So that the question is understood, a person on Medicare may elect to have Original Medicare and A Good MediGap (Supplemental Insurance ) from a private insurance company OR they can elect to have Medicare Advantage which is administered by a private insurance company.

My personal bias is that a person is usually better off with Original Medicare and a Supplement. However, that is not a blanket statement. Some people are better off with Medicare Advantage Products.

Which one you choose will have an impact on you.

• Medicare Advantage products must be selected only during the Open Enrollment (going on now – ends 12/31).
• Medicare Supplements may be purchase any time during the year, and you are guaranteed you will be accepted when you first go on Medicare.
• Also, if you live in CA – you are guaranteed that you will be issued if you enroll in your birth month and already have a plan with another carrier. This is a HUGE protection, should you company raise its premium more than you feel is warranted.

I am here to help you with any questions you have.  (Don’t forget to give me your date of birth. It helps me help you.)

Contact Me.

Traditionally, from Jan. 1st to March 31st each year, Medicare Advantage (MA) members have had the option to switch to a different Medicare Advantage Plan.

Starting in 2011, the three-month period is shortened to six weeks and is no longer an Open Enrollment Period. It becomes the Annual Disenrollment Period (ADP).

From Jan. 1st to Feb. 14th only, Medicare Advantage members may disenroll from their Medicare Advantage Plan, but cannot enroll in a different Medicare Advantage Plan. Their only option will be to return to Original Medicare and select a traditional Medicare Supplement and/or a Part D Prescription Drug Plan.

The Annual Enrollment Period from Nov. 15th to Dec. 31st is not changing for 2010, but it will be especially important for Seniors to make the right decision during this time period. If they select a Medicare Advantage plan, in most cases they will be locked into that plan for a whole year until the 2011 Annual Enrollment Period. If a Senior decides to switch from an MA plan to a traditional Medicare Supplement, what’s the value for them?

• Traditional Medicare Supplements provide Seniors the freedom to choose whichever doctor or hospital they want.
• A Medicare Supplement from any Company we write with is guaranteed renewable as long as premiums are paid on time.

I highly recommended that you review what you have over the next 30 days. Feel free to contact me and I will help you with this.

Each fall Medicare announces its deductibles and co-payments for the following year. The 2011 deductibles and co-payments have been announced. The biggest increase is an additional $32 for the hospital Part A deductible that must be paid for each hospital confinement that begins a new benefit period. The HDF and F+ high deductible amount did not change and remain at $2,000 for 2011 the third year in a row. (See Below)

These modest increases, in comparison to other things going on in the industry, further highlight that a person is generally served best by having Original Medicare and a good Plan F or High Deductible Plan F (depending on their finances and health).

I am here to give individual attention to your needs. Call me and I will help you decide which company has the best plan to serve you.

2011
Hospital Part A Deductible for first 60 days $1,132 ($32 increase)
Copayment for days 61-90 $283 per day ($8 increase)
Copayment for days 91-150 $566 per day ($16 increase)
Medicare Part B Annual Deductible $162 ($7 increase)
Annual Deductible HDF and F+ $2,000 (NO Change)
Plan K annual out-of-pocket limit $4,640 ($20 increase)
Plan L annual out-of-pocket limit $2,320 ($10 increase)

The Medicare Advantage Annual Election Period starts November 15th and runs through December 31st.

During this time, Medicare beneficiaries may change prescription drug plans, change Medicare Advantage plans, return to original Medicare, or enroll in a Medicare Advantage plan for the first time.

I am again urging my clients (and potential clients) to return to original Medicare and secure a good Medicare Supplement Policy. Why should a person do this – especially if Medicare Advantage seems cheaper?

There are FIVE very good reasons:

1) The Medicare Advantage Program came into existence when George Bush was president. Although well conceived and intended, Congress has made so many changes to the program that it barely resembles the original intent.

2) Under Medicare Advantage plans, physicians may accept you one week and refuse you the next. Or they could accept your neighbor, but choose not to accept you. This is referred to as “deeming”. This is not a slam on doctors, as a person does not work for free – and they may decide that is exactly what they are being asked to do. So whereas they might do that for someone they have a close relationship with, they may reason that they cannot do this for most people, as they would quickly go out of business.

3) Medicare Advantage Programs are being tweaked every single year, and I have yet to see the changes improve the program. Rather, the changes weaken it and take away. Where this is going should be obvious to anyone. Why stay with a program that one has to constantly evaluate?

4) Original Medicare has worked fairly well since its inception in the mid-60′s. Are their problems? Assuredly there are. But from my viewpoint, much less than with the Medicare Advantage Program or even that which is experienced in the under-65 health programs.

4a) Original Medicare is, in my opinion, still the most stable of all health insurance programs available to a large group of individuals today. The only programs I (might) view as more stable are only available to a select few.

5) By adding the right Medicare Supplement to Original Medicare – a person has absolute control over how they spend their health care dollars. A person can accept some of the risk or have 100% coverage, their choice!

5a) And the best part is … in the long run I still think that a person spends less with Original Medicare and a Good Supplement.

I’m here to help. Call me or email me with any questions you may have.

Michael Myers
209-390-1163

What can be done about it now?

There are five scenarios in which Medicare Advantage members may disenroll from their plan.

Scenario #1
If you are disenrolled from an MA plan because the plan is leaving Medicare, stops giving care in their area, or the customer moves out of the plan’s service area, you are eligible to change. Customers in this scenario are guaranteed issue of a Medicare Supplement plan A, B, C, F, HDF, K, or L that are sold in their state by any insurer.

Customers can apply for a Medicare Supplement as early as the day they receive notice that their MA coverage will end, but no later than 63 days after the MA coverage ends.

Scenario #2
You joined an MA Plan when you were first eligible for Medicare Part A at age 65, and within the first year of joining you may exercise your right to switch to Original Medicare. Customers in this scenario are guaranteed issue of any Medicare Supplement plan sold in their state by any insurer. Customers can apply for a Medicare Supplement as early as 60 days before the date their MA coverage will end, but no later than 63 days after the MA coverage ends.

Scenario #3
Or … you dropped a traditional Medicare Supplement to join Medicare Advantage for the first time, less than a year ago and you wish to switch back to Original Medicare. Customers in this scenario are guaranteed issue of the Medicare Supplement policy they had before they joined MA if the same insurance company they had before still sells it. If the former Medicare Supplement policy isn’t available, they can buy a Medicare Supplement plan A, B, C, F, HDF, K, or L sold in their state by any insurance company. Customers can apply for a Medicare Supplement as early as 60 days before the date their MA coverage will end, but no later than 63 days after the MA coverage ends.

Scenario #4
You have been with an Medicare Advantage plan for more than one year and are considering dis-enrolling and returning to original Medicare, and then purchasing a Medicare Supplement.

In most cases, an MA enrollee must stay enrolled for that calendar year starting the date their overage begins. According to Medicare, a customer who has been with an MA plan for more than one year may disenroll if Medicare has made a determination that a Medicare Advantage organization materially misrepresented plan provisions or violated its agreement with the enrollee. Customers in this scenario are guaranteed issue of Medicare Supplements A, B, C, F, HDF, K, and L that is sold in their state by any insurance company. [This one is tough to do].

Scenario #5
If you dis-enroll from Medicare Advantage, having been on Medicare Advantage MORE THAN one year and are not in Scenario 4, you are NOT guaranteed issue. This simply means that your application will be medically underwritten. You may or may not qualify, but this is something I will likely be able to tell you at the time of application.

I have been helping people with Medicare Supplements since the early 1980′s. In almost all cases, I prefer my clients to be with original Medicare and purchase a Medicare Supplement. I believe that, in the long run, this is the most cost effective decision. It certainly is the decision with the most stability.

Call me anytime if you have questions, or if I can assist you in any way.

Michael

With recent rate hikes on individual and group insurance plans, many experts are recommending that consumers shop around as many commonly do with auto insurance. For instance, California Insurance Commissioner Steve Poizner, in a recent statement said,

“As a consumer you need to shop around. A different provider may prove to be a better value for a particular individual or family’s needs, and all of them are looking for new customers. I encourage consumers who are not happy with their rates, co-pays, benefits or service to look at other options.”, says Poizner.

Honest, consumer based evaluation of health plans and carriers are really the need of the hour. We think that this is the role that the insurance intermediary should volunteer to take up. In fact, this is exactly what we have been doing for some time now.

Most people find insurance confusing. I am here to help. My only preference in insurers is the one that will fill your need and circumstances best. This is why I offer the selection of companies I offer.

Whether the need is group insurance, individual/family plans or Senior health plans (Medigap), I save people money with my “Solutions That Work”.

So if you do not have insurance and need it, or if you have it and think it’s too high, call me. I can help.

Call me at 209-390-1163 or 866-301-9652.

Michael Myers

Although not actually correct, I am going to include the so-called “Medicare Advantage” plans in this discussion.

Technically, Medicare Advantage Plans (Plan C) is not a Medicare Supplement – it is a Medicare and Medicare Supplement alternative. But you only care about what is the best choice, so I will be referring to them in this post.

Medicare Advantage Plans were often viewed as the best choice by many – if for no other reason, some were zero cost (other than the Medicare Part B premium). It is my opinion that these are going to get less available each year, and except in rare situations, I am not a fan of Medicare Advantage plans. I would prefer my clients have something that is not likely to change at all … whereas Medicare Advantage plans, by their very design change every year! (And sometimes they get withdrawn in the middle of the year). I think people should be shown the dignity of allowing them to plan – and live their plan. I don’t think it respectful to constantly be forcing change. I therefore am not a fan of those plans.

Of the Medicare Supplements on the market, I still prefer Plan “F”. With Plan “F” and original Medicare, all normal medical expenses are generally covered in full. I think it good that a person can plan for their health insurance needs and know what they are going to be. I have had clients on “Plan F” plans for over 15 years – and they would not change for anything!

A good second choice is Plan “N” – one of the new plans. This plan works much like a group health plan that a person may be accustomed to. The premium on this plan is less than a Plan “F”, however, you do have co-pays and share of costs to consider. In my opinion – Plan “F” is the better choice over the long haul – but Plan “N” is a reasonable second choice if a person desires to save monthly premium.

No matter which insurance company you purchase these plans from, if they have the same letter designation, they are the same plan. Which company is best? By “best”, I find most people mean “lowest premium”. Assuming that the company handles claims properly. I too will use premium as one of the benchmarks I use to decide which company I feel is “best”.

To answer which company is “best”, several factors must be considered. Your home zip code, your date of birth and whether you are male or female.

I can help you find the “best” company. Just call and ask me. I can be reached at 209-390-1163. I am looking forward to talking to you.

Over the thirty years or so I have been working in sales, I have seen sales gurus come and go. Their advice sometimes has merit, sometimes it simply does not. Some are genuinely interested in helping others in sales learn what it is people want and need. Others just like the sound of their own voice.

One of the worse pieces of self-proclaimed wisdom is the strong idea that a sales person should never become “an unpaid consultant”.

I could not disagree more. Here is why:

Product – no matter what it is – insurance, financial services, legal aid, plumbing, carpentry … well, you get the idea, no matter what it is – it’s just a commodity.

Customers form their strongest relationships with people who give the most value. In today’s selling environment, what you sell — be it a product or service — is, in itself, the least valuable thing that you offer. In fact, it is probably viewed by most buyers as a commodity
But good advice is something people do not get from very many people. Good advice trumps whatever the product is by a 1,000 percent!

So ask me any question about insurance. I am here to help, even if I don’t have something that will be useful to you. The worst case scenario is I will point you in the right direction. And if I can help you, I will give you the choices you need to make a good decision you will be happy with for a long time.

Sometimes people will continue working primarily due to feeling the need for health insurance. This is understandable, in view of the uncertainty today.

When a person does reach Medicare age, questions often arise. Questions like:

1) What is original Medicare?

2) What are Medicare Advantage Plans?

3) What about prescription drugs? And finally …

4) What about Long Term Care?

Original Medicare is broken into two parts, Part A (Hospital) and Part B (Doctors and other things). Part “A” comes with Social Security and you do not pay for it. Part “B” you do pay for, as it is subtracted from your Social Security Check. Some people qualify for help with this premium, while others pay more (due to large incomes). Most people pay $96.50 for Part “B”. Some people elect not to enroll in this, but I believe that almost everyone should enroll in Part “B”. It is the best deal in health care today.

Medicare Supplement Plans (sometimes called MediGap policies), pay on the deductibles and co-pays that Medicare does not pay. They only pay on expenses that are “covered” by Medicare. In other words: if Medicare pays something for the service, then MediGap policies have a benefit. Conversely, if Medicare does not cover the expense at all, then neither does any MediGap policies.

Medicare Supplement polices are standardized. Each policy has a letter designation, and every company who sells that “letter designation’ has the same policy. So a “Plan F” from company XYZ is the same policy and has the same benefits as a “Plan F” from company ABC. The only difference is the premium and how well a company serves your needs.

I am a big advocate of original Medicare combined with a good supplement. In my view, and in most cases, a person will have the lowest overall medical expenses choosing this option. (Ask me and I will help you decide if this would be true for you). But the best part is a person’s medical expenses are predictable using this option.

You are allowed to enroll without health questions when you enroll in Part “B” of Medicare. The legal time frame is three months prior to three months after (a total of seven months). Some companies choose to allow more time. And some companies allow this at any time on some plans. And in CA, a person can change companies but keep the same plan in their birthday month without health questions.

Choosing Original Medicare with its Part “A” and Part “B” along with a MediGap policy is felt by many (including myself) to be best for people who wish to know exactly what their health costs will be or for those who travel a lot.

Medicare Advantage Plans are also known as Medicare Part “C”. It is essentially the privatization of Medicare. A person still pays for Part “B”, but could pay anywhere from Zero dollars to around a hundred dollars per month for the plan. It is different in each County. Although it is Medicare, these plans work a little more like a person may be use to coming off a group health plan. Typically, you will have co-pays and the like, with a maximum out of pocket. You do not know what your total costs will be, but you do know the maximum it could be (which is typically considerably higher than staying with Original Medicare and a supplement). These plans differ somewhat in that a doctor may choose to accept it or not, and may in fact, choose to accept you this week, but not next week. He may choose to accept your best friend, but not accept you. A physician cannot do this with original Medicare, but it is legal for him to do this with Medicare Advantage Plans. They refer to it as “deeming”. A decision to accept you does not establish a policy, but rather a decision made on each visit. Just so you know, it is not common for Physicians to do this, but it can and does happen for reasons beyond anything you have control over.

Medicare Advantage Plans operate under very strict enrollment procedures, but a person needs to know that each year, for the last six weeks of the year, a person can change their plan, or return to Original Medicare, if they choose. There are other times, under various rules that allow changes. Ask me for it, and I will give you the complete rules regarding this.

The important thing to understand is that a person does not give up Medicare when enrolling in one of these plans. However, there are rules that must be followed and it is in a person’s best interest to review this each year, as under current CMS (Center for Medicare and Medicaid Services) rules, the plans may change each year. I cannot stress enough the need to do this if a person chooses a Medicare Advantage Plan. The changes can be drastic.

Medicare Advantage Plans, in my view, are not a good option. However, there are exceptions to this statement. If appropriate, they are usually best for people; 1) who wish to keep premiums low, 2) do not mind taking a risk on the total potential out of pocket, and 3) do not travel a lot.  Some counties still have zero premium plans available, which covers a person as well as they may be use to under their group insurance plan (of course, each plan is different and a comparison should be made).

Prescription Drugs are covered under Medicare Part “D”. These plans are typically sold nationally (as opposed to by County). They can be included in Medicare Advantage Plans or purchases separately. It takes quite a lot to explain these, but suffice it to say that there are quite a few differences between plans. The design of these plans came out of Congress, and I cannot explain the rationale behind the design, as I find the design illogical. However, I can show you, not only a good plan for you, but also how to utilize the plan to best serve your interests which means, to save you money.

Long Term Care is really a separate subject. Although Medicare does have a Limited Benefit for Skilled Nursing, the two operative words are “Limited” and “Skilled”. It is good for short stays while a person is recovering and making progress. Basically, it is for those instances where a person is not sick enough to be in the hospital, but still needs some care while recovering. It is not for long-term convalescent care. This type of coverage can be handled in a lot of different ways, and which way is best for an individual will depend on their financial situation, married or not, and a host of other factors. The only constant is planning is needed. The decision cannot be made at the time of need, or at least not made well.

There are 636,000 Medicare Advantage Plan Seniors that are being cancelled. About half of those enrolled in Medicare Advantage plans in my county are being impacted by this.

Now its true that some will find other plans to select from. But its important to understand that of the approximately 9,500,000 seniors still covered by Medicare Advantage Plans; many of these seniors are facing reduced benefits as many Medicare Advantage carriers are LOWERING BENEFITS TO SENIORS!
 
Simply stated, over 10,000,000 seniors are being impacted by the decisions being made in Washington.
 
I saw much of this coming, and this is why I have for a very long time advocated that Seniors – in most cases – are far better served by staying with Original Medicare and purchasing a separate, stand-alone, Part D (prescription) plan.

With the right Medicare Supplement, many, if not most, people – even after paying premiums – will have less out of pocket on health care costs.

For those impacted by this, (with a copy of their disenrollment letter), Medicare Supplements will be Guaranteed Issued with no waiting periods for any pre-existing health conditions. Everyone qualifies!

But even if this is not the case, let me help you decide what product serves you the best. I am here to help. Call me (209-390-1163) or email me today.