Tag Archives: medicare supplement

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

Switching from Medicare Advantage to Medigap in California: What You Need to Know

Each year, many people in California decide to leave their Medicare Advantage (Part C) plan and return to Original Medicare (Part A and Part B) with a Medicare Supplement (Medigap) plan. Often, this happens when premiums, copays, or out-of-pocket costs increase, or when clients find their favorite doctors or hospitals are no longer in their plan’s network.

If you’ve ever wondered how to switch from Medicare Advantage to Medigap, it’s important to understand how the process works, and the potential challenges if you have existing health conditions.

You Can Switch Back to Original Medicare — But You’re Not Automatically Guaranteed Medigap Approval

You can drop your Medicare Advantage plan and go back to Original Medicare during certain times of the year, such as the Annual Election Period (AEP), which goes from October 15th through December 7th every year or during the Medicare Advantage Open Enrollment Period, which goes from January 1st through March 31st.

However, many people are surprised to learn that once they return to Original Medicare, they must apply separately for a Medicare Supplement plan, and approval is not guaranteed. In most cases, insurance companies can review your health history, which is called “medical underwriting,” and deny coverage if you have serious or chronic health conditions. That’s why timing and knowing the rules can make all the difference.

Medicare Guaranteed Issue Rights: The Hidden Opportunities

Here’s the good news… even if you have health problems, there are special Guaranteed Issue (GI) rights or situations that often let you enroll in a Medigap plan without health questions or underwriting.

These rights apply in specific situations and many beneficiaries don’t realize they qualify. Some are tied to Medicare Advantage plan changes, others to state-specific protections. In California, there are several lesser-known GI opportunities that can help people switch to Medigap coverage, even when they’ve been told “no” before.

I work with clients every year who thought they couldn’t qualify due to health issues and I’ve helped them get accepted for Medicare Supplement coverage using legitimate Guaranteed Issue options that most agents aren’t aware of or don’t mention to their clients.

Why Work with a Specialist Who Knows the California Rules

The Medicare rules in California are unique. Between the California Birthday Rule and other state-specific guaranteed issue protections, there are several ways to save money and secure coverage without medical underwriting.

As an independent Medicare Supplement insurance specialist, I work with all the major insurance carriers throughout California, Nevada, and several other states. My goal is simple. I want to help you find the best Medicare Supplement plan with the lowest premium and the most reliable coverage, year after year.

Let’s See What You Qualify For

If you’re considering leaving your Medicare Advantage plan or want to see if you qualify for a Guaranteed Issue Medicare Supplement, don’t wait until it’s too late.

There is no cost for my help. I’m paid by the insurance carriers, not my clients. I can review your situation, identify any Guaranteed Issue opportunities, and help you apply for the coverage that fits your needs and budget.

Contact me today to learn your options and see how much you could save on your Medicare Supplement plan.

About the Author

As an independent Medicare Supplement insurance specialist, I work with all the major insurance carriers throughout California, Nevada, and several other states. I shop around for my clients every year during their 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 for the same exact plan and coverage! Please click here to read 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

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

How the California Birthday Rule Can Save You Hundreds on Your Medigap Plan — Every Year

Introduction

If you’re a Medicare Supplement (Medigap) policyholder living in California, there’s a little-known benefit that could save you hundreds (or even thousands) of dollars a year and many people don’t even know that it exists. It’s called the California Birthday Rule, and it gives you the right to switch your Medigap plan every year around your birthday, REGARDLESS OF YOUR HEALTH!

IMPORTANT: You can change your Medicare Supplement any time of the year, but if you do it around your birthday, it’s a lot easier because you don’t have to answer any health questions, there’s no medical underwriting, and YOU CAN’T BE TURNED DOWN FOR COVERAGE!

Medigap Plans Are Standardized

Nationwide, there are 10 standardized Medicare Supplement lettered plans to choose from, Plan A through Plan N. When I say “standardized,” that means that the coverage and benefits for every lettered plan are exactly the same regardless of what insurance carrier you sign up with. In other words, Plan G is Plan G, Plan N is Plan N, etc., regardless of what insurance carrier you are with. So it’s much easier to compare plans since every plan is exactly the same no matter which insurance carrier offers it.

NOTE: Technically, there are actually 12 standardized Medigap plans to choose from because there are high-deductible versions of Plan F and Plan G. In 2025, you will pay a $2,870 deductible before your coverage for either of these plans would begin.

As you can see, the only difference between Plan F and Plan G is the Medicare Part B deductible.

Which Medigap Plan is Best?

For those who are turning 65 or starting Medicare today, the best and most comprehensive Medigap plan is Plan G, which pays for everything except for the Medicare Part B deductible. The current annual Part B deductible (in 2025) is $257. That amount can change from year to year, but historically, it hasn’t changed by much.

Medicare Access and CHIP Reauthorization Act of 2015

Due to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Medigap Plan C and Plan F were discontinued for new Medicare beneficiaries starting on January 1st, 2020. This legislation eliminated the availability of Medigap plans that cover the Medicare Part B deductible for individuals who became eligible for Medicare on or after that date. However, Plan C and Plan F are still available for people who were eligible for Medicare before 2020 or who already have one of those plans. They just aren’t available for those individuals that turned 65 or started Medicare on or after January 1st, 2020.

Let’s look at a common example of how switching under the Birthday Rule can save you money.

Why Plan G is More Popular Than Plan F

If you have a Plan F Medicare Supplement, you’re probably paying more than you need to. It’s usually much cheaper and more cost effective to switch to Plan G because both plans are identical in coverage except for the Medicare Part B deductible, which is $257 in 2025. Plan F covers that small deductible, while Plan G does not. That is the only difference between the two plans, yet the premiums for Plan F are usually significantly higher.

Even though Plan F covers that $257, it often costs $400–$1,000 more per year in premiums than Plan G, so in most cases, you’d save money by paying the lower monthly premium for Plan G and just covering that $257 deductible yourself.

IMPORTANT: If you can save more than $257 per year by switching from Plan F to Plan G, then Plan G is cheaper and more cost effective.

For example, if your Plan F premium is $250 per month and you can get Plan G for $200 per month, that’s a gross savings of $50 per month or $600 per year. If you pay the $257 on your own, your net savings will still be $343 per year ($600 – $257 = $343)! The Medicare Part B deductible is payable only one time per calendar year, so after you pay that small deductible, there is absolutely no difference between Plan F and Plan G for the remainder of the year!

NOTE: If you have Plan F and you switch to Plan G, if you’ve already met your $257 Part B deductible, you won’t pay it again until the following year since that small deductible is payable only one time per calendar year.

What Is the California Birthday Rule?

The California Birthday Rule is a special California state law that allows active Medigap policyholders in California to switch to a new Medigap plan with “equal or fewer” benefits every year around their birthday without medical underwriting during a 60-days following their birthday.

NOTE: In California, most carriers accept applications from 30 days before your birthday up to 60 days after your birthday, a 91-day window to switch Medigap plans without medical underwriting.

Most states don’t have a birthday rule, and if you develop a serious health condition, you could be stuck with your current health insurer and Medigap plan. But thanks to the California Birthday Rule, you have a guaranteed open enrollment period every year to shop around and save money on your premiums without worrying about being stuck or declined.

What Does Equal or Fewer Mean?

Again, under the birthday rule, you can switch to any Medigap plan that offers “equal or fewer” benefits than your current plan. In other words, you can switch from your current Medigap plan to any other Medigap plan that offers benefits that are the same or less comprehensive than what you currently have.

For example:

  • You cannot upgrade to a plan with more benefits (such as Plan N to Plan G).
  • You can switch to a plan with the same level of benefits (such as Plan G to another Plan G with a different carrier).
  • You can downgrade to a plan with fewer benefits (such as Plan F to Plan G, Plan G to Plan N, etc.).

This rule exists to prevent people from waiting until they are sick to “upgrade” to more generous coverage. However, it does give you freedom to shop around for lower prices on the same or lesser coverage without worrying about health questions or being declined.

Examples of “Equal or Fewer”

  • If you have Plan F, you can switch to Plan F with a different insurance carrier or to Plan G, Plan N, etc.
  • If you have Plan G, you can switch to Plan G with another insurance carrier or to Plan N, etc.
  • If you have Plan N, you can switch to Plan N with a different insurance carrier or to Plan A, etc.

Even if you’re not sure whether your current plan is the best deal, you can always switch to the same plan with a different insurance carrier during your birthday rule window, often saving hundreds and sometimes thousands of dollars per year without changing any of your benefits.

What States Have a Medigap Birthday Rule?

Today, more states are slowly adding their own birthday rules. Here is a current list of states that have a Medicare birthday rule:

  • California
  • Illinois
  • Idaho
  • Kentucky
  • Louisiana
  • Maryland
  • Nevada
  • Oklahoma
  • Oregon
  • Utah
  • Virginia
  • Wyoming

States with Year-Round Guaranteed Issue or Open Enrollment Rights

These states don’t have a Medicare birthday rule, but they offer year-round guaranteed issue or open enrollment periods without underwriting:

  • Connecticut
  • Maine
  • Missouri
  • New York
  • Washington

Do Most People Use the Birthday Rule?

Surprisingly, no! Many people don’t know this rule exists and they stay on overpriced Medigap plans for years thinking they’re stuck because of health issues, etc. If you take advantage of the birthday rule each year, you can keep your premiums under control and avoid being overcharged.

Rates Vary Significantly Between Insurance Carriers

As mentioned before, Medigap plans are “standardized” meaning that Plan G is Plan G, Plan N is Plan N, etc. The coverage and benefits for every Plan G, etc. are exactly the same regardless of what insurance carrier you are with. However, the rates between insurance carriers are not standardized. Every insurance carrier charges their own rates.

For example, right now in the 92024 zip code (San Diego), the Plan G rates for a 70 year old single female range from $217.78 to $319.79 per month! That’s a difference of $102.01 per month or $1,224.12 per year for the same identical plan and coverage!

NOTE: Several years ago, one of my clients, a husband and wife, moved to San Diego from Los Angeles. They were paying $809.00 per month for Plan G with United American, and I got them Plan G with Mutual of Omaha for $367.01 per month, which was a savings of $441.99 per month or $5,303.88 per year for the save identical plan and coverage! Rates are based primarily on age and zip code, and they are constantly changing. It‘s critically important to shop around every year!

How to Apply and Save Money!

To take advantage of the California birthday rule, you must do the following:

  • Live in California
  • Have an active Medigap plan
  • Switch to a Medigap plan with “equal or fewer” benefits
  • Apply during the 30 days before up to 60 days after your birthday
  • Email me at Ron@RonLewisInsurance.com or call me at 760.525.5769 (cell) or 866.718.1600 (toll-free) for a free quote or to switch plans

It only takes a few minutes to apply and there is never a charge for my service!

Conclusion

If you currently have a Medigap plan, you can change your plan every year around your birthday, REGARDLESS OF YOUR HEALTH! If you apply during your annual 60-day open enrollment period under the California Birthday Rule, YOU CANNOT BE TURNED DOWN FOR COVERAGE!

As an independent insurance agent specializing in Medicare Supplements, I work with all the major insurance carriers, not just one. (A “captive” insurance agent can only represent one insurance carrier.) I will do the shopping for you and find you the best rates, not just this year, but I shop around for all my clients every year around their birthday! The monthly premiums are exactly the same whether you let me do the shopping for you to save you money on your premiums or if you contact an insurance carrier directly! Please visit Client Testimonials to read what some of my clients have to say about me.

Call, text, or email me today, and I’ll help you review your options in just a few minutes with no pressure or obligation. Let me help you save hundreds, or even thousands of dollars, on the exact same Medigap plan you already have. Won’t that be a nice birthday present?

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

Medicare Fraud Awareness: Protect Yourself and Your Benefits

Medicare fraud is a serious issue that affects millions of Americans each year, and it costs taxpayers billions of dollars. Fraudulent activities not only waste valuable resources but can also put your personal health information at risk. This article takes a closer look at Medicare fraud, how to recognize it, and what you can do to protect yourself.

What is Medicare Fraud?

Medicare fraud occurs when someone intentionally misleads or deceives Medicare for financial gain. Here are some examples:

  • Billing for services you didn’t receive: Providers may bill Medicare for treatments, tests, or procedures that you didn’t actually receive.
  • Falsifying diagnoses or treatments: Some fraudulent providers might fabricate medical records to justify unnecessary treatments or prescriptions.
  • Unnecessary tests or treatments: Some providers might encourage you to undergo tests or treatments that are unnecessary, just so they can bill Medicare for them.
  • Medicare card theft: Fraudsters may steal your Medicare card to use it for unauthorized services or sell it to others.

How to Identify Medicare Fraud

It’s important to stay vigilant and be aware of potential fraud. Here are a few red flags to watch out for:

  • Unsolicited Calls or Visits: Be wary of phone calls or home visits from people who say they’re from Medicare or healthcare companies, especially if they are asking for your personal information. Medicare will never call you without reason to request personal information.
  • Offers of “Free” Services: If someone offers you “free” services in exchange for your Medicare number, that’s a huge red flag. While some services are covered by Medicare, be cautious about anything that sounds too good to be true.
  • Incorrect or Unfamiliar Charges: Always review your Medicare Summary Notice (MSN) or Explanation of Benefits (EOB). If you see charges for services you didn’t receive, contact the provider immediately.
  • Pressure to Join a Plan or Buy a Product: Scammers may pressure you to sign up for a plan or buy a product that you don’t need. Take your time to make decisions and consult with a trusted advisor if needed.

How to Protect Yourself From Medicare Fraud?

Here are some ways to protect yourself from Medicare Fraud:

  • Safeguard Your Medicare Number: Treat your Medicare card like a credit card. Don’t share it with anyone except your trusted healthcare providers.
  • Be Informed: Know what services and treatments are covered by your Medicare plan. Review your benefits regularly and ask questions if something doesn’t seem right.
  • Keep Track of Your Medical Bills: Stay organized by keeping records of your appointments, prescriptions, and any medical services you receive. This will make it easier to spot discrepancies on your billing statements.
  • Report Suspected Fraud: If you believe you’ve been a victim of Medicare fraud or notice suspicious activity, don’t hesitate to report it to:
    • Medicare: Call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov.
    • The Department of Health and Human Services Office of Inspector General (OIG): You can file a report online at oig.hhs.gov.

What Happens After Reporting?

Once a fraud case is reported, Medicare’s fraud prevention team will investigate the issue. If fraudulent activity is found, it could result in fines, loss of provider licenses, or even criminal charges against the perpetrator. Additionally, reporting helps Medicare improve fraud detection measures to protect other beneficiaries.

Final Thoughts

Medicare fraud is a real threat, but with awareness and vigilance, you can protect yourself and your healthcare benefits. Always question anything that seems suspicious and don’t hesitate to report anything unusual. Your attention to detail can help stop fraud and safeguard your Medicare benefits.

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 Ace Property and Casualty, AFLAC, 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. 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

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

Choosing the Best Medicare Supplement Plan

If you are turning 65 or you are new to Medicare, it can be very confusing trying to figure out which Medicare Supplement plan (aka Medigap plan) is right for you. The purpose of this article is to answer your questions and to make the Medicare transition easier for you and a lot less stressful!

10 Standardized Medicare Supplement 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 Medigap plan are identical regardless of what carrier you sign up with. For example, Plan G is Plan G, Plan N is Plan N, Plan F is Plan F, etc.

Medigap Plans Are Standardized But Premiums Are Not Standardized

While the coverage and benefits for each of these plans are standardized, the monthly premiums are not standardized, and prices vary significantly between insurance carriers for the same identical plan and coverage. Other factors can affect the premiums such as your age, zip code, marital status, whether you use tobacco products, etc.

For example, in the 92024 zip code (Encinitas, CA), the Plan G rates for a 70 year old female range from $152 per month to $262 per month, which is a difference of $110 per month or $1,320 per year for the same identical plan and coverage! In California, rates usually go up every year as we get older. For this reason, it’s important to shop around every year to make sure you aren’t paying more than you should be! I periodically stay in touch with my clients, and I shop around for them every year around their birthday.

IMPORTANT: As an independent insurance agent, I work with the major insurance carriers, not one particular company. If you or someone you know has a Medigap plan, I’m happy to shop around for you, and there is no charge for my service!

The California Birthday Rule

In California, we have a law called the California Birthday Rule. This law applies to all California residents who already have a Medigap policy.

Under the birthday rule, you have an annual 90-day open enrollment period that begins 30 days before your birthday and ends 60 days after your birthday. During this period, you can switch to any other Medigap policy that has “equal or fewer” benefits.

For example, if you have Plan G with Carrier A, you can switch to Plan G with Carrier B, regardless of your health and without answering any health questions. There is no medical underwriting and you cannot be turned down for coverage! If you have Plan G, you can also switch to Plan N because Plan N has fewer benefits than Plan G.

If you have Plan N, you can switch to Plan N with another carrier, but you cannot switch to Plan G because Plan G has more benefits than Plan N, etc.

NOTE: You can change your Medigap plan any time of the year, but if you do so outside of your 90-day annual open enrollment period under the California Birthday Rule, you will have to answer health questions and be medically underwritten, and you can be turned down for certain health conditions.

The Three Best Medicare Supplement Plans

Although there are 10 standardized Medigap plans to choose from, Plan F, Plan G, and Plan N are the three best and most popular plans.

As you can see from the chart, Plan F provides the most comprehensive coverage. Plan G is identical to Plan F except it does not cover the Medicare Part B deductible. Plan N also does not cover the Part B deductible and there are co-payments for doctor visits, emergency room visits, and it does not cover Part B excess charges. Please continue reading for more detailed information.

Plan G Medicare Supplement

For those who are turning 65 on or after January 1st, 2020, Plan G is the best plan today because your only out-of-pocket (OOP) expense is the Medicare Part B deductible, which is currently $226 for all of 2023.

NOTE: That small deductible can change from year to year, but historically, it hasn’t changed significantly. In fact, the Part B deductible decreased from $233 in 2022 to $226 in 2023.

The Part B deductible zeros out every January and starts all over again. Once you meet that small annual deductible, you won’t have any other OOP costs for the remainder of the calendar for any Medicare-approved doctors visits, surgeries, hospitalizations, etc.

Plan F Medicare Supplement

Prior to January 1st, 2020, Plan F was considered to be the best Medicare Supplement plan because there were no deductibles, co-payments, or OOP costs. The only difference between Plan F and Plan G is the Medicare Part B deductible. Plan F pays for that small deductible, and Plan G doesn’t. That is the only difference between the two plans!

NOTE: For those individuals that had Plan F prior to January 1st, 2020, they can still keep their plan and switch to Plan F with other insurance carriers if they want, but Plan F isn’t available for individuals who started Medicare on or after January 1st 2020 because of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.

Although Plan F covers the Medicare Part B deductible and Plan G doesn’t, the premiums for Plan F are significantly more than the premiums for Plan G, which is why most people with Plan F have switched to Plan G.

Most People With Plan F Have Switched to Plan G

Most people who had Plan F have switched to Plan G because in most cases, the premiums for Plan G are significantly less, and even if you have to pay the $226 Part B deductible, you still end up saving money by switching to Plan G!

For example, if someone has Plan F and their premium is $250 per month and they can get Plan G for $180 per month, that’s a gross savings of $70 per month or $840 per year! If you subtract the $226 Medicare Part B deductible, that’s still a net savings of $614 per year!

NOTE: If you have Plan F and you want to switch to Plan G, if you have already met your $226 Medicare Part B deductible for this year, you would not have to pay it again until the following year since the Part B deductible is payable only one time per calendar year.

Medicare Supplement Plan N

Plan N isn’t as popular as Plan G because there are more OOP costs, but the premiums are usually a little lower, but not significantly lower than the Plan G premiums. If you are in relatively good health and rarely go to the doctor, you may want to consider Plan N if you want lower monthly premiums and you are willing to incur more OOP costs. However, Plan G is a better option if you’re willing to pay slightly higher premiums for much better coverage than Plan N.

NOTE: If you are not in the best of health and you go to the doctor often, Plan N is not a good choice as you are required to pay co-payments for every office visit, and with all those payments, Plan G would normally be more cost effective.

With Plan N, you are responsible for paying the annual $226 Medicare Part B deductible (like you are with Plan G). You must also pay co-payments of up to $20 per doctor visit and co-payments of up to $50 for emergency room visits. However, if you are admitted to the hospital, the emergency room co-payment is waived.

Another difference between Plan N and Plan G is that Plan G covers the Medicare Part B “excess charges” and Plan N doesn’t. If your doctor doesn’t accept “Assignment” (the amount Medicare agrees to pay for a service), they may charge you up to an additional 15% of the bill. This fee is known as an excess charge.

Between Plan N and Plan G, I would recommend Plan G if the premiums aren’t significantly different and it’s not a financial burden to pay the Plan G premiums.

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 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 to find them the best Medigap rates. Please click here to see some of my client testimonials.

If you have any questions, please don’t hesitate to contact me. If you have any friends that are turning 65 or that have Medicare Supplements, I’m happy to shop around for them, and there is no charge for my service!!! Also, please feel free to forward this blog on to anyone 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

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

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

2019 Medicare Deductibles, Coinsurance, and Out-Of-Pocket Limits

The new 2019 Medicare deductibles, coinsurance, and out-of-pocket limits were recently released, and they go into effect on January 1st, 2019.

January 2019

Medicare Part A (Hospital Insurance)

  • Part A Deductible: This deductible is increasing $24 to $1,364 per benefit period.
  • Part A Coinsurance: Inpatient Hospital Care (Days 61-90). Increasing $6 to $341 per day.
  • Lifetime Reserve Coinsurance: Inpatient Hospital Care (Days 91-150). Increasing $12 to $682 per day.
  • Skilled Nursing Facility (SNF) Coinsurance: (Days 21 through 100) Increasing $3 to $170.50 per day.

NOTE: A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and not received skilled care in any other facility for 60 days in a row. This is not an annual deductible; there can be multiple benefit periods (up to six) in a calendar year!

Medicare Part B (Medical Insurance)

  • Part B Annual Deductible: Increasing $2 to $185 per year.

NOTE: For those of you with a Plan G Medicare Supplement (also known as Medigap because it picks up the gap in coverage not covered by Medicare), Plan G is identical to Plan F with the exception of the Part B deductible. Once this deductible has been met, Plan F and Plan G are exactly the same. If you are saving more than $185 per year on your premiums by switching from Plan F to Plan G, then Plan G ends up costing less than Plan F.

Medicare Supplement Plan-Specific Deductibles and Out-of-Pocket  Limits

  • High Deductible Plan F Annual Deductible: Increasing $60 to $2,300 per calendar year.
  • Plan K Annual Out-of-Pocket Limit: Increasing $320 to $5,560 per calendar year.
  • Plan L Annual Out-of-Pocket Limit: Increasing $160 to $2,780 per calendar year.

Part D Prescription Drug Plans

The new 2019 Part D deductible is $415 once a year.

How Do These Changes Affect My Medicare Supplement?

If you have a Medicare Supplement, your benefits are automatically adjusted every year to cover the new deductibles, co-payments, and coinsurance amounts in 2019.

Do You Have a Medicare Supplement Plan?

If you have a Medicare Supplement plan, contact me for a free quote! As an independent insurance agent, I work with all the major insurance carriers, and more than likely, I can save you hundreds of dollars on your Medicare Supplement premiums for the same exact plan and coverage!

If you have any questions or comments, please let me know!

Thanks!

Ron Lewis

Ron@RonLewisInsurance.com
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)

–

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!”

*****************************************************

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)

Medicare Supplements – Why Pay Wholesale When You Can Pay Retail?

Yes, you read the title correctly. When it comes to Medicare Supplement plans, which are also known as Medigap plans because they pay for the “gaps” in coverage that are not paid for by Medicare, some of my clients prefer to pay retail instead of wholesale! That’s right, “Why pay less when you can pay more?”

retail

Most people that I meet are very happy to save a lot of money on their insurance premiums, but there are always some that really don’t seem to care. Or maybe they are skeptical because it just “seems too good to be true,” which I can totally understand.

A Tale of Two Cities, I Mean Two Clients…

I was working with two different clients yesterday, Client “A” and Client “B.”

two clients

Client “A”

Client “A” has Plan F with Blue Shield of CA, and his monthly premium is $279 per month. I shopped around for him and found several other insurance carriers that are offering Plan F at much lower rates. The lowest rate that I found for him is $179.33 per month. That is a savings of $99.67 per month or $1,196.04 per year for the same identical plan and coverage!

Many people who have Plan F have been switching to Plan G because both plans are identical except there is no deductible with Plan F, and there is a small $166 (Part B) deductible with Plan G. That is the only difference between the two plans!

However, Plan G is usually much more cost effective (cheaper) because the rates are lower. So even if you pay the $166 deductible, in most cases, you still end up spending much less money with Plan G than Plan F.

In addition to getting the current Plan F rates for Client “A,” I also provided him with the current Plan G rates for comparison. If he switched from Plan F to Plan G, he would have saved even more money! The best Plan G rate is $156.70 per month. That would be a gross savings of $122.30 per month or $1,467.60 per year! If he spent the $166 deductible, his net savings would still be $1,301.60 per year! In this particular case, Client “A” would have saved even more money by switching from Plan F to Plan G.

Inexplicably, Client “A” decided to keep his current plan for another year!

Client “B”

Client “B” also has Plan F with Blue Shield of CA, and her rate is $219 per month. I shopped around for her and, like Client “A,” I found several other insurance carriers that are also offering Plan F at much lower rates. The lowest rate that I found for Client “B” is $170.99 per month. That is a savings of $48.01 per month or $576.12 per year for the same identical Medicare Supplement plan and coverage!

Client “B” also had the option to switch from Plan F to Plan G, and again, she would have saved even more money on her premiums by doing so. Her current Plan F rate is $219 per month, and the best Plan G rate for her is $147.19 per month. That would be a gross savings of $71.23 per month or $854.76 per year! If she spent the entire $166 deductible, her net savings per year would still be $688.76 per year!

Just like Client “A,” Client “B” also decided to keep her current plan for another year!

Some Common Misconceptions

It’s very baffling to me when I can literally save someone hundreds and even thousands of dollars a year on their premiums for the same exact plan and coverage, and for whatever reason they are not interested in doing so.

If my auto and homeowner’s insurance agent told me he could save me $100 a month on my premiums, I would be thrilled to be able to save that much money. I guess that some people just aren’t as happy about saving money as I am!

Save-Money

Misconception #1 – By Switching Medigap Plans, I Won’t Be Able to Go to the Same Doctors

Some people are reluctant to change Medigap plans because they are afraid that they won’t be able to continue seeing the same doctors. This is a misconception because you can go to ANY doctor or hospital in the US with your Medicare Supplement as long as the doctor or hospital accepts Medicare. If your doctor accepts your current Medicare Supplement plan, then they have to accept ANY Medigap plan or insurance carrier that you have, PERIOD.

Misconception #2 – The Rates Are Too Good to Be True

If the new rates are significantly lower than the current plan, some people think it’s either too good to be true or a huge rate increase is soon to follow. This is also a misconception because most of the carriers that I work with lock in their rates for the first 12 months, so there wouldn’t be any unexpected rate increases.

Misconception #3 – My Coverage Will Not Be the Same

Another common misconception is that the coverage will not be the same, even if someone is switching from Plan F to Plan F or Plan G to Plan G, etc. There are 10 “standardized” plans to choose from, Plan A through Plan N. This means that the coverage for every standardized plan is exactly the same with every insurance carrier. So if someone has Plan F with Blue Shield and they want to switch to Plan F with Mutual of Omaha, etc., the coverage is exactly the same. Plan F is Plan F is Plan F…Period!

One of the other reasons people don’t want to switch their Medicare Supplement plan is because they fear change. “Everything has been going great so far. Even though the rates are cheaper and the coverage is the same, why take a chance by going with a different carrier?”

If you decide to switch carriers, the transition is seamless. Your coverage with the first insurance carrier will end at the end of the month, and the new coverage begins on the 1st of the following month. There are no forms or paperwork to fill out. When you go to the doctor after your new coverage begins, they will make a copy of your new Medicare Supplement card, and after that, everything will be the same as before.

The California Birthday Rule

In California, there is a law called the California Birthday Rule. If you have a Medicare Supplement, you are lucky to live in California for more reasons than just the beautiful weather and the great beaches!

happy-birthday

This law guarantees you the right to switch insurance carriers, EVERY YEAR, within 30 days of your birthday (before or after) REGARDLESS OF YOUR HEALTH and without answering any health questions on the application! This is known as your annual open enrollment period. If another insurance carrier is offering the same plan that you currently have, or if they are offering another plan that has fewer benefits, you are guaranteed the right to switch carriers every year if you want to, and you cannot be turned down due to health reasons.

For example, if you have Plan F and another carrier is offering Plan F for a lower rate, you are guaranteed the right to switch to the other carrier every year around your birthday, without answering any health questions on the application. Likewise, you are guaranteed the right to switch to a plan with fewer benefits as well. So if you have Plan F, which has the most comprehensive coverage, you could switch to Plan G if you want to because Plan G has fewer benefits than Plan F.

NOTE: Under the California Birthday Rule, if you have Plan F, you can switch to any other plan, but if you have any other plan, you cannot use the California Birthday Rule to switch to Plan F because it has more benefits than any other plan.

You can actually switch insurance carriers or plans any time of the year, but if you do so at any time other than during the 30 days before or after your birthday, you will have to answer the health questions on the application, you will be medically underwritten, and you could be turned down for coverage due to medical reasons. If you have any serious health conditions, you should apply during the 30 days before your birthday!

In most other states, there isn’t a birthday rule. That means that once you sign up, if you later develop any serious health issues, you would have to meet minimum health and underwriting requirements if you wanted to change your Medicare Supplement plan or your insurance carrier. If your insurance rates increased significantly, you could be stuck paying very high premiums for many years! In California, that would never happen because you can always change your insurance every year around your birthday, regardless of your health!

Rates Vary Significantly Between Insurance Carriers For the Same Identical Plans and Coverage

In California, rates are based on “attained age,” which means that your rates are based on your current age, and they usually go up in price every year as you get older. As mentioned before, there are 10 “standardized” Medicare Supplement plans to choose from, Plan A through Plan N. When I say “standardized,” that means that the coverage for Plan F, Plan G, etc. is exactly the same no matter which insurance carrier that you are with.

Although the coverage is exactly the same with every insurance carrier, the rates (prices) vary significantly between insurance carriers!

dollars

For example, in the 92056 zip code the Plan F rates for a 72 year old man range in price from $164.06 to $278.86 per month! That is a difference of $1,377.60 per year for the same exact plan and coverage! In other words, some 72 year old individuals in the 92056 zip code are paying $164.06 per month for their Plan F coverage while others are paying $278.86 per month for their Plan F coverage!

Examples of How I Recently Saved Clients Money By Switching From Plan F to Plan F

Here are some examples of how I took advantage of the California Birthday Rule and saved my clients a lot of money on their annual premiums by switching them from Plan F with one carrier to Plan F with a different carrier:

  • $142.08
  • $257.64
  • $334.08
  • $338.64
  • $349.68
  • $432.84
  • $498.24
  • $501.78
  • $501.78
  • $516.96
  • $536.76
  • $879.84
  • $1,003.56

Examples of How I Recently Saved Clients Money By Switching From Plan F to Plan G

Here are some other examples of how I took advantage of the California Birthday Rule and saved my clients a lot in their annual premiums by switching them from Plan F with one carrier to Plan G with a different carrier:

  • $203.12
  • $278.96
  • $349.16
  • $425.48
  • $462.68
  • $600.00

Although it’s not the norm, the most I have ever saved one of my clients, a married couple, was over $5,300 per year just by switching from Plan G with one insurance carrier to Plan G with a different insurance carrier! As you can see, it’s really important to shop around and compare rates!

Sometimes I Feel Like “I Get No Respect!”

Once in a while, however, I feel like Rodney Dangerfield because “I get no respect!” Most of my clients are 65 or over and many are retired and on fixed incomes. The majority are very receptive to saving money on their insurance premiums, but once in a while, I have to practically beg people to let me save them hundreds and even thousands of dollars a year on their premiums, and quite honestly, that drives me crazy!

Rodney_Dangerfield2

For whatever reasons, some people, like Client “A” and Client “B,” are apparently not so budget conscious. I was very excited and happy to tell them how much money I could save them, and their response was basically “Let me think about it!”

Think about it? Really? What is there to think about! It seems to me that it’s pretty much a no-brainer. I can hear them now. “Do I want to save $1,200 per year on my premiums for the same exact plan and coverage? Hmm, this is really a tough one. What am I going to do with an extra $100 a month? This might complicate my taxes! Eh, who needs this kind of stress and aggravation!”

stress

I don’t want any of my clients to feel stressed or aggravated! If you’re one of those individuals that prefer to pay wholesale instead of retail, instead of the other way around, please don’t hesitate to contact me if you have any questions or if I can help in any way. If you’d like me to, I’m happy to do the shopping for you, EVERY YEAR, to save you money on your Medicare Supplement insurance!

NOTE: Although this article focuses primarily on Medigap plans in California, I am licensed and work with Medicare Supplement insurance plans outside of California as well. If you need premium rates for other states, I am happy to provide you with that information as well.

If you or someone that you know would like a free quote, please let me know. If you know anyone that might enjoy reading this blog, please feel free to forward it on! And please feel free to send me any of your questions, comments, and feedback!

Thank you,

Ron Lewis

Save Money On Your Medicare Supplement by Comparing Rates Each Year

One of the most rewarding parts of my job is helping my clients save money on their Medicare Supplement (Medigap) insurance premiums. Most of the time, I can usually save individual clients at least $30 to $50 per month ($360 to $600 per year) on their premiums. Occasionally, I have saved them as much as $1,000 to $1,200 per year on their premiums!

medigap

I don’t mean to come across as bragging, because I’m not. However, I am very happy and excited because this past week I was able to save one of my clients (a husband and wife on a fixed income) over $5,300 per year on their Medicare Supplement premiums!  I was able to do this just by simply switching them to the same exact plan that they had, but with a different carrier!

They had Plan G with another company for quite a few years, and they were very happy with the company and their coverage. Their insurance rates were very low when they originally took out their plans, and the company always paid their claims promptly and without a problem, just as most Medicare Supplement insurance companies do. However, over time, their rates crept up, slowly but steadily. Until this past week when they called me, they didn’t realize that they were literally paying thousands of dollars more for their insurance than they should be!

Most people shop around every year or two and compare rates on their auto and homeowner’s insurance. Medicare Supplements are no different. If you have a Medicare Supplement plan, it is critically important that you shop around every year and compare rates between various companies because insurance rates vary significantly from one carrier to the next for the same identical plan and coverage. For example…

For a 72 year old female living in the 92056 zip code, the current Plan F rates range from $164.06 per month to $245.50 per month! That is a difference of $81.44 per month or $977.28 per year more for the same exact insurance coverage!

Attained Age

In California, Medicare Supplement insurance premiums are based on attained age. This means that as you get older, your rates usually continue to go up every year. Many companies start off at the “younger” ages (65 to 70) with very competitive rates, but over time, the rates continue to go up. Every company is different, and some companies raise their rates a lot more than others.

If you become complacent and don’t shop around every year to compare rates, you are probably paying hundreds or even thousands of dollars more per year on your insurance premiums than you should be!

California Birthday Rule

In California, there is a law called the California Birthday Rule. This law allows anyone with a Medicare Supplement to switch to another insurance carrier every year within 30 days of their birthday (before or after), REGARDLESS OF THEIR HEALTH and without medical underwriting, if another insurance carrier is offering the same plan, such as Plan F, at a lower rate. During the annual 30-day open enrollment period, you are also guaranteed the right to switch to a “lesser” plan, such as from Plan F to Plan G, etc.

CA Birthday Rule

If you have a Medicare Supplement plan, you are guaranteed the right to shop around every year within 30 days of your birthday to save money on your insurance premiums. During this period, you cannot be turned down for coverage, regardless of your health.

You Can Apply for Medicare Supplement Plans All Year Long

Unlike Medicare Advantage 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. The only difference is that if you apply using the California Birthday Rule within 30 days of your birthday, you do not have to answer any of the health questions on the application, and you cannot be turned down for coverage due to health conditions.

If you apply for a Medicare Supplement plan any time of the year other than during your annual 30-day open enrollment period, you will have to answer the health questions on the application, and if you have certain health conditions, you could be turned down for coverage. If you are in relatively good health, you should not have any problem qualifying for a Medicare Supplement plan.

Guaranteed Issue Situations In California

In California, there are certain circumstances when you would qualify for a Medicare Supplement due to a guaranteed issue situation.

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If you can answer YES to any of the following questions, you may be eligible for guaranteed issue:

  1. Has your employer-sponsored retiree plan that is supplementing Medicare involuntarily terminated?
  2. Has your employer-sponsored retiree plan stopped providing Medicare supplement benefits or the Medicare Part B 20% coinsurance for services?
  3. Have you lost eligibility for an employer-sponsored retiree plan due to divorce or death of a spouse or family member?
  4. Has your Medicare Advantage plan increased your premium or co-payments by 15% or more, reduced your benefits, or terminated its relationship with your medical provider who was treating you?
  5. Have you moved out of the area of your MA plan or Program for All-Inclusive Care for the Elderly (PACE) organization?
  6. Has your MA plan, Medicare SELECT Plan, PACE provider or any other health plan under contract with Medicare: (a) committed fraud; (b) ended or lost its contract with Medicare; (c) misrepresented the plan you bought, or (d) failed to meet its contractual obligations to Medicare beneficiaries, as determined by the federal government?
  7. Did you join a MA plan or PACE organization when you first became eligible for Medicare at age 65, and you want to switch to a Medicare Supplement policy during your first 12 months in the MA plan or PACE organization?
  8. Have you switched from a Medicare Supplement policy to a MA plan, PACE organization, Medicare SELECT plan, or any other health care organization contracting with Medicare, for the first time since becoming eligible for Medicare within the past 12 months?
  9. Has your MA plan left your area, and if so, did your MA plan benefits end within the past 123 days?

NOTE: Many people with Medicare Advantage plans who have serious health issues can still qualify for a guaranteed issue Medicare Supplement plan. See item #4 above.

What Insurance Carriers Do I Work With?

As a licensed independent insurance agent, I work with ALL the major insurance carriers in California. Most importantly, I WORK FOR YOU, not a particular insurance company! I’m also licensed in Arizona, Colorado, Nevada, and Washington state. Here are some, but not all, of the Medicare Supplement insurance carriers that I work with:

  • Aetna
  • Anthem Blue Cross
  • Blue Shield of California
  • Cigna
  • Health Net
  • Humana
  • Individual Assurance Company (IAC)
  • Mutual of Omaha
  • Oxford
  • Stonebridge
  • Transamerica
  • UnitedHealthcare (AARP)
  • United of Omaha

Let Me Do the Shopping For You!

While it is unusual for me to be able to save most of my clients over $5,300 per year on their annual insurance premiums like I did this past week, it is not unusual for me to give someone a free, no obligation quote and save them anywhere from $300 to $500 per year on their Medicare Supplement premiums. That happens quite frequently.

As an independent insurance agent, I have access to insurance quote engines and other information that is not available to the public. You should take advantage of my knowledge and experience and let me do the shopping for you to save you money on your insurance premiums.

grocery-shopping-cartIf you have a Medicare Supplement plan, please contact me for a free, no obligation quote. More than likely, I will save you hundreds of dollars on your Medicare Supplement insurance premiums.

As one of my clients, I will contact you every year, about a month before your birthday, and I will let you know what the best rates are at that time. You always have the option to either keep your current plan, or you can take advantage of the California Birthday Rule and change carriers if another company is offering better rates.

Either way, I strive to build trust and relationships with my clients. I will not do a magic act and disappear after you have your new policy, 😉 and you will always have the peace of mind knowing that you are not paying hundreds or even thousands of dollars more than you should be for your Medicare Supplement insurance.

If you have any questions, or if you or anyone that you know would like a free Medicare Supplement quote, please contact me at (760) 652-6060 or toll-free at (866) 718-1600. You can also reach me by email at Ron@RonLewisInsurance.com. Your questions and feedback are always welcome!