600 (Toll-free)
Ron@RonLewisInsurance.com
www.MedigapExpress.com

The California Birthday Rule is Changing!

happy-birthday

Under the California Birthday Rule, you can change your Medicare Supplement, also known as Medigap, every year during the 30 days following your birthday, to any other Medigap plan that has “equal or lesser” benefits.

For example, you can switch from Plan F to Plan F, Plan G to Plan G, Plan F to Plan G, Plan G to Plan N, etc. You just can’t switch from Plan G to Plan F, etc. under the birthday rule. You can do this REGARDLESS OF YOUR HEALTH and without answering any of the health questions on the application. You CANNOT be turned down for coverage!

NOTE: You can change Medigap plans any time of the year, but if you do so at any time other than around your birthday, you will have to answer the health questions on the application and your application will be medically underwritten.

Most states don’t have a birthday rule, so this law is definitely beneficial for California residents because in other states, if your health should change and your rates go up significantly, or you are not happy with your Medigap plan or carrier, you could be stuck because your application will be medically underwritten.

As of July 1st, 2020, the 30-day annual open enrollment period under the California Birthday Rule will be increasing from 30 to 60 days. Most carriers will let you apply for a Medigap plan under the birthday rule during the 30 days before or after your birthday; the new rule will be a 90-day window starting 30 days before and up to 60 days after your birthday each year.

Medigap Puzzle Pieces

Some carriers, such as Health Net, Mutual of Omaha, and Transamerica, have already implemented these changes. With these carriers, you can now qualify as a “guaranteed issue” under the California Birthday Rule during the 30 days before and up to 60 days following your birthday. These new changes with other carriers such as Anthem Blue Cross, Blue Shield of California, and Cigna won’t go into effect until July 1st, 2020.

10 Standardized Plans To Choose From

Nationwide, there are 10 standardized Medigap plans to choose from, Plan A through Plan N. The term “standardized” means that the coverage and benefits for every Plan F, Plan G, Plan N, etc. are exactly the same no matter what carrier you are with. Plan F is Plan F, Plan G is Plan G, etc.

2020 Medigap Chart

Medigap Premiums Are Not Standardized

Although Medigap plans are standardized, the premiums for these plans are not standardized, and the rates vary significantly from one insurance carrier to another for the same exact plan and coverage.

Under the California Birthday Rule, the main reason you would want to change plans is to save money on your Medigap insurance premiums. In California, there are over two dozen Medigap insurance carriers to choose from. The only difference between them is the price.

For example, Julie will be turning 70 on April 25th, and her Plan G rate with Humana has increased to $205.00 per month. I contact Julie during the 30 days before her birthday (as I do for my clients) to compare rates and review her Medigap options. I let her know that she can get the same exact plan and coverage she now has (Plan G) with Transamerica for $153.00 per month.

Because Julie has had some serious health issues recently, she normally would not be able to change her Medigap insurance coverage. However, because of the California Birthday Rule, Julie can apply for Plan G with Transamerica during the 30 days before her birthday, and her new Plan G coverage will begin on May 1st. (Coverage usually begins on the first of the month following your birthday.) Because of the California Birthday Rule, Julie is now saving $52 per month or $624 per year for the same exact plan and coverage she had before by switching her Plan G from Humana to Transamerica.

NOTE: As of Julie 1st, 2020, Julie can take advantage of the California Birthday Rule every year during the 30 days prior to her birthday and up to 60 days following her birthday. As mentioned earlier, some carriers have already made this change.

Save Money

Rates Vary Significantly Between Insurance Carriers

Although Medigap plans are standardized, Medigap rates are not standardized, and they vary significantly between insurance carriers. For example, in the 92009 zip code (Carlsbad, California), the Plan G rates for a 70 year old single female range from $152.14 per month with Transamerica to $269.87 per month with UnitedHealthcare (UHc) through AARP! That is a difference of $117.73 per month or $1,412.76 per year!

The Application Process

Most Medigap insurance carriers in California use online applications. I work with clients throughout California and in several different states, so it’s not necessary to meet face to face. The application process is simple, and it usually takes less than 15 minutes to complete.

In addition to the application, most carriers request a copy of your current Medigap card showing which plan you currently have. Some carriers also want something such as a copy of a current bill or bank statement showing that a recent payment has been made. Once the application has been submitted, the entire application process takes about a week or two to complete.

Application-Header

New MACRA Law

As of January 1st, 2020, the Medicare Access and CHIP Reauthorization Act (MACRA) went into effect. Under MACRA, if you turn 65 or become eligible for Medicare Part B on or after January 1st, 2020, Plan F and Plan C will not be an option for you since they pay the Medicare Part B deductible, which is $198 per calendar year in 2020. If you turned 65 or became eligible for Medicare prior to January 1st, 2020, then you can still sign up for Plan F, Plan C, etc., and those plans will still be available in the future.

MACRA

Not All Insurance Carriers Are the Same

Although Medigap plans are standardized, some insurance carriers include some “extra” benefits with their plans such as free gym memberships, vision, hearing, and free personal emergency response systems (PERS), etc. Some insurance carriers guarantee and lock their rates for the first 12 months while others don’t. Some have better customer service, etc. It’s important to shop around and compare rates and to find the right plan and insurance carrier for you. I can help you with that.

For More Information

As an independent insurance agent, I work with all the major insurance carriers in California and several other states. I shop around for my clients, every year, to find them the best rates.

If you have any questions about the California Birthday Rule, etc. or if you would like a free, no-obligation Medigap quote, please don’t hesitate to contact me toll-free at (866) 718-1600 or at Ron@RonLewisInsurance.com. And please feel free to visit my website!

More Information

 

 

Are You a Hospital Inpatient or Outpatient?

If you are on Medicare and you are hospitalized, it’s important for you to know if you are being classified as a hospital “inpatient” or “outpatient!”

If you are classified as an outpatient or “under observation,” this can adversely affect how much you will pay for hospital services such as X-rays, drugs, and lab tests. This may also affect whether Medicare will cover the care you receive in a Skilled Nursing Facility (SNF) following a hospital stay.

You’re an inpatient beginning when you are formally admitted to a hospital with a doctor’s order. The day before you are discharged is your last inpatient day.

You’re an outpatient if you’re getting emergency department services, observation services, outpatient surgery, lab tests, X-rays, or any other hospital services, and the doctor hasn’t written an order to admit you to a hospital as an inpatient.

IMPORTANT: Even if you stay overnight in a hospital, you could still be classified as an “outpatient” or “under observation.”

inpatient vs outpatient

Observation services are hospital outpatient services given to help the doctor decide if you need to be admitted as an inpatient or if you can be discharged. These services may be given in the emergency room or another area of the hospital.

The decision for inpatient hospital admission is a complex medical decision based on your doctor’s judgment and your need for “medically necessary” hospital care. An inpatient admission is generally appropriate for payment under Medicare Part A when you’re expected to need 2 or more midnight’s of medically necessary hospital care, but your doctor must order this admission and the hospital must formally admit you for you to become an inpatient.

You may get a Medicare Outpatient Observation Notice (MOON) that lets you know you’re an outpatient in a hospital or critical access hospital. You must get this notice if you’re getting outpatient observation services for more than 24 hours.

The MOON will tell you why you’re an outpatient getting observation services, instead of an inpatient. It will also let you know how this may affect what you pay while in the hospital, and for care you get after leaving the hospital.

observation

How Much Do I Pay as an Inpatient?

Medicare Part A (Hospital Insurance) covers inpatient hospital services. Generally, this means you pay a one-time deductible for all of your hospital services for the first 60 days you’re in a hospital.

Medicare Part B (Medical Insurance) covers most of your doctor services when you’re an inpatient. You pay 20% of the Medicare-approved amount for doctor services after paying the Part B deductible.

NOTE: Most Medicare Supplement insurance plans will pay the entire Part A hospital deductible of $1,408 (in 2020) and most or all of the remaining 20% of the Medicare Part B expenses that are not covered by Medicare.

inpatient

How Much Do I Pay as an Outpatient?

Medicare Part B covers outpatient hospital services. Generally, this means you would pay a co-payment for each outpatient hospital service. This amount may vary by service. Part B also covers most of your doctor services when you’re a hospital outpatient. You pay 20% of the Medicare-approved amount after you pay the Part B deductible. Again, most Medicare Supplement insurance plans will pay for most or all of the Part B expenses that are not covered by Medicare.

In most cases, prescription and over-the-counter drugs you get in an outpatient setting such as an emergency room are not covered by Part B.

In certain circumstances, if you have a Medicare Prescription Drug Plan (PDP), also known as Medicare Part D, these prescriptions may be covered. You may have to initially pay out-of-pocket for these prescriptions and then submit a claim later on to your PDP for a refund.

Outpatient

How Would My Hospital Status Affect Skilled Nursing Home Care?

Medicare will only cover care you receive in a Skilled Nursing Facility (SNF) if you first have a “qualifying inpatient hospital stay.” This means that you must have been classified as a hospital inpatient (not an outpatient or under observation) for at least three days counting the day you were admitted as an inpatient, but not counting the day of your discharge.

If you don’t have a 3-day inpatient hospital stay and you need care after your discharge from a hospital, you should ask if you can get home health care or if any other programs such as Medicaid or Veterans’ benefits can cover your SNF care. Always ask your doctor or hospital staff if Medicare will cover your SNF stay.

Any days you spend in a hospital as an outpatient before you are formally admitted as an inpatient are not counted as inpatient days. An inpatient stay begins on the day you are formally admitted to the hospital as an inpatient with a doctor’s order. That’s your first inpatient day. The day of discharge does not count as an inpatient day.

NOTE: During the time you’re getting observation services in a hospital, you’re considered an outpatient. This means Medicare won’t count this time towards the 3-day inpatient hospital stay needed for Medicare to cover your SNF stay. If you have a Medicare Advantage (MA) plan, your costs and coverage may be different. You should check with your plan.

To qualify for SNF care, you must meet Medicare’s requirements and enter a Medicare-approved facility within 30 days after leaving a the hospital. Medicare covers the first 100 days of nursing home care after a three-day inpatient hospital stay. During the first 20 days in a nursing home, Medicare pays for all approved amounts. During the 21st through the 100th day, Medicare pays all up to $176 per day. After the 100th day, Medicare pays nothing.

NOTE: Most Medicare Supplements will pay the difference that is not covered by Medicare during the 21st though the 100th day in a skilled nursing home.

Common Hospital Situations That May Affect Your SNF Coverage

Situation You came to the ER and you were formally admitted to the hospital with a doctor’s order and spent 3 days in the hospital as an inpatient after admission. You were discharged on the 4th day.

Is My SNF Stay Covered? Yes, if all other coverage requirements are met. You met the 3-day inpatient hospital stay requirement for a covered SNF stay.

Situation You came to the ER and spent one day getting observation services. Then, you were formally admitted to the hospital as an inpatient for 2 more days.

Is My SNF Stay Covered? No. Even though you spent 3 days in the hospital, you were considered an outpatient while getting ER and observation services. These days don’t count toward the 3-day inpatient hospital stay requirement.

You Have Medicare Rights

No matter what type of Medicare coverage you have, you have certain guaranteed rights. As a person with Medicare, you have the right to all of these:

  • Have your questions about Medicare answered.
  • Learn about all of your treatment choices and participate in treatment decisions.
  • Get a decision about health care payment or services, or prescription drug coverage.
  • Get a review of (appeal) certain decisions about health care payment, coverage of services, or prescription drug coverage.
  • File complaints (sometimes called “grievances”), including complaints about the quality of your care.

For more information about your rights, the different levels of appeals, and Medicare notices, visit Medicare.gov to view the booklet “Medicare Rights & Protections.” You can also call 1-800-MEDICARE (1‑800‑633-4227). For more information, please click here to access a video I made about this subject.

Medicare Rights

Conclusion

If you are hospitalized, you must be classified as an “inpatient,” not an “outpatient” or “under observation” to receive maximum Medicare benefits, and you must be hospitalized for three full days as an inpatient in order to receive care in a skilled nursing facility. Otherwise, you may have high out-of-pocket costs and you may not be able to get other Medicare benefits you would otherwise be entitled to.

If you have any questions, or if you would like a Medicare Supplement quote, please contact me at (760) 652-6060 or at Ron@RonLewisInsurance.com or go to www.MedigapExpress.com.

Why You Should Replace Your Medicare Advantage Plan with a Medicare Supplement

The Annual Enrollment Period (AEP), which is from October 15th through December 7th each year, is almost here!

If you currently have a Medicare Advantage (MA) plan, you should switch back to Original Medicare and get a Medicare Supplement plan instead!

IMPORTANT: If you have a Medicare Supplement plan (aka “Medigap” because it picks up the “gap” in Medicare coverage) the AEP does not apply to you unless you want to enroll in or change your Prescription Drug Plan (PDP).

Why Medicare Supplement Plans Are Better

With Original Medicare (Part A and Part B) and a Medicare Supplement, you have much more freedom of choice and lower costs than you do with an MA plan!

NOTE: Medicare Part A is hospital insurance and Part B is medical insurance.

Which Plan Gives You the Most Freedom?

With an MA plan, you are locked into the plan’s network of doctors, specialists, hospitals, and care facilities. If you want to see a specialist, you often have to see your preferred care provider first, who acts as a gatekeeper, before you can see a specialist within your network. If you want to see a specialist or doctor that is outside of your network, good luck! That will cost you a lot more in out-of-pocket (OOP) costs.

gatekeeper_

With a Medicare Supplement plan, you can go to ANY doctor, specialist, hospital, or care facility in the US as long as they accept Medicare!

For example, the MD Anderson Cancer Treatment Center in Texas accepts Medicare and therefore, they accept ALL Medicare Supplement plans. They don’t, however, accept most MA plans!

Which Plan Has Lower Out-Of-Pocket Costs?

With an MA plan, your OOP costs can be as high as $6,700 per calendar year and even higher if you go to doctors and/or care facilities that are outside of your network! With a Plan F or Plan G Medicare Supplement (the two best Medigap plans), the most you would normally pay in OOP costs in a calendar year is either $0 with Plan F or $183 with
Plan G!

out of pocket costs

NOTE: The $183 is the Medicare Part B (Medical) deductible, which is $183 per calendar year in 2017. That amount can change from year to year, but historically, it has always been very stable.

Maximum Out-Of-Pocket Costs for MA Plans in San Diego

The following data was obtained from the Medicare.gov website and shows the current OOP costs for MA plans in the 92009 zip code in San Diego. These costs currently range from $3,300 to $6,700 per calendar year!

If you go out-of-network with your MA plan, your OOP costs will be even higher!

Current (in-network) Maximum OOP Costs for MA Plans in the 92009 Zip Code:

  • AARP MedicareComplete SecureHorizons Essential (HMO) – $4,900
  • AARP MedicareComplete SecureHorizons Plan 4 (HMO) – $3,400
  • AARP MedicareComplete SecureHorizons Premier (HMO) – $4,300
  • AARP MedicareComplete SecureHorizons Value (HMO) – $5,300
  • Aetna Medicare Choice Plan (PPO) – $6,000
  • Aetna Medicare Select Plan (HMO) – $3,400
  • Anthem MediBlue Coordination Plus (HMO) – $6,700
  • Anthem MediBlue Plus (HMO) – $3,400
  • Blue Shield 65 Plus (HMO) – $3,400
  • Brand New Day Classic Care Drug Savings (HMO) – $3,400
  • Brand New Day Classic Choice for Medi-Medi (HMO) – $6,700
  • Care1st AdvantageOptimum Plan (HMO) – $3,400
  • Coordinated Choice Plan (HMO) – $6,700
  • Health Net Healthy Heart (HMO) – $3,400
  • Health Net Seniority Plus Sapphire (HMO) – $6,700
  • Health Net Seniority Plus Sapphire Premier (HMO) – $6,700
  • Humana Gold Plus H5619-016 (HMO) – $4,900
  • Humana Value Plus H5619-037 (HMO) – $6,700
  • Kaiser Permanente Senior Advantage San Diego (HMO) – $4,900
  • Scripps Classic offered by SCAN Health Plan (HMO) – $3,400
  • Scripps Plus offered by SCAN Health Plan (HMO) – $6,700
  • Scripps Signature offered by SCAN Health Plan (HMO) – $4,000
  • Sharp Direct Advantage Gold Card (HMO) – $3,400
  • Sharp Direct Advantage Platinum Card (HMO) – $3,300
  • Sharp SecureHorizons Plan by UnitedHealthcare (HMO) – $3,400

In contrast, in a calendar year, your maximum OOP costs are either $0 with a Plan F Medicare Supplement or $183 with a Plan G Medicare Supplement!

Is Your MA Plan’s Maximum OOP Costs Really No More Than $6,700 Per Year?

If you stay within your MA plan’s network, your maximum OOP costs are not supposed to be more than $6,700 per calendar year. However, if you go outside of the plan’s network, your OOP costs can be significantly higher than that!

Suppose that you get really sick and need expensive treatment such as Chemotherapy, etc. in the second half of the year. You could end up paying up to $6,700 (or whatever your plan’s maximum OOP cost is) by the end of the calendar year and guess what? Your OOP maximum zeros out in January, and it starts all over again!

If you are still receiving expensive medical care in the beginning of the year, you could potentially end up paying your maximum OOP cost two different times in a
12-month period! For example, if your maximum OOP cost is $6,700, your total OOP cost in a 12-month period, not a calendar year, could be more than $13,400!

Which Plan Has Lower Co-Payments?

If you have an MA plan, you will make a co-payment almost every time you go to the doctor, see a specialist, a physical therapist, etc. With most Medicare Supplement plans, there are no co-payments for doctor’s visits, etc.

Co Payment

How Difficult is it to Switch From an MA Plan to Original Medicare and a Medicare Supplement Plan?

That depends if you are in a Special Enrollment Period (SEP).

Special Enrollment Period

If you currently have an MA plan, and you are in a SEP, you can switch to Original Medicare and to any six of the 10 “standardized” Medicare Supplement plans any time of the year, REGARDLESS of your health.

The six “guaranteed issue” Medicare Supplement plans are plans A, B, C, F, K, and L. In other words, if you are in a SEP, you are guaranteed the right to get a Plan F Medicare Supplement, but not a Plan G supplement, etc.

NOTE: You could apply for Plan G, but you would be medically underwritten, and you could be turned down for certain medical conditions.

The 10 Standardized Medicare Supplement Plans

Nationwide, there are 10 “standardized” Medicare Supplement plans to choose from (Plans A through N). The term “standardized” means that the benefits and coverage for every Plan F, Plan G, etc. is exactly the same with every insurance carrier. Unlike MA plans, which are not standardized, it’s much easier to compare “apples with apples” with Medicare Supplement plans.

Medicare Supplement rates are not standardized. They vary significantly between insurance carriers. For that reason, it’s very important to shop around every year!

2017-Medicare-Supplement-Chart

NOTE: In the preceding chart, notice that the only difference between Plan F and Plan G is the $183 per calendar year Part B deductible.

SEP Situations

Here are some SEP situations that would guarantee you the right to switch back to Original Medicare and a Medicare Supplement plan:

  • The plan is leaving the Medicare program or stops service in your area.
  • You move out of the plan’s service area.
  • You leave the plan because the company has not followed certain rules or has misled you.
  • You decide to switch to Original Medicare within the first year of joining an MA plan when first eligible for Medicare Part A at age 65.

If you are in one of these situations, you cannot be turned down for Medicare Supplement insurance coverage, regardless of your health!

If You Are Not In a Special Enrollment Period

If you are not in a SEP, you will have to wait until the AEP (between October 15th and December 7th) to switch back to Original Medicare (Part A and Part B) on January 1st of the following year.

Although you can switch back to Original Medicare, there is no guarantee that you will be able to get a Medicare Supplement plan because you will be medically underwritten, and you must be in relatively good health to qualify for a Medicare Supplement plan.

If You Have Serious Health Conditions, You May Not Be Able to Get a Medicare Supplement Plan!

If you are not in a SEP and you are coming off of an MA plan during the AEP, you would normally have to meet minimum underwriting requirements to qualify for a Medicare Supplement plan, and you could be turned down for coverage.

If you live in California and you have serious health issues, more than likely, I can still get you a Medicare Supplement without having to answer any medical questions on the application! Call me for more details!

The Pros and Cons of MA Plans and Medicare Supplement Plans

Is there really an advantage to having a Medicare Advantage plan? Let’s take a look at the pros and cons of each, and you can decide for yourself.

Pros-and-Cons-of-Alternative-Lending

MA Plan Advantages

Here are some benefits of having an MA plan:

  1. MA premiums can be very low, and some plans have no monthly premiums at all.
  2. Some MA plans include Medicare prescription drug coverage (Part D).
  3. Maximum OOP costs are “limited.” Plans vary, but in 2017, the most you can pay in OOP costs is $6,700 per calendar year. (I wouldn’t really call this a “benefit” since $6,700 is a lot of money! With a Plan F Medicare Supplement, you won’t pay any OOP costs!)
  4. Some MA plans offer additional benefits such as vision, hearing, dental, and other health and wellness programs. (Note that some Medicare Supplement plans also offer additional benefits such as free gym memberships, vision, and hearing aid benefits.)

Medicare Supplement Plan Advantages

Here are some benefits of having a Medicare Supplement plan:

  1. You have much more FREEDOM of choice with a Medicare Supplement than you do with an MA plan because you can go to ANY doctor, hospital, specialist, or care facility in the United States as long as they accept Medicare. (You can’t do that with an MA plan.)
  2. You have much for financial stability with a Medicare Supplement than an MA plan because there are no unexpected spikes in costs and OOP expenses for co-payments, hospitalizations, surgeries, chemotherapy, etc.
  3. With a Plan F or Plan G Medicare Supplement, other than your premiums, your maximum OOP costs in a calendar year will be either $0 (Plan F) or $183 (Plan G) per calendar year in 2017. With an MA plan, your maximum OOP costs can be as high as $6,700 per calendar year!
  4. Chemotherapy is very expensive. With an MA plan, you have to pay the entire 20% Medicare Part B co-payment for chemotherapy, which can cost thousands of dollars. With a Plan F or Plan G Medicare Supplement, the most you will pay for Chemotherapy is either $0 (Plan F) or $183 (Plan G)!
  5. You are not limited to a specific geographic region or a restrictive network of doctors, hospitals, specialists, care facilities, etc. like you are with an MA plan. With most MA plans, you must use their providers or you may pay more or all of the costs if you go out of their network.
  6. With a Medicare Supplement, you can go directly to the specialist of your choice, ANYWHERE in the United States, as long as they accept Medicare. With most MA plans, you must go through your primary care doctor first (the “gatekeeper”) before you can see a specialist within your network.
  7. There are no HMO or PPO plans or networks with Medicare Supplements. If you have an MA plan and you go to a doctor, other health care provider, facility, or supplier that doesn’t belong to the plan’s network for non‑emergency or non-urgent care services, your services may not be covered, or your costs could be higher.
  8. If you want to go to a renowned treatment center such as the MD Anderson Cancer Treatment Center in Texas, you can do so with any Medicare Supplement, as long as they accept Medicare. You can’t do that with most MA plans.
  9. If you move to another part of the country, you can keep your Medicare Supplement, but you cannot keep your MA plan if you move out of your network.
  10. There are only 10 “standardized” Medicare Supplement plans to choose from, (Plan A through Plan N). Since Medicare Supplements are standardized, the coverage and benefits for every Plan F, Plan G, etc. is exactly the same with every insurance carrier, so it’s much easier to shop around and compare “apples with apples.” MA plans are not standardized, and the co-payments, deductibles, out of pocket costs, etc. vary significantly between MA plans, and they change every year making them unnecessarily complicated and confusing.
  11. Your Medicare Supplement plan cannot be cancelled as long as you pay your premiums. MA plans are annual contracts, and they can be cancelled or benefits changed at the end of each calendar year.
  12. There are no provider networks with Medicare Supplements. With MA plans, providers can join or leave a plan’s provider network anytime during the year meaning that you could have to start shopping around for a new doctor while simultaneously undergoing Chemotherapy or other specialized medical treatments.
  13. There is no AEP for Medicare Supplements, and you don’t have to shop around every year and make sure that your coverage, co-payments, co-insurance, deductibles, and benefits haven’t changed since the previous year. If there are any Medicare changes from one calendar year to the next, your Medicare Supplement will automatically pay the difference.
  14. You can travel around the US for as long as you want (or even move to a different geographic location), and your Medicare Supplement cannot be cancelled for leaving your “service area.” With most MA plans, if you travel outside of the MA plan’s service area for more than six months, you could be disenrolled from the plan.
  15. With most Medicare Supplements, there are no co-payments when you go to the doctor. With most MA plans, you have to pay co-payments when you go to the doctor.
  16. With Medicare Supplements, pre-certification is not required for surgeries, etc. as long as the procedure is “medically necessary.” With most MA plans, pre-certification is required for surgeries or before getting expensive treatments.
  17. You can switch Medicare Supplement plans or insurance carriers any time of the year as long as you meet minimum health and underwriting requirements. With an MA plan, you can only join or leave an MA plan during the AEP. Otherwise, you are locked into your plan for the entire calendar year, except for certain circumstances, such as moving out of your plan’s service area, etc.)

As you can see, you are much better off with a Medicare Supplement plan than you are with a Medicare Advantage plan!

Conclusion

If you currently have a Medicare Advantage (MA) plan, you have given up your Original Medicare rights that you have worked so hard for, and you are compromising your freedom to go to the best doctors, hospitals, specialists, neurosurgeons, care facilities, etc. in the United States.

I would strongly urge you to switch back to Original Medicare and get a Medicare Supplement plan during the upcoming AEP, between October 15th and December 7th)! Contact me TODAY for more information or a free quote!

As an independent insurance agent specializing in Medicare Supplements, I work with ALL of the major insurance carriers, not one particular company. I will shop around for you, every year, and save you money on your Medicare Supplement insurance!

If you live in California and you have a serious medical condition, more than likely, I can still get you a Medicare Supplement at a competitive price without answering any of the health questions on the application!

I hope that you have found this article to be helpful and informative. Please feel free to forward this article to anyone who may be interested.

Your comments and feedback are appreciated! If you have any questions, please contact me… I’m always happy to help!

Thank you!

Ron Lewis
www.MedigapExpress.com
Ron@RonLewisInsurance.com
866.718.1600 (Toll-free)

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Should You Sign Up for a Medicare Prescription Drug Plan?

I just turned 65 yesterday, August 20th, and my Medicare Part A (Hospital) and Part B (Medical), Medicare Supplement, and Medicare Prescription Drug Plan (PDP), also known as Part D, all started a few weeks ago on August 1st, 2017.

NOTE: For most people, their Medicare benefits usually begin on the 1st of the month when they turn 65.

Fortunately, I’m in pretty good health, and I only take two relatively inexpensive medications. Since there is a late enrollment penalty added to your monthly PDP premiums if you don’t sign up for a PDP when you are first eligible (turning 65 or starting Medicare Part B), I decided that I was going to at least sign up for the cheapest PDP to avoid the penalty later on.

Pills

How Much is the Part D Penalty?

The cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage.

According to the Medicare.gov website “Medicare calculates the penalty by multiplying 1% of the “national base beneficiary premium” ($35.63 in 2017) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.”

NOTE: The national base beneficiary premium may increase each year, so your penalty amount may also increase each year.

The late enrollment penalty is approximately $0.34 per month for every month you could have had prescription drug coverage but didn’t. For example, if you went 10 months without PDP coverage before you started a new PDP, the total penalty would be approximately $3.40 per month ($0.34 x 10 months) on top of the regular prescription drug plan monthly premium. Again, the penalty amount can increase in the future.

Part D Penalty

My Prescription Drug Plan Coverage — Before and After Medicare

Before I started on Medicare, I had some limited prescription drug plan coverage through my Affordable Care Act (Obamacare) health insurance, which wasn’t so “affordable.”

I take two medications: Fluticasone nasal inhaler and Levothyroxine. Through my previous pharmacy, the regular price of the Fluticasone was $56.80 per month, but with my Obamacare insurance, I was paying $20.00 per month. In addition to that, I was paying $12.68 per month for the Levothyroxine.

Altogether, before I started on Medicare, I was paying $32.68 per month for both prescriptions.

In contrast, I recently signed up with the Medicare “Humana Walmart Rx Plan” because it is currently the cheapest and most cost-effective drug plan for my particular situation. During the next Annual Enrollment Period (AEP), which is from October 15th through December 7th each year, I may sign up for a different PDP plan if I find another plan that is better than the one that I currently have.

Regardless of what PDP you currently have, you should always shop around every year during the AEP between October 15th and December 7th.

open-enrollment-street-sign

NOTE: I am not certified to sell prescription drug plans, and I am not recommending, endorsing, or promoting Humana or any particular insurance carrier. My primary focus and area of expertise is with Medicare Supplement insurance plans.

With my Humana PDP, I pay a monthly premium of $17 per month, and I have a $400 per calendar year deductible. However, the two prescriptions that I take are classified as
Tier 1 prescriptions, and under my current plan, Tier 1 and Tier 2 prescriptions are not subject to the deductible, so I don’t have to pay any deductibles for the two prescriptions that I take!

With my Humana PDP, I chose to have my prescriptions mailed to me every three months, so I no longer have to drive to the pharmacy to pick up my prescriptions each month. That’s a nice benefit too!

NOTE: In my particular situation, the mail-order option ended up costing me less than picking my prescriptions up from a pharmacy, but that isn’t always the case.

For the Fluticasone, I am currently paying $8.00 TOTAL for a three-month supply! That comes out to $2.67 per month! For the Levothyroxine, I do not have to pay anything other than my monthly premium!

As mentioned before, I am currently paying $17.00 per month for my Humana PDP premium, and my total out-of-pocket cost for my medications is $2.67 per month for a total cost of $19.67 per month. In contrast, I was paying $32.68 per month prior to Medicare just for my prescriptions, not including my not-so-reasonably-priced health insurance premium.

I am very happy with my Medicare prescription drug plan. For me, it is significantly better than the prescription coverage that I had before I was on Medicare.

happy

Is a Medicare Prescription Drug Plan Good for Everyone?

Fortunately for me, the prescriptions that I take are relatively inexpensive, but I know that isn’t the case for everyone. Some of my clients take a lot of expensive prescriptions, and a PDP doesn’t always save them money or else some of the prescriptions may not be covered at all by the PDP, which is very frustrating.

Some people don’t take any prescriptions at all, and they may question whether it makes sense to sign up for a PDP if they currently don’t need one, even though their health could (and probably will) change at some point in the future.

Because of the late enrollment penalty, I would still recommend signing up for the cheapest PDP, at least for the time being, if it isn’t a financial hardship.

NOTE: This blog addresses my experience with Medicare prescription drug plans. To read about my experience with Medicare Supplement insurance plans, please click here.

Everyone is different, and what is good for one person isn’t necessarily good for another. Should you sign up for a prescription drug plan? That is a personal decision and a question that only you can answer.

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I am an independent insurance agent specializing in Medicare Supplement insurance plans. I work with all the major insurance carriers in California, Washington, and several other states. If you have any questions, or if you would like for me to shop around for you to save you money on your Medicare Supplement insurance, please don’t hesitate to let me know!

Thank you!

Ron Lewis
www.MedigapExpress.com
Ron@RonLewisInsurance.com
866.718.1600 (Toll-free)

Hello Medicare, and Goodbye Obamacare!

In several months from now, a good friend of mine will be turning 65 years old. While he is not anxious to get any older than he already is, he is happy about one thing… he will be getting off of Obamacare and onto Medicare!

65th-birthday-latex-balloons

My friend used to have a really good, low-deductible health insurance plan that was very affordable. But under Obamacare, all of that changed. The quality of his health insurance decreased significantly while his Affordable Care Act (ACA) premiums, co-payments, and deductibles increased dramatically. But fortunately, he now has maternity coverage, which is something that he never had before! Sorry about the sarcasm!

Pregnant man

When he goes onto Medicare, it will be just the opposite; the quality of his health insurance will increase significantly while the cost of his premiums, co-payments, co-insurance, and deductibles will all decrease!

Current Coverage

For example, he currently has a Bronze 60 ACA plan. The annual deductible is $4,800 per calendar year if he goes to “participating” providers and $9,000 per calendar year if he goes to “non-participating” providers! According to his health plan, “You must pay all the costs up to the deductible amount before this plan begins to pay for covered services you use. The integrated deductible applies to both medical and pharmacy services.” Therefore, the deductibles apply to prescription drug coverage as well.

Once the deductible is met, my friend must pay 40% of the remaining costs until he has reached the maximum out-of-pocket (OOP) cost, which is $6,550 per calendar year for “participating” providers and $9,650 per calendar year for “non-participating” providers.

NOTE: According to his current health insurance plan, OOP costs do not include “Premiums, balance-billed charges, some co-payments, charges in excess of specified benefit maximums, and health care this plan doesn’t cover.” So, total OOP costs are really much higher than $6,550 or $9,650 per calendar year when you factor in premiums and other miscellaneous costs.

The deductible and OOP costs start all over again every January. If he got really sick in the last six months of the year, there is a real possibility that he could reach his maximum OOP costs of $6,550 (or $9,650) again in the first six months of the following year. That means that he could potentially have total OOP costs in excess of $13,100 to $19,300 in a twelve-month period, not including his premiums!

My friend has a subsidized plan through Covered California. Although he pays $268.52 per month for his Bronze 60 PPO plan, the full premium that others are paying for the same identical (non-subsidized) plan is $784.79 per month, which isn’t exactly cheap for a high-deductible, catastrophic plan! I’m pretty sure you can buy or lease a luxury automobile for a lot less than that!

Mercedes

Medicare Coverage

In contrast, he won’t have to pay anything for his Medicare Part A (Hospital) insurance, and he will pay $134.00 per month for his Medicare Part B (Medical) insurance. In addition to his Original Medicare, he will need to take out a Medicare Supplement plan to pick up the difference in co-payments, deductibles, and co-insurance that Medicare does not pay.

Medicare Supplement Coverage

Of the 10 standardized Medicare Supplement plans (aka Medigap plans because they pick up the “gaps” in coverage that are not covered by Medicare), Plan F and Plan G are the two best plans:

  • Plan F pays for ALL of the co-payments, deductibles, and co-insurance that is not covered by Medicare. With Plan F, there are NO DEDUCTIBLES OR OUT-OF-POCKET COSTS!
  • Plan G is identical to Plan F except for the $183 per calendar year deductible for outpatient treatment such as physician services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests, and durable medical equipment.

NOTE: In 2017, the Part B deductible is $183 per calendar year. This amount can change from year to year, but historically, it has been very stable. With Plan G, once you have met the $183 per calendar year deductible, there are no other out of pocket costs, and Plan G is exactly the same as Plan F. The monthly premiums for Plan G are usually significantly less than the monthly premiums for Plan F, so Plan G usually ends up being more cost effective than Plan F.

For this reason, many people with Plan F have been switching to Plan G. Also, beginning on January 1st, 2020, Plan F will no longer be available for new people who are turning 65.

Although my friend’s ACA health plan is a PPO, he is still restricted to doctors, specialists, hospitals, care facilities, etc. that are within his health plan’s network. If he goes out of the network or goes to “non-participating” providers, he pays even more!

With Original Medicare and Medicare Supplements, there are no networks, HMO’s, or PPO’s, so my friend will have much more freedom of choice than he presently has with his ACA plan.

freedom

With a Medicare Supplement plan, you can go to ANY doctor, specialist, care facility, or hospital in the United States, as long as they accept Medicare! If you later move to another state, you can keep your Medicare Supplement plan and use it ANYWHERE in the US!

Medicare Supplement Premiums

In California, Medicare Supplement rates are based primarily on your age and zip code. If my friend decides to splurge and go with Plan F (the “Cadillac” plan) he will have a $0 deductible and no out-of-pocket costs! For age 65, his monthly premium will be as low as $132.00 per month!

Rates can vary significantly between insurance carriers for the same identical plan and coverage, so it’s important to shop around every year!

If my friend wants to save money on his Medicare Supplement premiums by signing up with Plan G, his maximum calendar year deductible AND out-of-pocket costs combined will be $183 per calendar year, and his monthly premium will be as low as $119.36 per month!

Plan F or Plan G

Scenario #1 – Total Costs if My Friend Signs up with Plan F

If he decides to sign up with Plan F, the most expensive Medicare Supplement plan, his total monthly premiums for his Medicare Part A ($0), Medicare Part B ($134.00), and his Plan F Medicare Supplement ($132.00) will be $266.00 per month!

NOTE: If he wants to, my friend can also pick up a good Prescription Drug Plan (PDP) for $17.00 per month.

Scenario #2 – Total Costs if My Friend Signs up with Plan G

If he decides to sign up with Plan G, the most popular Medicare Supplement plan, his total monthly premiums for his Medicare Part A ($0), Medicare Part B ($134.00) and his Plan G Medicare Supplement ($119.36) will be $253.36 per month!

Conclusion

My friend is currently paying $268.52 per month for a high-deductible, catastrophic ACA health insurance plan that is basically worthless.

If he decides to sign up for a Plan F Medicare Supplement with no deductibles or out-of-pocket costs, his total cost for coverage under Medicare and his Medicare Supplement will be $266.00 per month!

If he decides to sign up for a Plan G Medicare Supplement with a $183 per calendar year deductible and no out-of-pocket costs, his total cost for coverage under Medicare and his Medicare Supplement will be $253.36 per month!

And now you know why my friend is smiling about his upcoming 65th birthday…
“Hello Medicare, and good riddance Obamacare!”

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Let me do the shopping for you and save you money on your Medicare Supplement! Contact me today for a for a free insurance quote and price comparison!

Ron Lewis
www.MedigapExpress.com
Ron@RonLewisInsurance.com
866.718.1600 (Toll-free)

Upcoming Changes for Medicare Supplement Plan F and Plan C in 2020

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As of January 1st, 2020, “newly eligible” Medicare beneficiaries will no longer be able to purchase Plan F and Plan C Medicare Supplement plans, which are also known as “Medigap” plans because they pick up the “gaps” in coverage that Medicare doesn’t cover.

NOTE: The high-deductible Plan F Medigap plan is also going away.

Individuals that are signing up for Medicare on or after January 1st, 2020, will not be able to sign up for any Medigap plan that covers the Medicare Part B deductible, which is currently $183 per calendar year in 2017.

Of the 10 “standardized” Medigap plans, Plan F and Plan C are the only two plans that cover the Part A (Hospital) and Part B (Medical) deductibles and coinsurance in full. These two plans are the only Medigap plans that offer “first-dollar” coverage for every doctor or hospital visit.

Why Are Plan F and Plan C Going Away?

These changes are taking place because of Section 401 in the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, which is also known as the “doc fix” law. To view the text, please click here.

In a nutshell, Nutshell ImageCongress passed this legislation to ensure that doctors would be paid adequately for providing Medicare services and to provide an incentive for doctors to continue accepting Medicare patients. Previous legislation had budgeted for doctors to have rate decreases over the years and there was concern that many doctors would stop accepting Medicare patients.

Because of the ever-increasing cost of medical care and the fact that more than 10,000 baby-boomers are turning 65 every day, Medicare is experiencing increased financial strain. Since individuals with Plan F and Plan C have no co-payments or deductibles, lawmakers fear that this lack of cost-sharing results in Medicare abuse, which is driving up costs.

It has been argued that the “first dollar” coverage available from Plan F and Plan C cause Medicare recipients to see their doctors more frequently than they would if they didn’t have all of their deductibles covered and had to pay some out-of-pocket costs when they did go to the doctor. Some claim that these changes will save Medicare billions of dollars each year in medical claim exposure.

In an effort to control costs by reducing claims, Congress has decided that it makes more sense for Medicare recipients to be responsible for more of their out-of-pocket medical expenses. Consequently, Congress has decided to eliminate Plan F and Plan C because they want Medicare beneficiaries to have more “skin in the game.”

No one knows if these measures will really reduce Medicare’s overall annual costs. Some argue that Medicare beneficiaries may end up waiting to get medical care for serious issues, which would ultimately cost Medicare more money in the future.

free-money

What Happens If I Have Plan F or Plan C Before January 2020?

Since the MACRA only prohibits the sale of Medigap Plan F and Plan C to “newly eligible” Medicare beneficiaries on or after January 1st, 2020, if you already have one of these plans in 2020, you will be exempted and “grandfathered” in. You will not lose your coverage!

You will still be able to purchase Plan F and Plan C policies from other insurance carriers after 2020 as long as you can medically qualify or if you are in an Open Enrollment or Guaranteed Issue situation.

If you were eligible for Medicare prior to 2020, but you delayed getting it because you are still working and have employer insurance, you will still be able to enroll in Plan F or Plan C after you stop working and switch back to Medicare.

What Happens If I Won’t Be Eligible for Medicare Until After January 2020?

For those individuals who will not be eligible for Medicare until January 1st, 2020 or later, although you will not be able to get Plan F, you will still be able to get Plan G, which is an excellent Medigap plan that is identical to Plan F in every way except for the $183 per calendar year deductible.

Today, many people that have Plan F have been switching to Plan G because the premiums for Plan G are usually significantly less than the premiums for Plan F. In most cases, Plan G will cost you less and is usually more cost effective, even if you pay for the entire Part B deductible!

Shop Around Every Year!

Since Medicare Supplement rates vary significantly between insurance carriers for the same identical plans and coverage, and since the rates in most states are based on your “attained” age, and they usually go up in price each year, it’s important to shop around every year, preferably during the 30 days before your birthday.

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If you live in California, there is a law called the “California Birthday Rule.” This law guarantees you the right to switch “like for like” Medigap plans, such as Plan F for Plan F, or you can switch to any other Medigap plan with fewer benefits, such as from Plan F to Plan G, etc. You can do this every year, REGARDLESS OF YOUR HEALTH, during the 30 days following your birthday! Most insurance carriers in California let you do this during the 30 days before or after your birthday.

Whether you decide to keep your current Plan C or Plan F, or if you want to find out how much you can save by switching to Plan G, you should take advantage of the California Birthday Rule and compare rates every year to make sure that you aren’t paying too much!

If you have any questions or comments, or if you’d like a free quote or rate comparison, please visit www.MedigapExpress.com or call my cell at (760) 525-5769 or (866) 718-1600 (Toll-free).

Thank you!

Ron Lewis