Some Medicare beneficiaries are receiving new Medicare card numbers as part of ongoing fraud protection efforts
Recently, some Medicare beneficiaries have heard that new Medicare card numbers are being issued in 2026. Many people are wondering whether this affects them. Here is what you should know.
Are Medicare Card Numbers Changing This Year
Yes, but only for a small number of people. The Centers for Medicare & Medicaid Services is mailing new Medicare card numbers to certain beneficiaries as part of a security update related to fraud prevention. If you are affected, your new card will arrive automatically by mail. You do not need to request one.
NOTE:Most Medicare beneficiaries will not receive a new number.
Why Some Medicare Numbers Are Being Replaced
From time to time, the Centers for Medicare and Medicaid Services updates Medicare identification numbers for certain beneficiaries as part of ongoing efforts to protect personal information and reduce fraud. If your number is affected, Medicare automatically sends a replacement card by mail and no action is required from you.
What Should You Do If You Receive a New Medicare Card
If you receive a new Medicare card in the mail, you should do the following:
Start using the new number immediately
Safely destroy your old card
Share your new number with your doctors if needed
Let your insurance agent know so your records stay updated
There is no cost for a replacement Medicare card. If your Medicare card is lost or damaged, you can request a replacement card at any time through your secure account at Medicare.gov or by calling (800) MEDICARE. Replacement cards are mailed directly from Medicare and there is never a fee for this service.
Important Fraud Warning
Medicare will never call unexpectedly asking for your Medicare number
Unfortunately, scammers often take advantage of situations like this.
Please remember that Medicare will never do any of the following:
Call you unexpectedly to ask for your Medicare number
Charge you for a replacement card
Ask for banking information to send a new card
Threaten that your coverage will be cancelled unless you respond immediately
Send plastic or chip Medicare cards
IMPORTANT:If someone contacts you and asks for personal information related to your Medicare card, it is very likely a scam.
How To Recognize An Official Medicare Mailing
An official Medicare mailing does the following:
Arrives by postal mail
Does not request payment
Does not ask for banking information
Includes your name exactly as shown on your Medicare card
Does not require immediate action to keep your coverage active
If something feels urgent or requests personal information, it is best to verify it before responding.
What Should You Do If You Receive a Suspicious Call
If you receive a suspicious call about Medicare, the safest step is to contact Medicare directly at (800) MEDICARE to confirm whether the request is legitimate. You are also welcome to contact me if you would like help reviewing anything you receive.
Where To Learn More About Medicare Fraud Prevention
If you would like additional information about how to protect yourself from Medicare fraud, these official resources can help:
These trusted sources explain warning signs and what steps to take if something does not seem right.
My Recommendation to Clients
If anyone contacts you about your Medicare card and you are unsure what to do, it is always best to verify the request before responding. Protecting your Medicare information helps prevent fraud and keeps your coverage secure.
If you ever receive a Medicare related notice and are unsure whether it applies to your coverage, I am always happy to help review it with you.
About the Author
I’m an independent Medicare Supplement insurance specialist working with most of the major insurance carriers throughout California, Nevada, and several other states. I help people turning 65 coordinate their Medicare enrollment so their Medicare Supplement and prescription drug coverage begin at the same time as Medicare.
I also work with many people who already have Medicare Supplement plans and would like to review their options. In California, the Medicare Supplement Birthday Rule allows policyholders to change their plans each year without medical underwriting, and I regularly help clients lower their premiums while keeping the same identical plan and coverage. Many of my clients have saved hundreds, and sometimes thousands, of dollars.
There is no charge for my services because I am compensated by the insurance carriers, not my clients. My goal is to help you find competitive premiums and provide dependable personal service year after year.
If you are turning 65 soon, or if you already have a Medicare Supplement plan and would like to review your options, I am happy to help.
You can also click here to read what my clients have to say about working with me.
Serving Medicare clients throughout California, Nevada, and several other states.
CA Insurance License: #0B33674 NV Insurance License: #3822123 AZ Insurance License: #681166
This website is operated by a licensed insurance agent and is intended for educational purposes only. I am not affiliated with or endorsed by Medicare or any government agency.
This blog is a step by step guide explaining when to enroll, whether you can sign up by phone or online, and how to coordinate Medicare with a Medicare Supplement plan.
The Medicare Initial Enrollment Period lasts 7 months. Applying during the 3 months before your birthday month helps ensure your Medicare and Medicare Supplement coverage start on time.
Turning 65 is an important milestone and for most Americans it means becoming eligible for Medicare. Many people turning 65 are surprised to learn that signing up for Medicare and choosing their coverage options involves several coordinated steps. Many people are unsure how to sign up, when to enroll, and which method is easiest. This blog explains the different ways to enroll in Medicare and which options work best depending on your situation.
Are You Automatically Enrolled in Medicare?
Some people are enrolled in Medicare automatically. You will usually be automatically enrolled in Original Medicare (Part A – Hospital insurance) and (Part B – Medical insurance) if you are already receiving Social Security retirement benefits at least four months before your 65th birthday.
If you are automatically enrolled:
Your Medicare card usually arrives about three months before your 65th birthday.
Coverage usually starts the first day of your birthday month (or the first day of the previous month if your birthday is on the 1st of the month).
No Medicare application is required unless you want to delay Part B.
If you are not receiving Social Security benefits yet, you will need to apply for Medicare yourself.
The Three Main Ways to Sign Up for Medicare
Most people turning 65 can sign up for Medicare online through Social Security by phone or by scheduling a Social Security appointment. Choosing the right enrollment method can help ensure your coverage starts on time.
If you need to enroll yourself, there are three main options:
1. Enrolling Online Through the Social Security Website
For most people turning 65, enrolling online through the Social Security website is the fastest and easiest method. Please click here to enroll online.
NOTE:I know it seems counter-intuitive, but you go to the Social Security website, not the Medicare website, to sign up for Medicare.
Advantages of online enrollment include the following:
Available twenty-four hours a day.
No waiting on hold.
Typically processed quickly.
Often completed in about fifteen minutes.
Best for the following situations:
People retiring at 65.
Individuals not covered by employer insurance.
Anyone comfortable using a computer.
For most applicants, this is the best and simplest way to enroll.
2. Enrolling by Phone With Social Security
Many people prefer speaking with a representative. You can still enroll in Medicare by calling Social Security at (800) 772-1213.
Sometimes enrollment can be completed during the call. In other cases, Social Security schedules a follow up phone appointment with a specialist who completes the application with you.
Advantages of phone enrollment include the following:
Helpful if you have questions.
Useful for coordinating employer coverage with Medicare.
Comfortable option for people who prefer personal assistance.
Best for the following situations:
Applicants delaying Part B because they are still working.
Individuals enrolling during a Special Enrollment Period.
People who want guidance through the process.
3. Enrolling Through a Local Social Security Office
Some applicants prefer in person assistance. You can schedule an appointment with your local Social Security office to apply for Medicare. To set up an appointment, call Social Security at (800) 772-1213. Most offices now require appointments instead of walk in visits.
Advantages of in person enrollment include the following:
Face to face support.
Helpful for complicated situations.
Useful if documentation is required.
Best for the following situations:
Applicants with unique eligibility situations.
Individuals who prefer meeting with someone directly.
When Should You Apply for Medicare?
Your Initial Enrollment Period (IEP) lasts seven months:
Three months before your 65th birthday month.
Your birthday month.
Three months after your birthday month.
Applying during the three months before your birthday month helps ensure your coverage starts on time.
What If You Are Still Working at Age 65?
If you or your spouse are still working and covered by employer health insurance, you may be able to delay Part B without penalty. This depends on the size of the employer and the type of coverage you have. Many people in this situation enroll in Part A (Hospital insurance) only and delay Part B (Medical insurance) until retirement. Before delaying Part B, it is important to confirm that your employer coverage qualifies. Please click here for more details.
NOTE:Part A is usually free, but the monthly premium for Part B is currently $202.90 for most people (in 2026), unless you are in a higher income bracket. If you are still working, you can usually defer paying the Part B premium until you leave your employer health plan.
Common Mistakes People Make When Signing Up for Medicare
Here are some common mistakes people make when signing up for Medicare:
Waiting too long to apply and risking delayed coverage.
Assuming enrollment happens automatically when it does not.
Delaying Part B without confirming employer coverage rules.
Missing the six month Medicare Supplement Open Enrollment window after Part B begins.
Avoiding these mistakes can save money and prevent future coverage problems.
Do You Need to Enroll in a Medicare Part D Prescription Drug Plan?
When you first become eligible for Medicare, it is important to consider whether you should enroll in a Medicare Part D prescription drug plan. If you do not enroll in a Part D plan when you are first eligible and you do not have other creditable prescription drug coverage, you may have to pay a lifetime late enrollment penalty if you enroll later. Creditable prescription drug coverage usually includes employer or union coverage that is expected to pay at least as much as standard Medicare prescription drug coverage. It is important to confirm whether your existing coverage is considered creditable before deciding to delay Part D enrollment.
IMPORTANT: Even if you do not currently take prescriptions, enrolling in a low cost Part D plan when you first become eligible can help you avoid future penalties. In California, some Medicare Part D plans are available with a $0 monthly premium, which makes enrolling early an easy way for many people to avoid future penalties while keeping costs low.
It is also important to know that Medicare Supplement plans do not include prescription drug coverage. A separate Part D plan is needed if you want prescription coverage. Most people choose to enroll in a Part D plan when their Medicare Part B begins so their prescription coverage starts at the same time as their medical coverage.
The timeline below shows when to enroll in a Medicare Part D plan so your prescription coverage begins at the same time as Medicare.
Enrolling in a Medicare Part D prescription drug plan when you first become eligible helps ensure prescription coverage begins on time and helps avoid lifetime late enrollment penalties if you enroll later.
How to Sign Up for a Medicare Prescription Drug Plan
Here are the most common ways to sign up for a Medicare Prescription Drug Plan:
Option 1: Enroll online (recommended) Visit Medicare.gov and use the Plan Finder tool to compare all available Part D plans in your area. This allows you to review premiums, pharmacy networks, and estimated drug costs side-by-side so you can choose the plan that best fits your needs.
Click here to watch a short video I made that explains step-by-step how to sign up for a prescription drug plan.
Because many insurance agents are not appointed with every Part D carrier, and many agents no longer offer Part D enrollment assistance due to increasingly complex CMS compliance requirements, Medicare.gov is often the best place to make sure you’re seeing every available option.
Click here to read another blog I wrote explaining why you may be better off shopping for your own prescription drug plan instead of using an insurance agent.
Option 2: Enroll by phone Call 1-800-MEDICARE (1-800-633-4227) and a Medicare representative can help you review your options and complete enrollment.
What Happens After You Enroll in Original Medicare?
Once you are enrolled in Original Medicare (Part A and Part B), it’s important to understand that Original Medicare typically covers about 80% of approved medical expenses, and there is no limit on your out-of-pocket costs. Because of this, most people choose to add additional coverage.
Your main options include:
A Medicare Supplement plan (also called Medigap)
A Medicare Advantage plan
A Part D prescription drug plan
If you choose a Medicare Supplement plan, which many people prefer because it helps limit unexpected out-of-pocket costs, the best time to apply is before your Medicare Part B effective date so your coverage can begin the same day your Medicare coverage starts. Many people submit their Medicare Supplement application one to three months before their Part B start date to help avoid any gap in coverage.
Your six-month Medicare Supplement Open Enrollment Period begins when your Part B coverage starts. During this six-month window, you cannot be turned down or denied coverage due to health conditions. However, applying before your Part B effective date helps ensure your Medicare Supplement coverage starts on time.
Some people choose a Medicare Advantage plan as an alternative way to receive their Medicare benefits. However, there are important differences between Medicare Advantage plans and Medicare Supplement plans.
Click here to read my article explaining why many people carefully compare these options before choosing a Medicare Advantage plan.
A Simple Checklist for Turning 65
Find out whether you will be automatically enrolled.
Decide whether you should delay Part B because of employer coverage.
Choose whether to apply online, by phone, or through a Social Security appointment.
Apply during the three months before your birthday month when possible.
Review Medicare Supplement options once your Part B start date is confirmed.
Understanding the Difference Between Enrolling in Medicare and Enrolling in a Medicare Supplement Plan
Signing up for Medicare and signing up for a Medicare Supplement plan are totally different. Enrolling in Medicare is done through Social Security and determines when your Part A and Part B coverage begin. Enrolling in a Medicare Supplement plan is done through a private insurance company using an insurance agent and helps cover most of the out of pocket costs that Original Medicare does not pay.
Many people assume these steps happen automatically together, but they do not. Coordinating the timing of your Medicare Supplement application with your Part B start date helps ensure your coverage begins the same day your Medicare coverage becomes active.
Medicare Supplements and Medicare Advantage Plans Are Totally Different
After enrolling in Original Medicare, most people choose either a Medicare Supplement or a Medicare Advantage plan. Understanding the difference between these options is an important step when planning your Medicare coverage.
After enrolling in Medicare Part A and Part B, most people choose either a Medicare Supplement plan or a Medicare Advantage plan. These are two different types of coverage and they work in very different ways. A Medicare Supplement works alongside Original Medicare and helps pay most out of pocket costs such as deductibles and coinsurance. A Medicare Advantage plan replaces Original Medicare coverage with a private plan that includes provider networks and different cost structures. Most Medicare Advantage plans are HMOs and your choices are limited.
Understanding the difference between these options is an important step when planning your Medicare coverage.
A Medicare Supplement Insurance Specialist Helps Coordinate Your Start Date
Applying for a Medicare Supplement plan one to three months before your Medicare Part B start date helps ensure there are no gaps in coverage when Medicare begins.
One of the most helpful things a Medicare Supplement insurance specialist can do is coordinate the timing between your Medicare Part B effective date and your Medicare Supplement application. Submitting your Medicare Supplement application before your Part B start date helps ensure your coverage begins the same day your Medicare coverage becomes active. This helps prevent gaps in coverage and allows you to move into Medicare with confidence.
California Residents Have an Additional Medicare Supplement Advantage
California residents can change their Medicare Supplement each year from their birthday up to 60 days after. No health questions required when switching to a plan with “equal or fewer” benefits.
With a Medicare Advantage plan, you can generally only change your coverage during the Annual Election Period (AEP), which runs from October 15th through December 7th each year, unless you qualify for a Special Enrollment Period. Coverage selected during this time begins on January 1st of the following year.
With a Medicare Supplement, you can apply to change coverage at any time during the year. However, in most cases, you will need to answer health questions and go through medical underwriting.
California residents have an added advantage under the California Birthday Rule. This law provides a 60-day window beginning on your birthday each year. During this time, you can switch to another Medicare Supplement plan with the “same or fewer” benefits without medical underwriting.
For example, if you have Plan G, you can switch to Plan G with any other insurance carrier, regardless of your health. In contrast, most states do not offer a birthday rule, which means individuals with health conditions may be unable to change plans or carriers without underwriting. If you are in California, it is a good idea to review your Medicare Supplement options around your birthday each year. I do this for my clients to help them take advantage of potential savings.
If you would like help reviewing your Medicare Supplement options or seeing if you may qualify for savings under the California Birthday Rule, I offer no cost consultations and would be happy to help you explore your options.
Final Thoughts
Signing up for Medicare does not have to be confusing. Understanding your enrollment options ahead of time helps ensure your coverage starts on time and helps you avoid unnecessary penalties or gaps in coverage.
If you are turning 65 soon and would like help coordinating your Medicare enrollment with a Medicare Supplement plan so your coverage begins on time, speaking with a licensed Medicare specialist can make the process much easier and more confident.
If you would like personalized help reviewing your Medicare Supplement options or timing your enrollment correctly, my contact information is below.
About the Author
I’m an independent Medicare Supplement insurance specialist working with most of the major insurance carriers throughout California, Nevada, and several other states. I help people turning 65 coordinate their Medicare enrollment so their Medicare Supplement and prescription drug coverage begin at the same time as Medicare.
I also work with many people who already have Medicare Supplement plans and would like to review their options. In California, the Medicare Supplement Birthday Rule allows policyholders to change their plans each year without medical underwriting, and I regularly help clients lower their premiums while keeping the same identical plan and coverage. Many of my clients have saved hundreds, and sometimes thousands, of dollars.
There is no charge for my services because I am compensated by the insurance carriers, not my clients. My goal is to help you find competitive premiums and provide dependable personal service year after year.
If you are turning 65 soon, or if you already have a Medicare Supplement plan and would like to review your options, I am happy to help.
You can also click here to read what my clients have to say about working with me.
Serving Medicare clients throughout California, Nevada, and several other states.
Ron Lewis Ron@RonLewisInsurance.com www.MedigapShopper.com (760) 525-5769 (866) 718-1600
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
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
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
If you’ve ever tried to compare Medicare Prescription Drug Plans (PDPs), also known as Medicare Part D, you know how confusing it can be. There are dozens of options, and each plan has its own list of covered drugs (called a formulary), preferred pharmacies, and cost structure. What looks like a small difference in co-pays or premiums can easily add up to hundreds of dollars over the course of a year.
Why Most Agents No Longer Sell Prescription Drug Plans
You might assume that a licensed insurance agent can help you find the best plan, and in the past, many could. However, today’s system makes that much more difficult. Because of how Medicare’s certification and contracting rules work, most independent agents are not certified with every drug plan available in your area. They can only recommend or enroll you in a limited number of specific plans they are contracted with and certified to sell.
If another company offers a plan with lower co-pays or better coverage for your medications, your agent may not even be allowed to discuss it with you. Why? Because they don’t get paid for selling plans they’re not certified or contracted to represent. Even if they know a different plan would save you money, compliance rules and commission structures prevent them from showing it to you.
The Hidden Time and Cost Burden on Agents
Before an agent can help anyone with a PDP or a Medicare Advantage (MA) plan, they must complete extensive training and certification every year. This starts with the AHIP certification exam, which takes many agents 10–20 hours of study time to complete. The AHIP exam covers topics such as Medicare compliance, plan rules, CMS marketing guidelines, etc.
But that’s only the beginning. Agents must also spend time studying and taking individual certification exams for EVERY insurance company whose plans they want to sell. Each carrier’s certification process is different. Some require several hours of training, testing, and annual renewal. Altogether, a well-rounded agent could easily spend 50+ hours each year just keeping up with certifications before they can even begin helping clients.
Then there are the CMS compliance rules, which now require all sales calls related to PDPs and MA plans to be recorded and stored securely for 10 years! The added administrative burden and potential liability make it even less practical for agents to offer these plans, especially since commissions for prescription plans are typically under $100 per year per client. Many agents have simply decided that it’s not worth the time and effort.
How You Can Shop and Enroll in a Drug Plan On Your Own
Fortunately, Medicare makes it easy for you to shop around on your own and sign up for a prescription drug plan at www.Medicare.gov by using the exact same tool that agents use.
This past year, I put together a short video that explains how to shop for and sign up for a Medicare prescription drug plan using the Medicare Plan Finder tool. It’s actually very easy, and there aren’t any significant changes since last year. Please click here to watch the video.
The Medicare Plan Finder is available 24/7 and it is updated every fall with the latest plan information. It allows you to make an informed decision without pressure or bias, and without worrying whether your agent is certified to sell a particular plan.
Review Your Coverage Each Fall
Even if you’re happy with your current PDP, it’s important to review your coverage each year during the Annual Election Period (AEP), which goes from October 15th through December 7th each year. PDPs are annual contracts, and drug prices, plan premiums, and pharmacy networks can change every year. What’s good this year may not be so good next year.
It only takes about 15 to 20 minutes to shop around and review your PDP options, and it could save you literally hundreds of dollars and ensure you have the right coverage for your specific prescriptions.
The Bottom Line
Most Medicare agents are honest, hardworking professionals who want to help their clients, but the system is stacked against them when it comes to prescription drug plans. Between certification costs, compliance rules, and low commissions, many agents have chosen to focus on Medicare Supplements, Medicare Advantage plans, or other types of insurance products instead.
By learning how to shop for your own prescription drug coverage at Medicare.gov, you can take control of your health care costs, stay informed, and make sure you’re always getting the best prescription drug plan every year.
About the Author
As an independent Medicare Supplement insurance specialist, I work with all the major carriers throughout California, Nevada, and several other states. I shop around for my clients every year during their 60-day annual open enrollment period under the California Birthday Rule to help them save money on their Medicare Supplement premiums. Many of my clients have saved hundreds, even thousands of dollars on the same exact plan and coverage! Please click here to see what my clients have to say about my services.
There is no charge for my services as I’m compensated by the insurance carriers, not my clients. My goal is to help you find the lowest premiums and provide the best personal service possible—year after year. Unlike many agents, I won’t disappear after you sign up!
If you enjoyed this blog and found it helpful, please leave your comments, questions, or feedback below and feel free to share this article with your friends!
Thank you!
Ron Lewis Ron@RonLewisInsurance.com www.MedigapShopper.com (760) 525-5769 – Cell (866) 718-1600 – Toll-free
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 ClientTestimonials 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 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.
The Annual Election Period (AEP) is from October 15th through December 7th each year. During this annual open enrollment period, you can sign up for or change your Medicare Advantage (MA) plan or your Prescription Drug Plan (PDP). Medicare Advantage and prescription drug plans are annual contracts, and they can change from year to year. Therefore, you should shop around and compare plans every year.
NOTE:If you have a Medicare Supplement, the AEP does not apply to you unless you want to enroll in or change your PDP.
If you have an MA plan and you want to change to a different MA plan, or if you want to leave your MA plan and switch back to Original Medicare, Part A (Hospital insurance) and Part B (Medical insurance), you would normally do so during the AEP. The new coverage will begin on January 1st of the following year. In most cases, you must stay enrolled in your MA plan for the calendar year beginning in January or on the date your coverage begins. However, in certain situations, you may be able to join, switch, or drop an MA plan during a Special Enrollment Period (SEP), such as if you move out of your plan’s service area, etc.
Pros and Cons – Medicare Supplements Versus Medicare Advantage Plans
When it comes to Medicare Advantage (MA) plans, I’m going to be totally honest and admit to you that I am biased because I don’t like them! Unless you can’t afford to pay the monthly premium for a Medicare Supplement (aka Medigap), I would NEVER recommend or advise someone to give up their Original Medicare rights (Part A and Part B) and sign up for an MA plan!
If you currently have an MA plan, or if you are thinking about signing up for one, I would strongly recommend that you read this article first so that you can make an “informed decision” about whether an MA plan is right for you and in your best interest.
There are pros and cons to each, but the benefits of having a Medicare Supplement plan far outweigh the benefits of having an MA plan. Please click here for a detailed comparison between Original Medicare and Medicare Advantage plans.
MA Plan Advantages
Here are some of the benefits of having an MA plan:
MA premiums can be very low, and some plans have no monthly premiums at all.
Some MA plans include Medicare prescription drug coverage (Part D).
Maximum out-of-pocket (OOP) costs are limited. Plans vary, but in 2025, the most you can pay for in-network OOP costs is $9,350 per calendar year. If you go out of network, you would normally pay all costs! (I wouldn’t really call this a benefit since $9,350 is a lot of money, and the most you would pay in OOP costs with a Plan G Medicare Supplement is the Medicare Part B deductible, which is currently $240 per calendar year in 2024! The Medicare Part B deductible for 2025 is projected to be $257. However, the Centers for Medicare & Medicaid Services (CMS) will not finalize the deductible until fall 2024.)
Some MA plans offer additional benefits such as vision, hearing, dental, and other health and wellness programs. (Some Medicare Supplement plans also offer additional benefits such as free gym memberships, vision, and hearing aid benefits.)
Medicare Supplement Plan Advantages
Here are some of the benefits of having a Medicare Supplement plan:
You have much more FREEDOM of choice with a Medicare Supplement than you do with an MA plan because you can go to ANY doctor, hospital, specialist, care facility, etc. in the United States as long as they accept Medicare, and most do, about 93%. (You can’t do that with an MA plan.)
You have much for financial stability with a Medicare Supplement than an MA plan because there are no unexpected expenses for deductibles, co-payments, hospitalizations, surgeries, chemotherapy, etc.
With a Plan G Medicare Supplement, other than your premiums, your maximum OOP cost in the 2025 calendar year will be no more than the Part B deductible, which is currently projected to be around $257. With an MA plan, your in-network maximum OOP “in-network” costs can be as high as $9,350! If you go out of network, your costs can be significantly higher.
NOTE:The Medicare Part B deductible is payable only one time per calendar year. If you’ve already met that deductible, you won’t have any other costs for Medicare-approved charges for the rest of the year.
You are not limited to a specific geographic region or a restrictive network of doctors, hospitals, specialists, care facilities, etc. like you are with an MA plan. Most MA plans are HMO’s and you will normally pay all costs if you go out of network.
With a Medicare Supplement, you can go directly to the specialist of your choice, ANYWHERE in the United States, as long as they accept Medicare. Most MA plans require you to go through a primary care doctor first and get permission to see a specialist within the local, geographic network.
Unlike MA plans, there are no HMO or PPO plans or networks with Medicare Supplements. You can go to any doctor or specialist in the US as long as they accept Medicare.
If you want to go to a renowned treatment center such as the MD Anderson Cancer Treatment Center in Texas, you can do so with any Medicare Supplement, as long as they accept Medicare. You can’t do that with most MA plans.
If you move to another part of the country, you can keep your Medicare Supplement, but you cannot keep your MA plan if you move out of your network.
There are only 10 “standardized” Medicare Supplement plans to choose from, (Plan A through Plan N). Since Medicare Supplements are standardized, the coverage and benefits for every Plan G, etc. is exactly the same with every insurance carrier, so it’s much easier to shop around and compare “apples with apples.” MA plans are not standardized, and the co-payments, deductibles, out of pocket costs, etc. vary between MA plans, and they change every year making them unnecessarily complicated and confusing.
A Medicare Supplement plan cannot be cancelled as long as you pay your premiums. MA plans are annual contracts, and they can be cancelled or benefits changed at the end of each calendar year.
There is no Annual Election Period (AEP) for Medicare Supplements, and you don’t have to shop around every year and make sure that your coverage, co-payments, co-insurance, deductibles, and benefits haven’t changed since the previous year. If there are any Medicare changes from one calendar year to the next, your Medicare Supplement will automatically pay the difference.
Medicare Supplements are “portable” meaning that you can keep them and take them with you if you travel to another state or if you move to another state, and your Medicare Supplement cannot be cancelled for leaving your “service area.” With most MA plans, if you travel outside of the MA plan’s service area for more than six months, you could be dis-enrolled from the plan.
With a Plan G Medicare Supplement, there are no co-payments when you go to the doctor. With most MA plans, you have to pay co-payments every time you see a doctor.
You can switch Medicare Supplement plans or Medicare insurance carriers any time of the year as long as you meet minimum health and underwriting requirements. With an MA plan, you can only join or leave an MA plan during the AEP or a SEP. Otherwise, you are locked into your MA plan for the entire calendar year.
NOTE:In California, there is a law called the California Birthday Rule. Under this law, if you have a Medicare Supplement, you can change it every year during the 60 days following your birthday to any other Medicare Supplement plan with “equal or fewer” benefits. For example, if you have Plan G, you can switch to Plan G with any other insurance carrier, regardless of your health. If you have Plan G, you can also switch to Plan N because Plan N has fewer benefits than Plan G, etc. Under the birthday rule, you just can’t switch from a plan with fewer benefits to greater benefits.
As you can see from the facts mentioned above, the benefits of having a Medicare Supplement far outweigh the benefits of having a Medicare Advantage plan.
Are Some Medicare Advantage Plans Really Free?
Because some MA plans have very low monthly premiums or no monthly premiums at all, some unscrupulous individuals promote them as “FREE” Medicare insurance plans, which is inaccurate, misleading, and, in my opinion, unethical. During the AEP, there are a lot of commercials for MA plans on TV. If you listen carefully, the one thing you’ll NEVER hear them mention is the maximum out-of-pocket costs for those plans. In 2025, in-network OOP costs can be as high as $9,350, and if you go out of network, you can pay significantly more!
Also, regardless of whether you have an MA plan or a Medicare Supplement plan, you still have to pay the monthly Medicare Part B premium, which is currently $174.70 per month for most people in 2024. The Medicare Part B premium in 2025 hasn’t been released yet, but it is estimated to be around $185.00 per month.
You Can Always Get a Medicare Advantage Plan But You Can’t Always Get a Medicare Supplement Plan
MA plans are adequate as long as you are healthy, but if your health should change and you develop a serious illness, you will wish that you had a Medicare Supplement instead of an MA plan because you will have much more freedom of choice and control over your health care with a Medicare Supplement!
Original Medicare (Part A and B) only cover about 80% of medical and hospital costs and Medicare Supplements pick up most of the remaining 20%. During the AEP, you can always switch from a Medicare Supplement to an MA plan, regardless of your health, and you can always switch from an MA plan back to Original Medicare (Part A and Part B), regardless of your health. However, if you switch back from an MA plan to Original Medicare during the AEP, there is no guarantee that you can get a Medicare Supplement as you must be in good health, answer health questions, and be medically underwritten to be approved. If you have any serious health issues, more than likely, you won’t be able to get a Medicare Supplement.
NOTE:There are some situations where you can switch from an MA plan to a Medicare Supplement as a “guaranteed issue” without answering any health questions or going through medical underwriting. If you are in this situation, please let me know.
Also, if you are in the first year of your MA plan, you are guaranteed the right to switch back to a Medicare Supplement during the first 12 months. This is called a trial right. The trial period gives you a year to try an MA plan and see if it’s right for you. If you decide it’s not, you are guaranteed the right to switch back to original Medicare (Parts A and B) and purchase a Medicare Supplement plan.
The Maximum Out of Pocket Cost for MA Plans Can Be Twice As Much As You Think
Depending on which MA plan you have, the most you would pay for in-network out-of-pocket (OOP) costs in 2025 is $9,350 per calendar year! If you go outside of your plan’s network, you will pay even more than that!
Now suppose that you get really sick and need expensive treatment in the second half of the year. You could end up paying up to $9,350 (or whatever your plan’s maximum OOP cost is) by the end of the calendar year, but your OOP maximum zeros out in January, and it starts all over again! You could potentially end up paying your OOP TWICE in a 12-month period!
Conclusion
If you have an MA plan, you give up your Original Medicare (Part A and Part B) rights and you compromise your freedom of choice to go to the best doctors, specialists, hospitals, care facilities, etc. throughout the United States. Unless you are impoverished and can’t afford to pay the monthly premium for a Medicare Supplement, I would never recommend an MA plan to a friend or family member as you are always better off with a Medicare Supplement.
I’m an independent insurance agent, not a captive agent, and I work with most of the major insurance carriers. I shop around for my clients, every year, and I will shop around for you too! If you have any questions or if you have an MA plan and would like for me to help you switch to a Medicare Supplement plan, please let me know! And if you have a Medicare Supplement, I’m happy to shop around for you to save you money on your premiums!
There’s no such thing as free Medicare insurance! As the old expression goes… “You get what you pay for!”
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
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!
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.
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.
The purpose of this blog is to provide you with some tips and tricks that will help you save money on your Medicare Supplement insurance (aka Medigap), which is designed to cover most or all of the co-payments, deductibles, and co-insurance not covered by Medicare. This article primarily applies to individuals living in California. With that said, a lot of the information in this blog still applies to other states as well, so hopefully, you will find this information to be helpful regardless of where you live!
IMPORTANT:Don’t confuse Medicare Advantage (MA) plans, also known as Part C, with Medicare Supplement plans! The two plans are entirely different! This article does NOT apply to MA plans.
Some Key Differences Between Medicare Advantage and Medicare Supplement Plans
With a Medicare Supplement, you have much greater freedom of choice than an MA plan because you can go to ANY doctor, specialist, hospital, care facility, etc. in the US as long as they accept Medicare, and most do, about 93%. With MA plans, you are much more restricted and have less freedom because most MA plans are HMO’s and you can only go to doctors, specialists, hospitals, care facilities, etc. that are in your local geographic network, and you must see your primary care doctor first and then get a referral to see a specialist in your network! You cannot go directly to a specialist!
With MA plans, your annual co-payments and deductibles are significantly more expensive than traditional Medicare Supplement plans. In fact, depending on which MA plan you have, the maximum in-network out-of-pocket (OOP) costs can be as high as $8,300 in 2023! If you go out of network, you will pay even more!
With a Medicare Supplement Plan G, the most popular Medicare Supplement plan, your maximum OOP cost for all of 2023 is only $226, which is the Medicare Part B deductible. There are many other reasons why I always recommend Medicare Supplements over MA plans, but that is a separate topic, and it’s beyond the scope of this article.
10 Standardized Medicare Supplement Plans
Nationwide, there are 10 standardized Medicare Supplement plans to choose from, Plan A through Plan N. The term “standardized” means that the coverage and benefits are exactly the same with every Plan F, Plan G, Plan N, etc. In other words, Plan G is Plan G, Plan N is Plan N, etc. regardless of what carrier you are with, so it’s much easier to compare “apples with apples,” etc.
Although Medicare Supplement plans are standardized, the premium rates are not standardized, and they vary significantly from one insurance carrier to another!
The following chart shows the 10 standardized Medicare Supplement plans that are available throughout the US.
NOTE: As of January 1, 2020, Plans C, F and High Deductible F cannot be sold to those newly eligible for Medicare. Newly eligible is defined as anyone who: (a) attains age 65 on or after January 1, 2020, or (b) who first becomes eligible for Medicare benefits due to age, disability or end-stage renal disease on or after January 1, 2020. Those enrolled in Plans C, F and High Deductible F prior to January 1, 2020 may keep their plan. Those individuals who became eligible for Medicare prior to January 1, 2020 may keep or purchase Plans C, F and High Deductible F after December 31, 2019.
TIP: You should shop around and compare rates every year or two to save money on your premiums.
Which Medicare Supplement Plan Is Best?
Of the 10 standardized Medicare Supplement plans, Plan F, Plan G, and Plan N (in green) are the most popular plans. Of those three plans, Plan F is considered to be the best because you have no out-of-pocket costs. For that reason, Plan F is also the most expensive plan, and not the most popular plan.
NOTE:As mentioned above, Plan F is no longer available for those individuals who are newly eligible for Medicare on or after January 1st, 2020. Plan F is still available for those who were eligible for Medicare prior to January 1st, 2020.In addition to the plans in the chart, there is also a high-deductible Plan F and a high-deductible Plan G. The annual deductible for both plans is currently $2,700 in 2023.
Most people who started off with Plan F, including myself, have switched to Plan G. Both plans are identical in every way except Plan F pays for the Medicare Part B deductible (currently $226 for all of 2023) and Plan G doesn’t. That is the ONLY difference between the two plans! Once you meet that small deductible, there is no difference in the coverage or benefits between Plan F and Plan G! The only major difference between the two plans are the premiums; in most cases, the Plan G premiums are significantly lower than the Plan F premiums!
It’s kind of like your auto insurance or your homeowner’s insurance. You can have a zero deductible, like Plan F, or you can have a $500 deductible or a $1,000 deductible, etc. The overall coverage is the same, but you pay a lot more for a $0 deductible versus a $500 or $1,000 deductible.
TIP: If you can save more than $226 per year on your premiums by switching from Plan F to Plan G, Plan G ends up being more cost effective, and you should switch to Plan G to save money on your insurance premiums!
Again, with a Plan G Medicare Supplement, your maximum OOP cost for all of 2023 is the Part B deductible, which is $226 in 2023. For example, if you have multiple doctor visits during the year, have a couple of surgeries and are hospitalized, the most you would normally pay for all of 2023 is the $226 Part B deductible and that’s all! With a Medicare Advantage plan, your maximum in-network OOP costs can be as high as $8,300 in 2023! If you go out of network, your OOP costs will be even more!
The California Birthday Rule
In California, there is a law called the California Birthday Rule. If you have one of the 10 standardized Medicare Supplement plans, such as Plan F, Plan G, Plan N, etc. you are guaranteed the right to switch your insurance plan or insurance carrier during the 60 days following your birthday each year, REGARDLESS OF YOUR HEALTH, and without answering any health questions or medical underwriting.
During this 60-day open enrollment period, YOU CANNOT BE TURNED DOWN FOR COVERAGE as long as you switch to any other plan with “equal or fewer” benefits. For example, if you have Plan G, you can switch to Plan G with any other carrier. Or, you could switch to a lower plan, such as Plan N because Plan N has fewer benefits than Plan G, etc.
NOTE:Unlike MA plans or prescription drug plans, you can change your Medicare Supplement plan any time of the year, but if you do so around your birthday, it’s easier because you don’t have to answer any health questions, there is no underwriting, and you cannot be turned down for coverage!
Although the California Birthday Rule specifies that you can apply for coverage during the 60-day open enrollment period after your birthday each year, many insurance carriers will let you apply during the 30 days BEFORE your birthday up to 60 days AFTER your birthday meaning you really have a 90-day open enrollment period each year for your Medicare Supplement! Although the majority of insurance carriers base their rates on your age after your birthday, a couple of the insurance carriers that let you apply during the 30 days before your birthday base their rates on your age on the application date, so their rates will be less than if you apply after your birthday.
TIP: If you live in California and you have a Medicare Supplement, you can often save money on your premiums by applying for a new Medicare Supplement plan during the 30 days before your birthday rather than during the 60 days after your birthday.
Most states do not have a birthday rule or anything similar. In those states, if you have a Medicare Supplement plan and you want to switch to a different insurance carrier with a more competitively-priced plan, you must fill out an application, answer health questions, and be medically underwritten and approved. If you have serious health issues, you will not be able to change plans.
NOTE: There are currently six states that have a birthday rule including California, Idaho, Illinois, Louisiana, Nevada, and Oregon. Before 2022, only two states had a birthday rule.
Qualifying for the California Birthday Rule
To qualify for the California Birthday Rule, you must meet the following requirements:
Live in California
Currently have a Medicare Supplement plan
Switch to a plan with the same or fewer benefits
Apply during the 30 days before your birthday up to 60 days after your birthday
Guaranteed Rate Locks
When you sign up for a new Medicare Supplement plan, most insurance carriers will guarantee and lock your premium rate for the first 6 to12 months.
TIP: To avoid any unexpected rate increases, I normally recommend going with an insurance carrier that locks their rates for the first year, if possible.
After the initial guaranteed rate lock period expires, an insurance carrier can raise your rate at any time as long as they raise everyone’s rates. (You cannot be singled out.) Just like your auto and homeowner’s insurance, it’s important to shop around every year around your birthday because rates change and what is good this year may not be so good next year. For this reason, I shop around for my clients every year around their birthday.
New to Medicare? Get a $25 Per Month Discount For the First Year!
If you are turning 65 or if you will be new to Medicare Part B (Medical insurance), a couple of insurance carriers will give you a $25 per month “Welcome to Medicare” discount for the first 12 months! These rates are almost impossible to beat during the first year. After the first year, the $25 discount will end, but you can still switch to another carrier each year around your birthday if you want, regardless of your health and without answering any health questions on the application.
Would You Like a Free Gym Membership?
If you like to go to the gym, several insurance carriers offer “Silver Sneakers” and “Silver and Fit,” which are free gym memberships to local participating gyms such as 24-Hour Fitness, LA Fitness, etc.
TIP: If you are paying a monthly fee to belong to a gym, eliminate that fee by signing up for a Medicare Supplement with an insurance carrier that offers Silver Sneakers or Silver and Fit!
Medicare Supplements Are Standardized but Medicare Supplement Rates Are Not Standardized!
In California, most insurance carriers base their rates on your “attained age.” This means that Medicare Supplement rates usually increase as we get older. Although the 10 nationwide Medicare Supplement plans are “standardized,” meaning that the coverage and benefits are exactly the same for every Plan G, Plan N, etc., insurance premiums for these plans are not standardized, and the rates vary significantly from one insurance carrier to the next for the same identical plan and coverage!
For example, for a 70 year old living in the 92056 zip code, the current Plan G Medicare Supplement premiums range from $158 to $243 per month! That is a difference of $85 per month or $1,020 per year for the same identical plan and coverage!
TIP: Periodically check your rates every year or two to make sure they are still competitively priced.
You Can Apply for Medicare Supplements All Year Long!
Unlike MA plans that have an Annual Enrollment Period (AEP) from October 15th to December 7th every year for a January 1st effective date, you can apply for Medicare Supplement plans all year long.
If you apply for a Medicare Supplement plan at any time of the year other than during your 60-day annual open enrollment period under the California Birthday Rule, you will have to answer the health questions on the application and be medically underwritten. If you have certain health conditions, you can be turned down for coverage. If you are in relatively good health, you should not have any problem qualifying for a new Medicare Supplement plan.
TIP: If you have a Medicare Supplement plan and you have a serious health condition, take advantage of the California Birthday Rule and apply around your birthday. It’s always easier to apply for a Medicare Supplement around your birthday since you don’t have to answer any health questions and you cannot be turned down for coverage!
Household Discounts
Some carriers give you a household discount (HHD) and others don’t. If you qualify for a HHD, some give more than others, from 5% to 12%! To qualify for a HHD, some carriers require both parties in the household to have a Medicare Supplement with the same company, and others only require that you live in the same household with another adult to qualify for the HHD. For example, if you have a roommate or live with someone that does not have a Medicare Supplement, you can still get a full HHD with certain carriers!
TIP: If you are married or you have lived with another adult in the house for at least one year, some companies will give you up to 12% HHD on your insurance premiums, even if your spouse, roommate, etc. doesn’t have a Medicare Supplement policy!
About Me
I hope that you have found this information to be interesting and informative. I’m an independent insurance agent with over 15 years of experience specializing in Medicare Supplement insurance, primarily in California. As an independent agent, I work with most of the major insurance carriers including Mutual of Omaha, Cigna, Blue Shield of CA, Anthem Blue Cross, Health Net, Aetna, etc. I have hundreds of clients, and I shop around for them every year around their birthday. Please click here to see some of my client testimonials.
FINAL TIP: If you have any questions, or if you know anyone that is turning 65 or starting Medicare, or if you would like for me to shop around for you, I’m happy to help, and there is no charge for my service!!! Please feel free to call me or send me an email! Also, please feel free to forward this blog to anyone you know who may be interested.
Medicare has a new initiative that will cover up to EIGHT over-the-counter COVID-19 tests each calendar month, at no cost to you.
Who’s Eligible?
Medicare will cover these tests if you have Medicare Part B (Medical Insurance). Medicare won’t cover over-the-counter COVID-19 tests if you only have Medicare Part A (Hospital Insurance). However, you may be able to get free tests through other programs.
When Did This Program Begin?
This initiative started on April 4th, 2022, and continues until the COVID-19 Public Health Emergency (PHE) ends. People with Medicare Part B can get up to EIGHT free over-the-counter tests per calendar month, and can then get another set of eight free over-the-counter tests during each subsequent calendar month through the end of the COVID PHE.
How Can I Get These Free Covid Test Kits?
You can get over-the-counter COVID-19 tests at any pharmacy or health care provider that participates in this initiative. Check with your pharmacy or health care provider to see if they are participating. If so, they can provide your tests and will bill Medicare on your behalf. A partial list of participating pharmacies can be found here. You should bring your red, white, and blue Medicare card to get your free tests, but the pharmacy may be able to get the information it needs to bill Medicare without the card.
I picked up eight free Covid test kits yesterday from my local Safeway pharmacy. The pharmacist placed the order in the morning, and I picked them up yesterday afternoon. On a personal note, the only thing I didn’t like is that the Flowflex test kits are made in China. I’d feel more comfortable if these kits were made in the USA.
NOTE:Some pharmacies also offer free N95 face masks.
Looking for a Great Dental, Vision, and Hearing Plan?
If you are looking for a dental plan, I would recommend that you consider Manhattan Life’s Dental, Vision, and Hearing (DVH) insurance plan. This plan can be used for dental only, or a combination of dental, vision, and hearing.
There is an annual deductible of $100 and unlike most dental plans, there are no required networks; you can go to the dentist of your choice!
NOTE:If you go to a dentist that’s in the Careington network, it will stretch your benefit dollars, but that is up to you.
There are three policy year benefit options available: $1,000 per year, $1,500 per year, or $3,000 per year.
If you are between the ages of 65 to 74, the $1000 plan is $37.58 per month, the $1,500 plan is $49.67 per month, and the $3,000 plan is $64.42 per month.
If you are between the ages of 75 to 85, the $1000 plan is $43.17 per month, the $1,500 plan is $57.08 per month, and the $3,000 plan is $74.08 per month.
Unfortunately, these plans are not available for ages 86 and older.
These plans are guaranteed issue and guaranteed renewable for life. During the first year, the plan will pay 60% of the costs. During the second year, the plan will pay 70% of the costs, and during the third year and after, the plan will pay 80% of the costs!
NOTE:Sometimes these percentages are based on “usual and customary” costs, but I recently bought new hearing aids at Costco for $1,800, and Manhattan Life paid 80% of the actual cost of the hearing aids!
For dental coverage, there are no waiting periods for Preventative Services such as semi-annual exams, cleaning and x-rays. There are no waiting periods for Basic Services such as x-ray, fillings and extractions (other than full mouth). For Major Services such as bridges, crowns, full-mouth dentures or partials, full-mouth extractions, and root canals, there is a 12-month waiting period, which is normal.
For vision coverage, basic eye exams and eye refractions are covered immediately, but there is a six-month wait for eyeglasses and contact lenses.
For hearing coverage, hearing exams are covered immediately, but there is a 12-month wait for new hearing aids and existing hearing aid repairs. After the initial 12-month waiting period, you will be reimbursed for 70% of the cost of your hearing aids after you’ve met the $100 annual deductible. If you don’t get hearing aids until you’ve had your plan for three or more years, like I did, hearing aids are covered at 80%!
NOTE: Unlike many dental plans, the annual deductible is based on a policy year, not a calendar year. So your first year is 12 months from the date your policy begins. Most other insurance carriers use a calendar year deductible, so if your plan starts on November 1st, your deductible starts all over again on January 1st, etc.
How Do I Get More Information or Sign Up For Coverage?
Please click here to find out more or to sign up for the Manhattan Dental, Vision, and Hearing insurance plan! There are two plans to choose from. Select “Dental, Vision, and Hearing Insurance,” not “DVH Select!”
Medicare Part A and Part B Premium and Deductible Changes for 2023
On September 27, 2022, the Centers for Medicare & Medicaid Services (CMS) released the 2023 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs.
Medicare Part A Premium and Deductible
Medicare Part A covers inpatient hospital, skilled nursing facility, hospice, inpatient rehabilitation, and some home health care services. About 99% of Medicare beneficiaries do not have a Part A premium since they have at least 40 quarters of Medicare-covered employment.
The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital will be $1,600 in 2023, an increase of $44 from $1,556 in 2022. The Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period.
In 2023, beneficiaries must pay a coinsurance amount of $400 per day for the 61st through 90th day of a hospitalization ($389 in 2022) in a benefit period and $800 per day for lifetime reserve days ($778 in 2022). For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $200.00 in 2023 ($194.50 in 2022).
Medicare Part B Premium and Deductible
Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.
Each year the Medicare Part B premium, deductible, and coinsurance rates are determined according to the Social Security Act. The standard monthly premium for Medicare Part B enrollees will be $164.90 for 2023, a decrease of $5.20 from $170.10 in 2022. The annual deductible for all Medicare Part B beneficiaries is $226 in 2023, a decrease of $7 from the annual deductible of $233 in 2022.
NOTE:If you have a Plan G Medicare Supplement, the Part B deductible that you are responsible for paying has been reduced from $233 to $226 in 2023.
The new 2023 Medicare & You guidebook was recently released. It is an excellent resource with a lot of great information. Please click here to download your free copy!
Get Your Free Guide to Health Insurance Booklet!
The 2022 Guide to Health Insurance for People with Medicare is also an excellent resource for Medicare information. Please click here to download your free copy!
About Me
As an independent insurance agent, I work with ALL the major Medicare Supplement insurance carriers. I will shop around for you, EVERY YEAR, to find you the best Medicare Supplement rates!
If you have any questions or if you know someone that is turning 65 or would like to save money on their Medicare Supplement insurance, please don’t hesitate to let me know! There is no charge for my service!!!
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.
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!
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.
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.
Since the only difference between Plan F and Plan G is the $198 Medicare Part B deductible, if you can save more than $198 per year on your premiums by switching from Plan F to Plan G, then Plan G ends up being more cost effective.
If you are saving exactly $198 per year, you are breaking even, and you’re better off staying with Plan F. If you are saving $300 or more per year by switching, it will definitely cost you less money by switching from Plan F to Plan G.
NOTE:If you decide to switch from Plan F to Plan G, and you have already met the $198 Medicare Part B deductible for the current year, you would not have to pay that deductible again until the following year.
Conclusion
As of July 1st, 2020, your annual open enrollment period under the California Birthday Rule is increasing from 30 to 60 days after your birthday. Most carriers will let you apply for coverage during the 30 days prior to your birthday, but the effective date of your new policy would normally be the 1st of the month following your birthday. And if you have Plan F or Plan G with another insurance carrier and you want to switch to an “Innovative” plan under the birthday rule with Blue Shield of CA, Anthem Blue Cross, Health Net, etc., you can now do so.
Since rates vary significantly between insurance carriers for the same identical plan and coverage, it is important to shop around, EVERY YEAR, to make sure that you aren’t paying too much.
As an independent insurance agent specializing in Medicare Supplement (Medigap) insurance, I work with all the major insurance carriers in California and several other states. If you have any questions or if you would like for me to shop around for you to save you money on your Medicare Supplement insurance, please don’t hesitate to let me know.
Ron Lewis
CA Lic# 0B33674
760.525.5769 (Cell)
760.718.1600 (Toll-free)
Ron@RonLewisInsurance.com www.MedigapExpress.com
The new 2019 Medicare deductibles, coinsurance, and out-of-pocket limits were recently released, and they go into effect on January 1st, 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!
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.
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!
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 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.
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!
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.
MA Plan Advantages
Here are some benefits of having an MA plan:
MA premiums can be very low, and some plans have no monthly premiums at all.
Some MA plans include Medicare prescription drug coverage (Part D).
Maximum 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!)
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:
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.)
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.
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!
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)!
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.
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.
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.
If you want to go to a renowned treatment center such as the MD Anderson Cancer Treatment Center in Texas, you can do so with any Medicare Supplement, as long as they accept Medicare. You can’t do that with most MA plans.
If you move to another part of the country, you can keep your Medicare Supplement, but you cannot keep your MA plan if you move out of your network.
There are only 10 “standardized” Medicare Supplement plans to choose from, (Plan A through Plan N). Since Medicare Supplements are standardized, the coverage and benefits for every Plan 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.
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.
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.
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.
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.
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.
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.
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!
I just turned 65 yesterday, August 20th, and my Medicare Part A (Hospital) and Part B (Medical), Medicare Supplement, and Medicare Prescription Drug Plan (PDP), also known as Part D, all started a few weeks ago on August 1st, 2017.
NOTE:For most people, their Medicare benefits usually begin on the 1st of the month when they turn 65.
Fortunately, I’m in pretty good health, and I only take two relatively inexpensive medications. Since there is a late enrollment penalty added to your monthly PDP premiums if you don’t sign up for a PDP when you are first eligible (turning 65 or starting Medicare Part B), I decided that I was going to at least sign up for the cheapest PDP to avoid the penalty later on.
How Much is the Part D Penalty?
The cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage.
According to the Medicare.gov website “Medicare calculates the penalty by multiplying 1% of the “national base beneficiary premium” ($35.63 in 2017) times the number of full, uncovered months you didn’t have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.”
NOTE:The national base beneficiary premium may increase each year, so your penalty amount may also increase each year.
The late enrollment penalty is approximately $0.34 per month for every month you could have had prescription drug coverage but didn’t. For example, if you went 10 months without PDP coverage before you started a new PDP, the total penalty would be approximately $3.40 per month ($0.34 x 10 months) on top of the regular prescription drug plan monthly premium. Again, the penalty amount can increase in the future.
My Prescription Drug Plan Coverage — Before and After Medicare
Before I started on Medicare, I had some limited prescription drug plan coverage through my Affordable Care Act (Obamacare) health insurance, which wasn’t so “affordable.”
I take two medications: Fluticasone nasal inhaler and Levothyroxine. Through my previous pharmacy, the regular price of the Fluticasone was $56.80 per month, but with my Obamacare insurance, I was paying $20.00 per month. In addition to that, I was paying $12.68 per month for the Levothyroxine.
Altogether, before I started on Medicare, I was paying $32.68 per month for both prescriptions.
In contrast, I recently signed up with the Medicare “Humana Walmart Rx Plan” because it is currently the cheapest and most cost-effective drug plan for my particular situation. During the next Annual Enrollment Period (AEP), which is from October 15th through December 7th each year, I may sign up for a different PDP plan if I find another plan that is better than the one that I currently have.
Regardless of what PDP you currently have, you should always shop around every year during the AEP between October 15th and December 7th.
NOTE:I am not certified to sell prescription drug plans, and I am not recommending, endorsing, or promoting Humana or any particular insurance carrier. My primary focus and area of expertise is with Medicare Supplement insurance plans.
With my Humana PDP, I pay a monthly premium of $17 per month, and I have a $400 per calendar year deductible. However, the two prescriptions that I take are classified as
Tier 1 prescriptions, and under my current plan, Tier 1 and Tier 2 prescriptions are not subject to the deductible, so I don’t have to pay any deductibles for the two prescriptions that I take!
With my Humana PDP, I chose to have my prescriptions mailed to me every three months, so I no longer have to drive to the pharmacy to pick up my prescriptions each month. That’s a nice benefit too!
NOTE:In my particular situation, the mail-order option ended up costing me less than picking my prescriptions up from a pharmacy, but that isn’t always the case.
For the Fluticasone, I am currently paying $8.00 TOTAL for a three-month supply! That comes out to $2.67 per month! For the Levothyroxine, I do not have to pay anything other than my monthly premium!
As mentioned before, I am currently paying $17.00 per month for my Humana PDP premium, and my total out-of-pocket cost for my medications is $2.67 per month for a total cost of $19.67 per month. In contrast, I was paying $32.68 per month prior to Medicare just for my prescriptions, not including my not-so-reasonably-priced health insurance premium.
I am very happy with my Medicare prescription drug plan. For me, it is significantly better than the prescription coverage that I had before I was on Medicare.
Is a Medicare Prescription Drug Plan Good for Everyone?
Fortunately for me, the prescriptions that I take are relatively inexpensive, but I know that isn’t the case for everyone. Some of my clients take a lot of expensive prescriptions, and a PDP doesn’t always save them money or else some of the prescriptions may not be covered at all by the PDP, which is very frustrating.
Some people don’t take any prescriptions at all, and they may question whether it makes sense to sign up for a PDP if they currently don’t need one, even though their health could (and probably will) change at some point in the future.
Because of the late enrollment penalty, I would still recommend signing up for the cheapest PDP, at least for the time being, if it isn’t a financial hardship.
NOTE:This blog addresses my experience with Medicare prescription drug plans. To read about my experience with Medicare Supplement insurance plans, please click here.
Everyone is different, and what is good for one person isn’t necessarily good for another. Should you sign up for a prescription drug plan? That is a personal decision and a question that only you can answer.
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I am an independent insurance agent specializing in Medicare Supplement insurance plans. I work with all the major insurance carriers in California, Washington, and several other states. If you have any questions, or if you would like for me to shop around for you to save you money on your Medicare Supplement insurance, please don’t hesitate to let me know!
As of January 1st, 2020, “newly eligible” Medicare beneficiaries will no longer be able to purchase Plan F and Plan C Medicare Supplement plans, which are also known as “Medigap” plans because they pick up the “gaps” in coverage that Medicare doesn’t cover.
NOTE:The high-deductible Plan F Medigap plan is also going away.
Individuals that are signing up for Medicare on or after January 1st, 2020, will not be able to sign up for any Medigap plan that covers the Medicare Part B deductible, which is currently $183 per calendar year in 2017.
Of the 10 “standardized” Medigap plans, Plan F and Plan C are the only two plans that cover the Part A (Hospital) and Part B (Medical) deductibles and coinsurance in full. These two plans are the only Medigap plans that offer “first-dollar” coverage for every doctor or hospital visit.
Why Are Plan F and Plan C Going Away?
These changes are taking place because of Section 401 in the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, which is also known as the “doc fix” law. To view the text, please click here.
In a nutshell, Congress passed this legislation to ensure that doctors would be paid adequately for providing Medicare services and to provide an incentive for doctors to continue accepting Medicare patients. Previous legislation had budgeted for doctors to have rate decreases over the years and there was concern that many doctors would stop accepting Medicare patients.
Because of the ever-increasing cost of medical care and the fact that more than 10,000 baby-boomers are turning 65 every day, Medicare is experiencing increased financial strain. Since individuals with Plan F and Plan C have no co-payments or deductibles, lawmakers fear that this lack of cost-sharing results in Medicare abuse, which is driving up costs.
It has been argued that the “first dollar” coverage available from Plan F and Plan C cause Medicare recipients to see their doctors more frequently than they would if they didn’t have all of their deductibles covered and had to pay some out-of-pocket costs when they did go to the doctor. Some claim that these changes will save Medicare billions of dollars each year in medical claim exposure.
In an effort to control costs by reducing claims, Congress has decided that it makes more sense for Medicare recipients to be responsible for more of their out-of-pocket medical expenses. Consequently, Congress has decided to eliminate Plan F and Plan C because they want Medicare beneficiaries to have more “skin in the game.”
No one knows if these measures will really reduce Medicare’s overall annual costs. Some argue that Medicare beneficiaries may end up waiting to get medical care for serious issues, which would ultimately cost Medicare more money in the future.
What Happens If I Have Plan F or Plan C Before January 2020?
Since the MACRA only prohibits the sale of Medigap Plan F and Plan C to “newly eligible” Medicare beneficiaries on or after January 1st, 2020, if you already have one of these plans in 2020, you will be exempted and “grandfathered” in. You will not lose your coverage!
You will still be able to purchase Plan F and Plan C policies from other insurance carriers after 2020 as long as you can medically qualify or if you are in an Open Enrollment or Guaranteed Issue situation.
If you were eligible for Medicare prior to 2020, but you delayed getting it because you are still working and have employer insurance, you will still be able to enroll in Plan F or Plan C after you stop working and switch back to Medicare.
What Happens If I Won’t Be Eligible for Medicare Until After January 2020?
For those individuals who will not be eligible for Medicare until January 1st, 2020 or later, although you will not be able to get Plan F, you will still be able to get Plan G, which is an excellent Medigap plan that is identical to Plan F in every way except for the $183 per calendar year deductible.
Today, many people that have Plan F have been switching to Plan G because the premiums for Plan G are usually significantly less than the premiums for Plan F. In most cases, Plan G will cost you less and is usually more cost effective, even if you pay for the entire Part B deductible!
Shop Around Every Year!
Since Medicare Supplement rates vary significantly between insurance carriers for the same identical plans and coverage, and since the rates in most states are based on your “attained” age, and they usually go up in price each year, it’s important to shop around every year, preferably during the 30 days before your birthday.
If you live in California, there is a law called the “California Birthday Rule.” This law guarantees you the right to switch “like for like” Medigap plans, such as Plan F for Plan F, or you can switch to any other Medigap plan with fewer benefits, such as from Plan F to Plan G, etc. You can do this every year, REGARDLESS OF YOUR HEALTH, during the 30 days following your birthday! Most insurance carriers in California let you do this during the 30 days before or after your birthday.
Whether you decide to keep your current Plan C or Plan F, or if you want to find out how much you can save by switching to Plan G, you should take advantage of the California Birthday Rule and compare rates every year to make sure that you aren’t paying too much!
If you have any questions or comments, or if you’d like a free quote or rate comparison, please visit www.MedigapExpress.com or call my cell at (760) 525-5769 or (866) 718-1600 (Toll-free).
If you are enrolled in a Medicare Advantage (MA) plan, February 14th is not only Valentine’s Day… it’s the last day that you can switch back to original Medicare if you no longer want to keep your MA plan.
The regular Medicare open enrollment period to get an MA plan or a prescription drug plan (PDP) is from October 15th through December 7th each year.
NOTE:If you have original Medicare and a Medicare Supplement (also known as a Medigap plan) the annual open enrollment period between October 15th and December 7th does NOT affect you unless you want to sign up for a PDP or change the PDP that you currently have.
Acronyms and Definitions
There are quite a few Medicare Acronyms, which can be a little confusing at first if you aren’t familiar with them. Here is a list of acronyms that are used in this article:
ANOC — Annual Notice of Change
MA — Medicare Advantage
MADP — Medicare Advantage Disenrollment Period
MAPD — Medicare Advantage Prescription Drug (plan)
MSA — Medicare Savings Account
PDP — Prescription Drug Plan
SEP — Special Enrollment Period
What is the Medicare Advantage Disenrollment Period?
If you have an MA plan and you want to switch back to original Medicare, you can do so during the Medicare Advantage Disenrollment Period (MADP), which is from January 1st through February 14th each year. This means that you will be covered under Medicare
Part A (Hospital) and Part B (Medical).
Can I Still Get Prescription Drug Coverage?
If you have a Medicare Advantage Prescription Drug (MAPD) plan, which is a combination of a Medicare Advantage plan plus a prescription drug plan, you can switch back to original Medicare and apply for a new and separate PDP, if you want to. However, if you have an MA plan that does not currently include prescription drug coverage, you will have to wait until the next Medicare open enrollment period between October 15th and December 7th.
NOTE:If you switch back to original Medicare, you must notify your MA or MAPD plan of your intention to leave their plan. However, if you have an MAPD and you sign up for a new PDP, you will automatically be dropped from your current plan, so it isn’t necessary to notify them.
What Am I Not Allowed to Do During the MADP?
As its name suggests, the MADP is very limited. Its only function is to give participants an opportunity to disenroll from MA or MAPD plans back to original Medicare. During this period, you’re not allowed to switch from one MA or MAPD plan to another, and you are not allowed to switch from original Medicare to an MA plan. You are also not allowed to change from one PDP to another during this period. For these kinds of changes, the only period when you can do so is during the regular Medicare open enrollment period between October 15th and December 7th.
Are All MA Plans Eligible for Disenrollment?
No. If you have a Medicare Medical Savings Account (MSA) or a Medicare MSA plan, then you’re not allowed to drop or switch plans during the MADP. Medicare MSA plans are a special kind of Medicare Advantage plan that combines a high-deductible insurance plan with a medical savings account that you can use to pay for your health care costs. The plan will only begin to cover your costs once you meet a high yearly deductible, which varies by plan.
When Does the MADP Change Take Effect?
Changes that you make during the MADP take effect on the first day of the following month. Therefore, if you want to switch back to original Medicare in February, your new effective date will be March 1st. It is also important to note that if you need to get prescription drug coverage along with the change, you must sign up no later than the February 14th deadline. That change also takes effect on the first day of the following month after enrolling.
If I Switch Back to Original Medicare, Am I Guaranteed the Right to Get a Medicare Supplement Plan?
In most cases, no. Unless you are relatively new to Medicare or in a Special Enrollment Period (SEP), if you switch back to original Medicare during the MADP, you are not guaranteed the right to sign up for a Medicare Supplement policy. This means that you would be responsible for all the deductibles, copayments, and coinsurance that are not covered by Medicare.
Before you switch back to original Medicare, you can (and should) apply for a Medicare Supplement plan, which will, in most cases, be medically underwritten. Ideally, it is best to apply before the February 14th deadline, so that you will know in advance if you meet the underwriting requirements that will qualify you for a Medicare Supplement.
As an independent insurance agent, I work with ALL the major Medicare Supplement insurance carriers. Rates vary significantly between insurance carriers, and I can not only do the shopping for you to make sure that you aren’t paying too much for your coverage, but some carriers have stricter underwriting requirements than others, and I may be able to find a carrier that will accept you if you have certain medical conditions.
What If I Have a Serious Health Condition and I Don’t Qualify For a Medicare Supplement?
If that is the case, I would probably advise that you stay on your current MA plan until the next Medicare open enrollment period that begins on October 15th. There are some “Tips and Tricks” that I am aware of that will usually qualify you for a Medicare Supplement, even if you have serious medical conditions! For example, during the annual open enrollment period, you will receive an Annual Notice of Change (ANOC) from your current MA plan. This notice will tell you of price changes from the current year to the following year.
In California, if your MA plan increased your premiums or copayments by 15% or more, reduced your benefits, or terminated its relationship with your medical provider who was treating you, you will qualify for a Medicare Supplement as a “Guaranteed Issue.” This means that regardless of your health, you can still get certain Medicare Supplement plans (plans A, B, C, F, K, or L)!
NOTE:Plan F is considered to be the most comprehensive plan, and it’s one of the most popular plans. In California, once you have Plan F, you can keep it for as long as you like or you can later switch to any other plan that you want!
Conclusion
Using the MADP is an option for those individuals who aren’t satisfied with their MA plans and want to return to original Medicare. Valentine’s Day is quickly approaching and the clock is ticking! If you want to make a change, you can still do so, but February 14th will be here soon!
If you have any questions or comments, or if you would like a free, no obligation Medicare Supplement quote, please don’t hesitate to let me know. Thank you!!!
Congress passed this legislation to ensure that doctors would be paid adequately for providing Medicare services and to provide an incentive for doctors to continue accepting Medicare patients. Previous legislation had budgeted for doctors to have rate decreases over the years and there was concern that many doctors would stop accepting Medicare patients.
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