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

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

What is Medicare?

Medicare is the federal health insurance program for:

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

Who is Eligible For Medicare?

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

What Are the Four Parts of Medicare?

Medicare is composed of four parts:

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

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

What Does Medicare Part A Cover?

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

What Does Medicare Part B Cover?

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

What Does Medicare Part C Cover?

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

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

What Does Medicare Part D Cover?

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

The Medicare Initial Enrollment Period (IEP)

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

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

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

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

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

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

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

Three Ways to Sign Up for Medicare

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Original Medicare Will Not Cover All of Your Costs!

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

The Part A Deductible and Co-payments

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

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

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

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

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

The Medicare Part B Deductible

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

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

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

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

10 Standardized Medicare Supplement Plans to Choose From

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

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

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

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

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

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

How Much Do Medicare Supplement Plans Cost?

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

The California Birthday Rule

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

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

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

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

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

About Me

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

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

Thank you!

Ron Lewis
CA agent #0B33674
NV agent #3822123

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

Tips and Tricks to Save Money On Your Medicare Supplement

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

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

Some Key Differences Between Medicare Advantage and Medicare Supplement Plans

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

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

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

10 Standardized Medicare Supplement Plans

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

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

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

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

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

Which Medicare Supplement Plan Is Best?

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

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

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

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

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

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

The California Birthday Rule

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

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

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

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

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

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

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

Qualifying for the California Birthday Rule

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

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

Guaranteed Rate Locks

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

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

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

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

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

Would You Like a Free Gym Membership?

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

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

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

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

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

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

You Can Apply for Medicare Supplements All Year Long!

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

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

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

Household Discounts

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

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

About Me

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

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

Thank you!

Ron Lewis
CA agent #0B33674
NV agent #3822123

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

Free Covid Test Kits, a Great Dental Plan, and More…

Free Covid Test Kits!

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.

For more detailed information, please click here.

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.

For more detailed information, please click here.

Get Your Free “Medicare & You” Guidebook!

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!!!

For testimonials, please click here.

REFERRALS ARE ALWAYS WELCOME!!!

Thank you!

Ron Lewis
CA agent #0B33674
NV agent #3822123

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

New CMS Marketing Rule Harms Medicare Beneficiaries

The Centers for Medicare & Medicaid Services (CMS) recently released their 2023 final rule, which includes two requirements that will have a significant impact on independent agents and brokers who sell Medicare Advantage (MA) and Prescription Drug Plans (PDP’s). In my opinion, this new CMS requirement will adversely affect Medicare beneficiaries because many independent insurance agents and brokers will no longer market or sell MA or PDP’s because of these onerous rules. Consequently, many Medicare beneficiaries will be left on their own to shop for these plans.

Although these new marketing guideline changes are for calendar year 2023, they begin on October 1st, 2022, just before the start of the 2023 Annual Election Period (AEP) for Medicare Advantage and prescription drug plans.

NOTE: The AEP begins on October 15th each year and ends on December 7th. Unless you are in a Special Enrollment Period (SEP), this is the only time of year you can switch to or from an MA or a PDP. With Medicare Supplements, you can change your plan any time of the year.

This new CMS ruling is in response to misleading TV commercials by Third Party Marketing Organizations (TPMO’s) and numerous consumer complaints to CMS. Under these new guidelines, the definition of TPMO’s has been expanded to include agents and brokers. The new definition of TPMO is too broad and will negatively impact many entities that are acting responsibly such as individual agents and brokers who will now be subject to new call recording requirements (see next section). It has been argued that consumer dissatisfaction is not usually with their insurance agent but with TPMO call centers that solicit beneficiaries to switch plans that do not necessarily meet their needs.

Do you recall those TV commercials and pitches from celebrities and pitchmen like Joe Namath, William Shatner, Jimmie Walker, etc.? They promise things from free meal delivery to money deposited in your Social Security account. A few MA plans may offer meal delivery for certain qualified individuals, but only one or two plans in your county may offer those benefits, but most don’t. And while the dental and vision coverage of MA plans may sound great, many plans only include routine visits, not more expensive items like dental implants, eyeglasses, etc.

There are a couple of things you need to consider before you race to your phone to “Call Now.” First, Joe Namath, while he may be a perfectly upstanding gentleman, is no Medicare expert. He is a paid endorser. In fact, I doubt he even understands what a Medicare Advantage plan is. Even if he is on a Medicare Advantage plan, I doubt he is concerned with the potential out of pocket costs involved. I believe his $25 million net worth may place him a little out of touch with the average American budget. Second, be aware that he is speaking on behalf of the Medicare Coverage Hotline, not Medicare. And if you were to pause the commercial on the last slide, you would see that The Medicare Coverage Hotline is a for-profit lead generation campaign. This means that they are simply trying to get you to call their 800 number so they can sell you as a lead to an insurance agent.

http://www.SeniorMark.com

New Call Recording Requirement

Agents and brokers must now record all sales calls with potential clients in their entirety including the enrollment process. These recordings must be retained in a HIPAA-compliant manner for 10 years! This applies to all new and existing clients.

What is considered a sales call? Anything that falls under the “chain of enrollment,” which is defined as the events from the point when a Medicare beneficiary becomes aware of an MA or PDP to the end of the enrollment process. This means when an agent is calling leads, scheduling appointments, collecting drug and provider lists and conducting education meetings and phone enrollments. All of these calls would fall under this category and must be recorded!

NOTE: Medicare Supplements are not included in the new call recording rules. However, if an agent is selling a Medicare Supplement and a PDP, the call must be recorded.

Zoom meetings must also be recorded. Only in-person, face-to-face marketing and sales appointments are excluded, however any follow-up calls related to sales and completing the enrollment process must be recorded. Sales calls conducted on cell phones must also be recorded.

Phone Recording Problems for Agents and Medicare Beneficiaries

This new phone recording requirement will add an additional burden to insurance agents attempting to assist Medicare beneficiaries when selecting suitable health and drug plans. According to the The National Association of Health Underwriters (NAHU), who are advocating against these new CMS changes, “The cost of setting up a HIPAA-compliant audio recording system with adequate and protected storage capabilities far exceeds the abilities of many of these licensed and certified agents who are now facing a decision as to whether to participate in this fall’s AEP.”

There is also a concern from Medicare beneficiaries who do not wish to have their enrollment recorded. An enrollment conversation can last hours, during which beneficiaries may disclose several private details about their health, financials and personal life. Many seniors are not comfortable with the requirement that these conversations be recorded and stored for up to 10 years, regardless of the protections that may be put in place for the recordings.

NAHU

New Disclaimer Requirement

When discussing MA or PDP’s, insurance agents must use the following disclaimer:

“We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.”

Agents must include the new disclaimer in the following places:

• Verbally stated during the first minute of a sales phone call
• Electronically conveyed when communicating with a potential client via email, online chat, or other electronic form of communication
• Prominently displayed on the agent’s website
• On all marketing materials, in print (12-point font) and television advertisements

Contact Congress Today to Delay this New CMS Marketing Rule

Please click here to contact your member of Congress to request that CMS implement a delay of six to 12 months, during which CMS will work with stakeholders to develop marketing regulations that will protect Medicare beneficiaries while allowing them access to their trusted independent agent or broker.

Upcoming Medicare Supplement Changes Beginning on July 1st, 2020

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

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

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 California Birthday Rule is Changing!

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

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

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

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

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

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

10 Standardized Plans To Choose From

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

Medigap Premiums Are Not Standardized

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

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

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

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

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

Rates Vary Significantly Between Insurance Carriers

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

The Application Process

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

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

New MACRA Law

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

Not All Insurance Carriers Are the Same

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

For More Information

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

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

 

 

Why I Recommend Medicare Part D Prescription Drug Plans

I wasn’t happy about turning 65, but as far as my medical and Prescription Drug Plan (PDP) coverage is concerned, Medicare is the best!

When it comes to my health insurance, I couldn’t be happier! Before I got on Medicare, I was paying a very high monthly premium for an Affordable Care Act (ACA) “Bronze” plan that had a $5,000 per calendar year deductible. Consequently, I rarely used my ACA health insurance benefits because of the ridiculously high deductible, but at least I had maternity coverage! (Pardon my sarcasm. 😉

Now, my Medicare Part B premium is $144.60 per month and my Medicare Supplement is $162.00 per month, so I’m currently paying a total of $306.60 per month with a ZERO deductible for my health insurance! My current health insurance is so much better than before!

Medicare Does Not Cover Outpatient Prescription Drugs

Medicare and Medicare Supplements do not cover outpatient prescription drugs, so most people sign up for a standalone PDP, also known as Medicare Part D. It is not required that you sign up for a PDP when you first turn 65 or begin your Medicare Part B (Medical insurance), but a lifetime monthly penalty will be added on if you sign up later on.

The Medicare Part D penalty is calculated by multiplying 1% of the “national base beneficiary premium” ($32.74 in 2020) by the number of full months that you were eligible for, but didn’t enroll in, a Medicare PDP and went without other creditable prescription drug coverage.

The penalty comes out to approximately $0.33 per month for every month you were eligible for a PDP but didn’t have one. So, to use round numbers, if you went 10 months without a PDP and then signed up for one, the monthly lifetime penalty would be about $3.30 per month on top of the regular monthly PDP premium.

NOTE: The penalty amount is re-calculated each year based on the new base beneficiary premium amount, so it may go up or down each year.

I’ve heard many people say that they are “healthy” and they don’t take prescriptions, so they don’t feel the need to sign up for a PDP when they start Medicare. Unless it’s a financial burden for you to sign up for one, I always advise my clients to at least sign up for the cheapest plan, which is only about $12.80 to $13.20 per month, depending upon where you live.

NOTE: Medicare Supplement insurance is my primary focus and specialization. I am not certified to sell PDP’s. If you want to apply, you can call the insurance carrier directly and have them enroll you on the phone, or you can enroll on your own on the Medicare.gov website. Please click here to see a short video I made that explains how to sign up for a prescription drug plan.

It’s Important to Shop Around Each Year

As with Medicare Supplement insurance, it’s important to shop around each year to make sure that you aren’t paying too much for your PDP. What is good this year, may not be so good (or affordable) next year. PDP rates can vary significantly from one PDP to another and from one pharmacy to another!

The Annual Election Period (AEP) goes from October 15th through December 7th each year. If you have a PDP or if you will be getting one, you should shop around every year during the AEP to see if there is a better plan for the following year because drug formularies and prices change from year to year. Coverage would begin in the following January.

Example of the Savings You Can Have With a PDP

In 2020, I switched my PDP to Clear Spring Health Premiere RX, and I’m currently paying $12.80 per month for my plan. Although I’m in relatively good health, I take three prescriptions on a regular basis:

• Levothyroxine Sodium
• Fluticasone Propionate nasal spray
• Latanoprost OP eye drops

The Von’s pharmacy is close to where I live and “in network” with my Clear Spring Health PDP. If I didn’t have a PDP, I would be paying $61.69 per month for the Levothyroxine Sodium, $62.69 per month for the Fluticasone Propionate, and $42.99 per month for the Latanoprost eye drops for a total of $167.37 per month or $2,008.44 per year!

With my PDP, I am paying $2.00 per month for the Levothyroxine Sodium, $6.00 per month for the Fluticasone Propionate, and $6.00 per month for the Latanoprost eye drops for a total of $14.00 per month in co-payments for all three of my prescriptions. When you factor in my monthly premium for my PDP of $12.80 per month, altogether, the total cost (premiums and co-payments) for my Clear Spring Health PDP is $26.80 per month or $321.60 per year!

In other words, I am saving $1,686.84 per year by having a prescription drug plan with Clear Spring Health ($2,008.44 – 321.60)!

What About GoodRx.com?

GoodRx.com is an excellent website to use regardless of whether you have a PDP or not. Please click here to see a short video I made about how to use the GoodRx website. Sometimes it is cheaper to use GoodRx than your PDP. One of the main problems with GoodRx is that sometimes you can find great deals on the website, but not always. Some people take some very expensive medications that are not on the GoodRx website, so it’s really hit and miss.

I looked up the three prescriptions mentioned above, and here are the current GoodRx costs in my zip code:

• Levothyroxine Sodium – $18.19
• Fluticasone Propionate nasal spray – $12.14
• Latanoprost OP eye drops – $15.32

The total cost for all three of these prescriptions at GoodRx is currently $45.65 per month or $547.80 per year. In comparison, with my PDP, my total cost is $26.80 per month or $321.60 per year! In this example, I am still saving over $225 per year by having a prescription drug plan. Also, the drug prices can change from month to month with GoodRx and you may have to run around to different pharmacies every month to pick up your various prescriptions.

PDP’s covers most prescription medications and some chemotherapy treatments and drugs. If Part B doesn’t cover a cancer drug, your Part D plan may cover it. PDP’s also cover all commercially available vaccines, except those covered by Medicare Part B, when they are reasonable and necessary to prevent illness.

Conclusion

Some PDP’s are good for some people but not others. It really depends upon what prescriptions you are taking, but I would always recommend that you go to the Medicare.gov website and check out the Medicare Plan Finder tool to see if a PDP makes sense for you or not. There are pros and cons to each, but in most cases, I would still recommend that you sign up for Medicare Part D, a prescription drug plan.

Are You a Hospital Inpatient or Outpatient?

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

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

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

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

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

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

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

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

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

How Much Do I Pay as an Inpatient?

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

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

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

How Much Do I Pay as an Outpatient?

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

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

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

How Would My Hospital Status Affect Skilled Nursing Home Care?

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

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

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

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

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

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

Common Hospital Situations That May Affect Your SNF Coverage

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

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

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

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

You Have Medicare Rights

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

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

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

Conclusion

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

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

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

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

Medicare Part A (Hospital Insurance)

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

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

Medicare Part B (Medical Insurance)

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

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

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

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

Part D Prescription Drug Plans

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

How Do These Changes Affect My Medicare Supplement?

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

Do You Have a Medicare Supplement Plan?

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

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

Thanks!

Ron Lewis

Ron@RonLewisInsurance.com
www.MedigapExpress.com

How to Reach a Live Person at the IRS!

Although the topic of this blog isn’t specifically insurance-related, I thought I’d pass this information on as a “public service announcement.”

Fortunately, I don’t usually have to call or deal with the Internal Revenue Service (IRS) much, but something unexpected came up with my social security, and I had to call the IRS. I was literally on the phone for hours pushing buttons and listening to a myriad of endless options. I was unable to speak with a live person, which is why I called in the first place.

Finally, out of frustration, I tried googling different ways to contact the IRS, and I found that a lot of other people were having the same problem that I was having. It seems that the IRS wants to make it as difficult as possible for someone to be able to reach one of their phone representatives.

I know that most people don’t need to call the IRS on a frequent basis, but in case you ever need to call them, here are the steps that you need to follow to actually speak with a real live human being at the IRS:

1. Call the IRS at 1-800-829-1040 between the hours of 7 AM – 7 PM local time, Monday through Friday.
2. Choose your language.
3. Choose option 2 for “personal income tax.” (Do NOT choose option 1 for refund information. If you choose refund information, it will send you to an automated phone line.)
4. Press 1 for “form, tax history, or payment.”
5. Press 3 “for all other questions.”
6. Press 2 for “all other questions.”
7. When asked to enter your social security number (SSN) or employment identification number (EIN) to access your account information, don’t enter anything. (After it asks you twice, you will get another menu.)
8. Press 2 for “personal or individual tax questions.”
9. After that, you should be transferred to an IRS agent.

I also tried calling a couple of “local” IRS offices, but it was just as challenging trying to talk with a live person. I tried the steps shown above, and they work! I hope that you don’t have to call or deal with the IRS, but if you need to call them, I think that you will find these steps to be helpful.

You can also access a lot of useful information on the IRS website, which is www.irs.gov.

Do You Have a Medicare Supplement Plan?

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

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

Thanks!

Ron Lewis

Ron@RonLewisInsurance.com
www.MedigapExpress.com

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

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

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

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

Why Medicare Supplement Plans Are Better

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

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

Which Plan Gives You the Most Freedom?

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

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

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

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

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

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

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

Which Plan Has Lower Co-Payments?

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

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:

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

Medicare Supplement Plan Advantages

Here are some benefits of having a Medicare Supplement plan:

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

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

Conclusion

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

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

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

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

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

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

Thank you!

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

–

Should You Sign Up for a Medicare Prescription Drug Plan?

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

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

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

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.

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

Please click the “Subscribe” button to be notified when I write future blogs.

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

Thank you!

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

Hello Medicare, and Goodbye Obamacare!

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

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

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

Current Coverage

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

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

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

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

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

Medicare Coverage

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

Medicare Supplement Coverage

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

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

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

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

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

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

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

Medicare Supplement Premiums

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

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

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

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

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

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

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

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

Conclusion

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

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

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

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

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

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

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

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

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).

Thank you!

Ron Lewis

If You Have a Medicare Advantage Plan, You Have Until Valentine’s Day to Switch Back to Original Medicare!

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!!!

Medicare Advantage Plans – Do the Advantages Outweigh the Disadvantages?

This article was originally written in October 2016, but I just updated it to reflect facts and information for 2022. The Annual Enrollment Period (AEP) for signing up for a Medicare Advantage (MA) plan or a Prescription Drug Plan (PDP) is here, and it goes from October 15th through December 7th each year. During this period, many “seniors” have to make choices regarding their health care for the following 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 want to change to a different MA plan in 2022, or if you want to leave your MA plan and switch back to Original Medicare, you must 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 right now that I am biased because I don’t like them! Unless you literally can’t afford to pay the monthly premium for a Medicare Supplement (also known as 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 financial 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 as demonstrated below.

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 2022, the most you can pay for in-network OOP costs is $7,550 per calendar year. If you go out of network, you would normally pay all costs! (I wouldn’t really call this a benefit since $7,550 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 $203 per calendar year in 2021!)

• 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, or care facility in the United States as long as they accept Medicare, and most do, approximately 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 costs in the 2021 calendar year will be no more than the $203 Medicare Part B deductible. With an MA plan, your in-network maximum OOP costs can be as high as $7,550 for the 2021-2022 calendar years! If you go out of network, your costs will be even 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.

• 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 G Medicare Supplement, the most you will pay for Chemotherapy is the $203 Medicare Part B deductible (payable only one time per calendar 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 pay all 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. Most MA plans require you to go through a primary care doctor first, before you can get permission to see a specialist within their 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.
• 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 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.
• 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 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. Otherwise, you are locked into your plan for the entire calendar year, except for certain circumstances, such as a Special Enrollment Period (SEP) such as moving out of your plan’s service area, etc.

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 insurance agents promote them as “FREE” Medicare insurance plans, which is inaccurate, misleading, and, in my opinion, unethical. Get ready to be inundated with Medicare Advantage commercials on the TV. Listen carefully. The one thing you will NEVER hear them mention is the maximum in-network out-of-pocket costs, which can be as high as $7,550 in 2022. If you go out of network, you will pay even more!

Also, regardless of whether you have an MA plan or a Medicare Supplement plan, you still have to pay the monthly premium for your Part B (Medical) insurance, which is currently $148.50 per month for most people. Individuals with higher income can pay more than that.

MA plans are adequate as long as you are healthy, but if your health should eventually 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! If you have serious health issues, you won’t qualify for a Medicare Supplement as they require medical underwriting, so you could be stuck with your MA plan.

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

In San Diego, the maximum in-network OOP costs for MA plans currently range from $845 to $7,550 for the 2022 calendar year.

NOTE: If you go out-of-network with your “free” MA plan, your OOP costs will be even greater!

The following data was obtained from the Medicare.gov website. It shows the in-network OOP costs for 2022 Medicare Advantage plans in the San Diego area, zip code 92024, in alphabetical order:

AARP Medicare Advantage Patriot (HMO)
UnitedHealthcare | Plan ID: H0543-121-0
$4,900 In-network

AARP Medicare Advantage SecureHorizons Plan 4 (HMO)
UnitedHealthcare | Plan ID: H0543-152-0
$3,400 In-network

AARP Medicare Advantage SecureHorizons Premier (HMO)
UnitedHealthcare | Plan ID: H0543-060-0
$4,300 In-network

AARP Medicare Advantage SecureHorizons Value (HMO)
UnitedHealthcare | Plan ID: H0543-013-0
$5,300 In-network

Aetna Medicare Select Plan (HMO)
Aetna Medicare | Plan ID: H0523-052-0
$3,400 In-network

Aetna Medicare Choice Plan (PPO)
Aetna Medicare | Plan ID: H5521-053-0
$6,700 In-network ($11,300 In and Out-of-network)

Aetna Medicare Eagle Plan (HMO)
Aetna Medicare | Plan ID: H4982-013-0
$4,200 In-network

Aetna Medicare Plus Plan (HMO)
Aetna Medicare | Plan ID: H4982-004-0
$2,000 In-network

Aetna Medicare Plus Plan 2 (HMO)
Aetna Medicare | Plan ID: H4982-015-0
$7,550 In-network

Anthem MediBlue Plus (HMO)
Anthem Blue Cross | Plan ID: H0544-065-0
$3,400 In-network

Anthem MediBlue Extra (HMO)
Anthem Blue Cross | Plan ID: H0544-081-0
$900 In-network

Anthem MediBlue Select (HMO)
Anthem Blue Cross | Plan ID: H0544-091-0
$2,500 In-network

Anthem MediBlue Coordination Plus (HMO)
Anthem Blue Cross | Plan ID: H0544-070-0
$7,550 In-network

Astiva Health Advantage (HMO)
Astiva Health | Plan ID: H1993-003-0
$845 In-network

Astiva Health Value (HMO)
Astiva Health | Plan ID: H1993-004-0
$7,550 In-network

AVA (HMO)
Alignment Health Plan | Plan ID: H3815-027-0
$999 In-network

AVA (PPO)
Alignment Health Plan | Plan ID: H4961-007-0
$3,900 In-network ($9,500 In and Out-of-network)

Blue Shield 65 Plus (HMO)
Blue Shield of California | Plan ID: H0504-028-0
$3,399 In-network

Blue Shield AdvantageOptimum Plan 1 (HMO)
Blue Shield of California | Plan ID: H5928-010-0
$3,400 In-network

Blue Shield AdvantageOptimum Plan 2 (HMO)
Blue Shield of California | Plan ID: H5928-053-0
$3,400 In-network

Blue Shield Coordinated Choice Plan (HMO)
Blue Shield of California | Plan ID: H5928-037-0
$6,700 In-network

Brand New Day Classic Care I Plan (HMO)
Brand New Day | Plan ID: H0838-025-0
$999 In-network

Brand New Day Classic Care II Plan (HMO)
Brand New Day | Plan ID: H0838-037-0
$999 In-network

Brand New Day Part B Savings Plan (HMO)
Brand New Day | Plan ID: H0838-049-0
$2,900 In-network

Brand New Day Classic Choice Plan (HMO)
Brand New Day | Plan ID: H0838-033-0
$7,550 In-network

Brand New Day Valor Care Plan (HMO)
Brand New Day | Plan ID: H0838-048-0
$4,500 In-network

CalPlus (HMO)
Alignment Health Plan | Plan ID: H3815-009-0
$4,900 In-network

Clever Care Balance Medicare Advantage (HMO)
Clever Care Health Plan | Plan ID: H7607-003-3
$5,999 In-network

Clever Care Fortune Medicare Advantage Plan (HMO)
Clever Care Health Plan | Plan ID: H7607-007-3
$888 In-network

Clever Care Longevity Medicare Advantage (HMO)
Clever Care Health Plan | Plan ID: H7607-002-3
$1,700 In-network

Clever Care Value Medicare Advantage Plan (HMO)
Clever Care Health Plan | Plan ID: H7607-008-3
$3,000 In-network

Harmony (HMO)
Alignment Health Plan | Plan ID: H3815-031-0
$2,900 In-network

Humana Gold Plus H5619-016 (HMO)
Humana | Plan ID: H5619-016-0
$3,200 In-network

Humana Honor (HMO)
Humana | Plan ID: H5619-120-0
$6,700 In-network

Humana Value Plus H5619-037 (HMO)
Humana | Plan ID: H5619-037-0
$7,550 In-network

Imperial Dynamic Plan (HMO)
Imperial Health Plan of California, Inc. | Plan ID: H5496-012-0
$899 In-network

Imperial Strong (HMO)
Imperial Health Plan of California, Inc. | Plan ID: H5496-014-0
$7,550 In-network

Imperial Traditional (HMO)
Imperial Health Plan of California, Inc. | Plan ID: H5496-007-0
$2,999 In-network

Imperial Traditional Plus (HMO)
Imperial Health Plan of California, Inc. | Plan ID: H5496-009-0
$2,999 In-network

Kaiser Permanente Senior Advantage B Only South (HMO)
Kaiser Permanente | Plan ID: H0524-002-0
$4,900 In-network

Kaiser Permanente Senior Advantage San Diego (HMO)
Kaiser Permanente | Plan ID: H0524-037-0
$3,400 In-network

Molina Medicare Choice Care (HMO)
Molina Healthcare of California | Plan ID: H5810-014-0
$7,550 In-network

Molina Medicare Choice Care Select (HMO)
Molina Healthcare of California | Plan ID: H5810-015-0
$7,550 In-network

Platinum (HMO)
Alignment Health Plan | Plan ID: H3815-016-0
$998 In-network

SCAN Alta (HMO)
SCAN Health Plan | Plan ID: H5425-082-0
$900 In-network

Scripps Plus offered by SCAN Health Plan (HMO)
SCAN Health Plan | Plan ID: H5425-040-0
$7,550 In-network

Scripps Signature offered by SCAN Health Plan (HMO)
SCAN Health Plan | Plan ID: H5425-004-0
$2,500 In-network

Scripps Classic offered by SCAN Health Plan (HMO)
SCAN Health Plan | Plan ID: H5425-005-0
$3,400 In-network

Select (HMO)
Alignment Health Plan | Plan ID: H3815-032-0
$3,400 In-network

Sharp Direct Advantage Gold Card (HMO)
Sharp Health Plan | Plan ID: H5386-003-0
$2,900 In-network

Sharp Direct Advantage Platinum Card (HMO)
Sharp Health Plan | Plan ID: H5386-004-0
$2,900 In-network

Sharp Direct Advantage VIP Plan (HMO)
Sharp Health Plan | Plan ID: H5386-005-0
$2,900 In-network

Sharp SecureHorizons Plan by UnitedHealthcare (HMO)
UnitedHealthcare | Plan ID: H0543-145-0
$3,400 In-network

Sharp Walgreens by UnitedHealthcare (HMO)
UnitedHealthcare | Plan ID: H0543-204-0
$2,900 In-network

the ONE + Rite Aid (HMO)
Alignment Health Plan | Plan ID: H3815-034-0
$3,400 In-network

UC San Diego Health Humana (HMO)
Humana | Plan ID: H5619-131-0
$2,800 In-network

UnitedHealthcare Medicare Advantage Assure (HMO)
UnitedHealthcare | Plan ID: H0543-172-0
$7,550 In-network

Wellcare No Premium (HMO)
Wellcare by Health Net | Plan ID: H0562-012-0
$3,000 In-network

Wellcare Plus Sapphire I (HMO)
Wellcare by Health Net | Plan ID: H0562-122-0
$3,450 In-network

Wellcare Plus Sapphire II (HMO)
Wellcare by Health Net | Plan ID: H3561-002-0
$3,450 In-network

As you can see, the maximum in-network out-of-pocket costs are very high with most MA plans.

Is the Maximum OOP Cost Really No More Than $7,550 Per Year?

Depending on which MA plan you have, the most you would pay for in-network OOP costs in 2021 and 2022 is $7,550 per calendar year! If you go outside of your plan’s network, you would end up paying even more than that!

Now 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 $7,550 (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 following year, you could potentially end up paying your maximum OOP cost TWICE in a 12-month period! For example, if your maximum OOP cost is $7,550, your total OOP cost in a 12-month period, not a calendar year, could be as much as $15,100 with your “free” MA plan!

Do Medicare Advantage Plans Really Cost Less Than Medicare Supplement Plans?

In California, Medicare Supplement rates are based primarily on your age and zip code. Plan G is the best and most popular Medicare Supplement plan because it pays all Medicare-approved costs except for the Medicare Part B deductible, which is currently $203 per calendar year.

NOTE: The Medicare Part B deductible can change from year to year, but historically, it has been very stable. The Centers for Medicare & Medicaid Services (CMS) has not officially released what the Part B deductible will be yet for 2022, but it is currently projected to be $217 per calendar year. The new Medicare costs for 2022 should be available during the first week of November 2021.

How Much Does a Plan G Medicare Supplement Cost?

In California, Medicare Supplement rates are based primarily on your age and zip code, whether you use tobacco, and sometimes whether you live with someone. Some carriers will give you a household discount (HHD) if you live with someone, even if they don’t have a Medicare Supplement.

Although Medicare Supplement plans are “standardized,” Medicare Supplement rates are not standardized, and they vary significantly from one insurance carrier to another. For example, for a 70 year old in the San Diego area (92024 zip code), the Plan G rates range from $148.63 per month to $225.70 per month for the same identical plan and coverage! For this reason, it is important to shop around every year to make sure that you aren’t paying too much for your Medicare Supplement.

I shop around every year for all of my Medicare Supplement clients to find them the best rates and the best insurance carriers.

If you have a Plan G Medicare Supplement and you are paying $148.63 per month plus the Medicare Part B deductible of $203 per calendar year in 2021, your total cost for the entire year, if you became seriously ill, would be $1,986.56 ($148.63 x 12 months = $1,783.56 + $203 Part B deductible).

In comparison, if you have a “free” MA plan, and your maximum in-network OOP cost is $7,550 per year, you could have saved up to $5,563.44 per year if you had signed up with a Plan G Medicare Supplement plan instead ($7,550 – 1,986.56 = $5,563.44). In addition to the benefits of a Medicare Supplement mentioned above, a Medicare Supplement is much more cost effective than a Medicare Advantage plan!

The AEP is the Time to Change Your MA Plan to a Medicare Supplement Plan

The Annual Election Period (AEP) begins on October 15th and ends on December 7th every year. If you have an MA plan or a Prescription Drug Plan (PDP), this is the time to shop around and change plans, if you want to, for next year. Your new coverage would begin on January 1st, 2022.

If you have an MA plan, this is also the time to switch back to original Medicare (Parts A and B) and to apply for a Medicare Supplement. To qualify for a Medicare Supplement, you must answer health questions on the application and meet minimum underwriting requirements, so you must be in relatively good health to be approved for a Medicare Supplement. If you have serious health issues, there are other ways to qualify for a Medicare Supplement without answering health questions or being medically underwritten. If you are in that situation, please let me know, and I’m happy to help!

NOTE: 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.

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 all the major insurance carriers. I shop around for all of 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! I’m happy to help!

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.MedigapExpress.com
(760) 525-5769 – Cell
(866) 718-1600 – Toll-free

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

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

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

A Tale of Two Cities, I Mean Two Clients…

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

Client “A”

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

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

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

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

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

Client “B”

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

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

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

Some Common Misconceptions

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

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

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

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

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

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

Misconception #3 – My Coverage Will Not Be the Same

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

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

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

The California Birthday Rule

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Sometimes I Feel Like “I Get No Respect!”

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

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

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

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

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

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

Thank you,

Ron Lewis

Major Medicare Supplement Rate Discrepancies Between Insurance Carriers!

Do you know that Medicare Supplement (MediGap) rates vary significantly between insurance carriers for the same identical plan and coverage? In the US, there are 10 “standardized” Medicare Supplement plans to choose from, plans A through N.

NOTE: The plans are labeled A, B, C, D, F, G, K, L, M and N to signify the plan differences. (Plans E, H, I and J are no longer available.)

The word “standardized” means that the coverage for Plan F, Plan G, etc. is exactly the same no matter what insurance carrier you have. For example, the coverage for Plan F is exactly the same with Mutual of Omaha, UnitedHealthcare, Blue Shield of CA, Aetna, Cigna, Anthem Blue Cross,  etc.

Although the coverage is exactly the same between insurance carriers for the standardized plans, the PREMIUMS ARE NOT THE SAME! In fact, most people are paying hundreds of dollars per year more for their insurance premiums than they should be!

For example, the Plan F premiums for a 70 year old living in the 92056 zip code in San Diego range in price from $153.98 per month to $264.19 per month. That’s a difference of $110.21 per month or $1,322.52 per year for the same identical plan and coverage! On the following rate sheet, you can see the different Plan F rates for 18 different insurance carriers in the 92056 zip code. Obviously, some carriers are more competitively priced than others!

As you can see, in the 92056 zip code, the Plan F rates for a 70 year old range in price from $153.98 per month to $264.19 per month! Again, that’s a difference of $110.21 per month or $1,322.52 per year for the same exact plan and coverage!

It’s Important to Shop Around Every Year!

The Medicare Supplement market is constantly changing, and so are the premiums. If you have a Medicare Supplement and you haven’t shopped around during the last year, there’s a good chance that you’re paying hundreds of dollars a year more for your insurance than you should be! Many people that I meet haven’t shopped around at all since they first signed up for Medicare! Many of these individuals haven’t heard from their insurance agent since then as well!

This past year, two of my clients (a husband and wife) had Plan G, and they were paying $809 per month for both of them, approximately $404.50 each! I shopped around for them and found them Plan G with a different carrier, Mutual of Omaha, and their total monthly premium is now $367.01 per month! That’s a savings of $441.99 per month or $5,303.88 per year! While this is not the norm, I can usually save most of my clients from $300 to $600 per year each on their Medicare Supplement insurance premiums and often more.

What is the Price Range for Plan F Medicare Supplement Rates?

In the following chart, I have taken the lowest and highest Plan F premiums for ages 65 through 90 in the 92056 zip code. As you can see, the monthly and annual differences are significant for every age group.

Is There An Open Enrollment Period for Medicare Supplement Plans?

No. Unlike Medicare Advantage (MA) plans, which have an annual open enrollment period from October 15th through December 7th every year, you can shop around and apply for Medicare Supplement plans all year long.

NOTE: There is a six month-open enrollment period for Medicare Supplements when you first sign up for Medicare Part B.

Do I Need to Be In Good Health to Get a New Medicare Supplement Plan?

Unless you are in a Special Enrollment Period (SEP), if you already have a Medicare Supplement, you need to be in relatively good health to apply for a new Medicare Supplement with a different carrier. However, if you have a Medicare Supplement and you apply during the 30 days before or after your birthday, you don’t have to answer any health questions on the application, and you cannot be turned down due to health reasons if you apply for the same plan or another plan with fewer benefits. For more details, please see the California Birthday Rule section below.

What Happens If I Am Not In Good Health? Can I Still Apply For a New Medicare Supplement Plan?

Yes, absolutely! Because of the California Birthday Rule, if you already have a Medicare Supplement and you have serious health issues, YOU CANNOT BE TURNED DOWN FOR COVERAGE if you apply during the 30 days before or after your birthday.

California Birthday Rule

In California, there is a law called the California Birthday Rule. This law guarantees you the right to apply for a new Medicare Supplement plan EVERY YEAR, as long as you apply during the 30 days following your birthday. This is also known as the annual 30-day open enrollment period.

NOTE: Although the California Birthday Rules specifies that you can apply, REGARDLESS OF YOUR HEALTH, during the 30 days following your birthday without being turned down for coverage, several insurance carriers will let you apply during the 30 days BEFORE or AFTER your birthday!

This is more advantageous for you because the premiums with these carriers are based on your current age when you apply, and your rates will be lower if you apply during the 30 days prior to your birthday. With these carriers, your new rates are also guaranteed and locked in for the first 12 months of your policy, so there won’t be any unexpected rate increases.

NOTE: Not all insurance carriers lock your rates for the first 12 months.

If you want to take advantage of the California Birthday Rule and apply during the 30 days before or after your birthday,  YOU CANNOT BE TURNED DOWN FOR COVERAGE as long as you apply for the same plan that you currently have OR if you apply for a different plan that has fewer benefits. For example, if you have Plan F (the most comprehensive plan) and you want to apply for Plan F with another carrier to save money on your premiums, or if you have Plan F and you want to apply with Plan G, etc.

NOTE: If you apply under the California Birthday Rule, there are no preexisting waiting periods for prior health conditions.

If you are in relatively good health, you can apply for a new Medicare Supplement plan any time of the year. If you have serious health issues, you should take advantage of the California Birthday Rule and apply for coverage during the 30 days before your birthday to save money on your premiums.

Consider Plan G to Save More Money On Your Premiums

Besides shopping around every year to make sure that you aren’t paying too much for your premiums, if you currently have Plan F, you should consider Plan G. Why? Because Plan G is identical to Plan F in EVERY way except you would pay a small $166 Part B (Medical) deductible one time per calendar year. That is the only difference between the two plans!

NOTE: I have an Obamacare Bronze plan, and my individual medical deductible is only $6,000 per year! I would gladly pay $166 per year for my medical deductible!

In other words, the most you would pay for any out-of-pocket expense with Plan G in any calendar year is $166. However, in most cases, you will save significantly more than $166 per year on your premiums, which usually makes Plan G a better value and more cost effective.

NOTE: The Part B (Medical) deductible is subject to change each year, but historically, it has remained stable.

To see the difference in coverage between Plan F and Plan G, please see the following chart:

As you can see, when you compare Plan F and Plan G, everything is exactly the same except for the $166 Part B deductible. Plan F has no deductible, and Plan G is basically Plan F with a small, $166 deductible.

Price Differences Between Plan F and Plan G

Although the two plans are almost identical in coverage, the rates for Plan G are usually significantly less than the Plan F rates. For a 70 year old in the 92056 zip code, the Plan F rates (above) range in price from $153.98 per month to $264.19 per month. The Plan G rates (below) range in price from $132.64 per month to $152.32 per month!

As you can see, the Plan G rates are significantly less than the Plan F rates for almost the same identical coverage.

Conclusion

The rates vary significantly from one insurance carrier to the next for the same identical plan and coverage. I recommend that you take advantage of the California Birthday Rule and shop around, every year, to make sure that you aren’t paying too much for your insurance. I would also suggest that you check out Plan G as another way to save a lot of money on your insurance premiums.

If you have any questions, or if you would like a free, no obligation quote, please don’t hesitate to let me know! I’m always happy to help!

Also, your feedback and comments are appreciated!

Thanks!

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

Save Money On Your Medicare Supplement by Comparing Rates Each Year

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

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

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

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

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

Attained Age

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

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

California Birthday Rule

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

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

You Can Apply for Medicare Supplement Plans All Year Long

Unlike Medicare Advantage plans that have an Annual Enrollment Period (AEP) from October 15th to December 7th every year for a January 1st effective date, you can apply for Medicare Supplement plans all year long. The only difference is that if you apply using the California Birthday Rule within 30 days of your birthday, you do not have to answer any of the health questions on the application, and you cannot be turned down for coverage due to health conditions.

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

Guaranteed Issue Situations In California

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

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

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

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

What Insurance Carriers Do I Work With?

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

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

Let Me Do the Shopping For You!

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

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

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

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

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

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

How to Use the Medicare.gov Website to Purchase a Prescription Drug Plan

The Medicare open enrollment period just started, and it goes from October 15th through December 7th. During this period, you can choose a Prescription Drug Plan (PDP) that will begin on January 1st, 2016. Many people are confused because they don’t know how to shop around for a PDP. You don’t have to be an “expert” or a rocket scientist to purchase your own PDP. The purpose of this blog is to help you save money on your insurance premiums and find a PDP that is right for you.

IMPORTANT If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, and you don’t get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later.

Accessing the Medicare.gov Website

If you have access to a computer and the Internet, shopping around for a PDP is really quite easy. If you’re ready to begin, follow these steps:

1.)  Navigate to the Medicare.gov website.

2.)  Under the blue tab at the top left-side of page that says Sign Up/Change Plans, click Find health & drug plans.

The Medicare Plan Finder page displays.

3.)  In the General Search section, enter your zip code and click Find Plans. The Step 1 of 4 page displays.

NOTE If a survey window displays, close it and continue.

4.)  In the first section, select Original Medicare, and in the second section, select I don’t get any Extra Help. After that, click Continue to Plan Results. The Step 2 of 4 window displays.

NOTE You can choose other options that are more appropriate for your situation.

5.)  Enter your prescriptions in the text box and choose the appropriate dosages for each. A window, similar to the following, displays.

6.)  After you select the appropriate prescription dose, click Add drug and dosage.

NOTE: Continue adding your prescriptions until your prescription drug list is complete. You can add up to 25 prescriptions, and you can see your list in the lower part of the window. You can also choose “mail order pharmacy” to have your prescriptions mailed to you. In some instances, it is more cost effective to do that. If you select “mail order pharmacy,” information for both retail pharmacies and mail order options will display.

7.)  Write down the Drug List ID number AND the Password Date on a separate piece of paper.

NOTE The prescriptions, dosages, etc. that you entered are saved, and you can enter this number and the date later on to retrieve your prescription information instead of reentering it again.

8.)  Click My Drug List is Complete when your drug list is complete. The Step 3 of 4 window displays.

9.)  Click Add Pharmacy to add up to two pharmacies, and then click Continue to Plan Results. The Step 4 of 4 window displays.

NOTE You can click the drop-down menu at the top of the page to select from more pharmacies near your zip code.

10.)  Click the check box next to Prescription Drug Plans (with Original Medicare), and then click Continue to Plan Results. The Your Plan Results window displays.

NOTE By default, the prescription drug plans are sorted from the lowest to highest estimated annual retail drug cost. In the Plan Results window, click View All to see all the plans.

Understanding the Plan Results Window

After you access the Plan Results window, you are ready to evaluate and compare prescription drug plans and decide which plan is best for you.

There are different variables to take into consideration when choosing a PDP. Here are some of the more important ones:

• Are drugs on the formulary?
• Drug restrictions
• Estimated annual drug costs
• Annual drug deductible
• Monthly premium
• Overall star rating of the company

Are Drugs on the Formulary?

If a drug is not on the PDP formulary, that means that the plan does not offer coverage for that specific drug, and you should continue looking at other plans.

Drug Restrictions

If there are drug restrictions, the plan may have certain coverage restrictions (including quantity limits, prior authorization, etc.) on a prescription drug. Although your prescription may have limitations, these limits may not necessarily adversely affect you, and the plan may still meet your needs. For example, if you take 30 pills a month and the plan will cover a maximum of 60 per month, that would not impact you, and the plan is still worth considering.

Estimated Annual Costs

This is an estimate of the average amount you might expect to pay each year for your prescription drug coverage. This estimate includes the following costs:

• Monthly premiums
• Annual deductible
• Drug copayments/coinsurance
• Drug costs not covered by prescription drug insurance

If you entered your drugs into the Medicare Plan Finder, then this estimate includes the cost of those drugs.

IMPORTANT If your prescriptions are covered by the plan’s formulary and there are no major drug restrictions on the plan, this is the critical piece of information you need to determine which plan you select because it factors in all your premiums, deductibles, co-payments, and miscellaneous drug costs for the entire year. I don’t really factor in the various co-payments of each prescription; the estimated annual costs tell you approximately how much you will spend during the entire year.

Compare the estimated total annual pharmacy and mail order costs between the different plans to determine which plan offers you the best deal for the entire year!

NOTE In the previous example, the total retail annual costs for Humana are approximately $341 compared to $221 for the mail order costs. For Aetna, the total retail costs are approximately $347 compared to $387 for the mail order costs. Therefore, in this example, the most cost-effective option is to purchase the Humana PDP and use their mail order service.

If you selected “I don’t take any drugs,” then this amount includes only the cost of the monthly premiums that you would pay for the plan and it does not include any drug costs. If you selected “I don’t want to add drugs now,” then this estimate includes the average drug costs for people with Medicare and may differ depending on your age and health status.

Annual Drug Deductible

Some plans have no annual deductible and others have a maximum annual deductible up to $360 per year. Again, use the estimated annual costs to determine the value of the plan, not just the deductibles, the co-payments, etc.

Monthly Premium

The lowest monthly premium (and deductible) does not necessarily mean that you will be saving the most money. Again, compare the estimated annual drug cost to determine which plan is the most cost effective.

Overall Star Rating of the Company

For plans covering drug services, the overall score for quality of those services covers many different topics that fall into four categories:

• Drug plan customer service: Includes how well the plan handles member appeals.
• Member complaints and changes in the drug plan’s performance: Includes how often Medicare found problems with the plan and how often members had problems with the plan. Includes how much the plan’s performance has improved (if at all) over time.
• Member experience with plan’s drug services: Includes ratings of member satisfaction with the plan.
• Drug safety and accuracy of drug pricing: Includes how accurate the plan’s pricing information is and how often members with certain medical conditions are prescribed drugs in a way that is safer and clinically recommended for their condition.

If the plan has a low star rating, I would not recommend signing up for it.

Drilling Down a Little Deeper on the Medicare.gov Website

To get more information about a specific plan, click on the name of the plan, which is a hypertext link. In the following example, click Humana Walmart Rx Plan (PDP).

After you click the name of the plan, a window, similar to the following, displays.

The previous window shows the phone numbers, for members and non-members.

NOTE  If you have questions about the plan or wish to enroll, you would call the phone number for non-members. For more information, see “Signing Up for a PDP Plan” below.

The previous window shows the estimated monthly totals for prescriptions at CVS Pharmacy.

The previous window shows the estimated monthly cost (premium and deductible) for prescriptions at CVS Pharmacy.

The previous window shows the estimated monthly cost (premium and deductible) for prescriptions at Costco Pharmacy.

The previous window shows the estimated monthly cost (premium and deductible) for prescriptions through a mail order pharmacy.

The previous window shows drug coverage information, such as formulary status and Tier information, for the various prescriptions you entered on the Medicare.gov website.

Signing Up for a PDP Plan

After you have evaluated and compared several prescription drug plans, you are ready to sign up for a PDP on your own.

Follow these steps to sign up for a prescription drug plan:

1.)  From the Your Plan Details window, click on the hypertext name of the plan you are interested in. In the following example, click Humana Walmart Rx Plan (PDP).

After you click the name of the plan you are interested in, a window, similar to the following, displays.

2.) Call the toll-free number for non-members, and speak to a representative of the company.

IMPORTANT  If you have questions about the plan or wish to enroll, you would call the phone number for non-members. When you decide to enroll, call the plan and verify that your prescriptions are covered by the plan and that the estimated annual retail pharmacy or mail order drug costs are accurate. You want to make sure that you are interpreting and understanding the information correctly from the Medicare.gov website.

Conclusion

After you go to the Medicare.gov website and play around with it a little, you will find that signing up for a prescription drug plan is really quite easy.

NOTE  If you are having trouble signing up for a prescription drug plan or if you ever have Medicare questions or need help understanding information on the Medicare.gov website, call 1-800-MEDICARE. They are open 24 x 7, and most of the representatives are very helpful.

My primary specialty is Medicare Supplement insurance, but if you have any questions or comments, please feel free to contact me at RonLewisInsurance@yahoo.com.